Vertigo: Causes, Symptoms, How to Diagnose & Ways to Treat

Vertigo may make you feel like your surroundings are moving or spinning. What are the common causes and symptoms of vertigo, and how can it be diagnosed and treated?

7 minute read

Vertigo is one of the most common types of dizziness and a 2018 systematic review showed that around 44% of people with symptoms of dizziness had peripheral vertigo. It can affect anyone of any age or sex.

In this article, we will look at what vertigo is, what are the symptoms and causes of vertigo, and how the condition can be treated.

What is vertigo?

Vertigo is not a condition in itself, but a symptom of another condition, such as a problem with your middle ear. During a vertigo attack, you may feel like you or your surrounding environment are moving or spinning.

There are two types of vertigo:

• Peripheral vertigo - this is the most common type of vertigo and is caused by problems with the inner ear or vestibular nerve that controls balance

• Central vertigo - this type of vertigo is caused by problems with the brain

What are the symptoms of vertigo?

Symptoms of vertigo vary from person to person and may be mild or severe and debilitating.

Vertigo symptoms may include:

• A sensation that you and/or your surrounding environment are spinning or moving (this is often worse with certain head movements)

• Dizziness

• Loss of balance

• Nausea (feeling sick)

• Vomiting (being sick)

• Increased sweating

• Headache

• Involuntary eye movements (nystagmus)

• Blurred vision

• Tinnitus (ringing or buzzing in the ears)

• Loss of coordination (ataxia)

• Hearing loss

What causes vertigo?

Vertigo is most commonly caused by problems with your inner ear that affect your balance. This type of vertigo is known as peripheral vertigo.

Peripheral vertigo may be caused by:

• Benign paroxysmal positional vertigo (BPPV) – this is the most common type of peripheral vertigo and occurs when calcium particles (otoconia) in the ear break loose and fall into the wrong area of the inner ear. It is usually triggered by certain head movements.

• Inner ear infections, such as vestibular neuritis or labyrinthitis 

• Ménière’s disease – a rare inner ear condition where excessive fluid builds up in the inner ear and can lead to ringing in the ears (tinnitus) and hearing loss

Other causes of vertigo include:

• Migraine

• Motion sickness

• Head or neck injury, especially when there is damage to the vestibular nerve

• Ear surgery

• Damage to the brain such as a stroke, brain tumour, or traumatic brain injury

• Some medical conditions like diabetes, arrythmia, syphilis or multiple sclerosis

• Shingles in or around your ear

• Perilymphatic fistula

• Low blood pressure

• Otosclerosis

• Acoustic neuroma

• Medications  – certain medications including some antibiotics, antidepressants, painkillers, and blood pressure medications may cause vertigo

Vertigo: When to see a doctor

Mild vertigo often goes away on its own, but in some cases, vertigo can be a sign of an underlying health condition that may need treatment.

Make an appointment with your GP if:

• Your vertigo symptoms are impacting your life or making it difficult to carry out normal activities

• Your symptoms don’t go away or keep coming back

Call 111, or see a doctor urgently if your vertigo is accompanied by:

• Sudden, severe headache

• Severe nausea or vomiting

• A very high temperature

• Feeling hot and shivery

Call an ambulance or go straight to A&E if your vertigo is accompanied by:

• Double vision

• Vision loss

• Chest pain

• Palpitations

• Difficulty speaking

• Difficulty walking

• Weakness, numbness or tingling in your arms or legs

• Hearing loss

• Double vision or loss of vision

How is vertigo diagnosed?

Vertigo is diagnosed using a combination of your symptoms and some tests. Your doctor will probably ask you some questions about your symptoms, general health, and medical history. They may ask you about:

• Your symptoms  

• When your symptoms started

• Whether you have any chronic (long-term) medical conditions

• Any regular medications you are taking

• Any previous surgeries

• Whether you experience other symptoms such as nausea, vomiting, tinnitus, or hearing loss

• How often your symptoms occur and how long they last for

• How your symptoms impact your daily life

• What, if anything, triggers your symptoms or makes them worse

• What, if anything, improves your symptoms

Your GP may perform a test to assess your balance where you move quickly from a sitting to a lying position. This test may trigger symptoms of vertigo. In some cases, your GP may refer you to a specialist for further tests.

What is the treatment for vertigo?

Vertigo treatment depends on what’s causing your vertigo, and how severe your symptoms are. It may involve managing your symptoms yourself, medication, exercises or, in rare cases, surgery.

Self-treatment for vertigo

Mild vertigo can usually be managed at home and often goes away on its own. Some things you can do yourself to help relieve symptoms of vertigo include:

• When you experience an attack, sit down straight away, or if possible, lie still in a quiet, dark room until the spinning sensation passes

• Move your head slowly and carefully

• Sleep with your head raised on two or more pillows

• Turn on the lights if you get up during the night

• Get out of bed slowly and sit on the edge of the bed for a while before standing up

• Avoid stress, as this can make vertigo symptoms worse

• Avoid bending over and instead crouch down at the knees to pick things up

• Avoid stretching your neck

Medication for vertigo

If your vertigo is caused by an inner ear infection, you may be prescribed antibiotics to treat this. Antihistamines may also help with symptoms of vertigo, and prochlorperazine may be prescribed to help relieve symptoms such as dizziness, nausea, and vomiting.

Exercises for vertigo

Your GP or specialist may show you some exercises to help with symptoms of vertigo, such as The Epley manoeuvre or Brandt-Daroff exercises.

Surgery for vertigo

In severe cases of disabling vertigo that haven’t responded to treatment, inner ear surgery may be performed. However, this is rare.

Surgery may also be needed to treat the underlying cause of vertigo, such as a brain tumour or head injury.

Summary

Vertigo has a variety of causes, and treatment for vertigo depends on the cause. Though not normally serious, vertigo can be debilitating and may affect your quality of life and your ability to carry out day-to-day activities.

If you are experiencing severe or ongoing symptoms of vertigo, talk to your GP about a suitable treatment.

Vertigo FAQs

Can stress cause vertigo?

Although stress doesn’t directly cause vertigo, it can make your symptoms worse.

Is vertigo dangerous?

Vertigo itself isn’t usually dangerous, but severe vertigo can result in loss of balance and falls. Vertigo can also be a sign of an underlying health condition that may be serious.

How long does vertigo last?

A vertigo attack can last from a few seconds to several hours, or even days. How long you experience attacks also varies from a few days to several months or years and depends on the underlying cause.

How do I know which ear is affected?

If you have Benign paroxysmal positional vertigo (BBPV), you can determine which ear is affected by performing the following exercise:

1. Sit on a bed so that if you lie down, your head will hang slightly over the end of the bed

2. Turn your head to the right and lie back quickly

3. Wait for one minute

4. If you feel dizzy, your right ear is affected

5. If you don’t feel dizzy, sit back up

6. Wait for one minute

7. Turn your head to the left and lie back quickly

8. Wait for one minute

9. If you feel dizzy, your left ear is affected

Can vertigo be cured permanently?

Some types of vertigo can be cured permanently, such as vertigo caused by an inner ear infection. Other types of vertigo may need long-term treatment to manage and reduce symptoms.