What vertigo is
Vertigo is a feeling that you or the room around you is spinning or moving when you are actually still. It is different from feeling light-headed or faint. Vertigo often comes with nausea, vomiting, sweating and difficulty walking straight, and it can be very frightening the first time it happens.
Our sense of balance depends on the inner ear, the eyes, the nerves in our joints and the brain working together. Vertigo happens when there is a problem in the inner ear balance organ, its nerve, or, less commonly, in the brain itself.
Common causes of vertigo
Most vertigo comes from the inner ear and is not dangerous, though it can be very unpleasant and disrupt daily life. Knowing the pattern of your symptoms, such as how long each spell lasts and what brings it on, helps the doctor find the cause quickly. The main causes are listed below.
- BPPV (benign paroxysmal positional vertigo): short spins lasting seconds when turning in bed, lying down or looking up, caused by tiny crystals moving inside the inner ear
- Vestibular neuritis or labyrinthitis: sudden severe vertigo lasting days, often after a cold or viral infection
- Meniere's disease: attacks of vertigo with ringing, fullness in the ear and hearing loss
- Vestibular migraine: vertigo with or without headache in people prone to migraine
- Stroke or other brain problems: less common but serious
Symptoms and warning signs
Along with spinning, people may have nausea and vomiting, unsteadiness, jerking eye movements, sweating, ringing in the ears or reduced hearing. Symptoms can last seconds, hours or days depending on the cause, and moving the head often makes them worse.
Vertigo that comes with weakness or numbness of the face, arm or leg, slurred speech, double vision, difficulty swallowing, severe headache or inability to walk even with support may be a stroke. This needs emergency care immediately, especially in older people or those with high BP, diabetes or heart disease.
How vertigo is diagnosed
The doctor will ask what the vertigo feels like, how long each episode lasts and what triggers it, and will check your ears, eyes, hearing and nervous system. A simple test called the Dix-Hallpike manoeuvre, in which the head is turned and lowered, can confirm BPPV in the clinic.
Hearing tests (audiometry) help diagnose Meniere's disease. An MRI or CT scan of the brain is advised if stroke or another brain cause is suspected. Blood pressure, blood sugar and an ECG may be checked if you also feel faint.
Treatment options for vertigo
BPPV is often treated in a few minutes with a repositioning manoeuvre, such as the Epley manoeuvre, in which the doctor moves your head through set positions to shift the crystals back into place. You may be taught exercises to do at home if it returns.
For vestibular neuritis and severe attacks, doctors may prescribe vestibular suppressants and anti-nausea medicines for a few days only, as longer use can slow the brain's natural recovery. Meniere's disease may need a low-salt diet and specific medicines. Vestibular rehabilitation exercises help the brain adapt and are very effective for lasting imbalance.
Staying safe during an attack
Vertigo increases the risk of falls and injuries, especially in older people who live alone. Pregnant women, the elderly and people with kidney or liver disease should use vertigo medicines only after checking with a doctor, as many cause drowsiness and confusion. These simple steps help keep you safe.
- Sit or lie down at once when a spell starts
- Get up slowly from bed, sitting first for a minute
- Keep a light on at night and remove floor clutter
- Do not drive, climb ladders or use machinery while dizzy
- Drink enough fluids, especially if you are vomiting
- Move your head gently rather than keeping it completely still for days
When to see a doctor for vertigo
See a doctor if vertigo is new, keeps coming back, lasts more than a day, or comes with hearing loss or ringing in the ear. Go to an emergency department straight away for any warning signs of stroke. A doctor or pharmacist can advise on safe short-term medicines, and a doctor can perform the right repositioning manoeuvre if you have BPPV.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Vestibular suppressants such as betahistine or cinnarizineReduce spinning sensations and are used in some inner ear conditions.Use only as your doctor advises; cinnarizine can cause drowsiness.
- Antihistamines such as meclizine or dimenhydrinateEase vertigo and nausea during acute attacks.Short-term use only; cause drowsiness, so avoid driving.
- Anti-nausea medicines such as prochlorperazine or ondansetronControl vomiting during severe episodes.Only on a doctor's prescription; some are not suitable for the elderly.
- Steroids such as prednisoloneSometimes used early in vestibular neuritis or sudden hearing loss.Only on a doctor's prescription; do not start or stop on your own.
See a doctor urgently if
- Get emergency help if vertigo comes with weakness or numbness in the face, arm or leg.
- Get emergency help if you have slurred speech, double vision or difficulty swallowing with vertigo.
- Get emergency help if you have a sudden severe headache or cannot walk even with support.
- See a doctor urgently if vertigo follows a head injury.
- See a doctor urgently if you have sudden hearing loss in one ear.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.