A sudden spell of dizziness can be disconcerting. You may feel sensations of lightheadedness, unsteadiness, or spinning (vertigo). In addition, you may sometimes experience nausea or vomiting.

But what conditions can cause sudden, intense dizzy spells, particularly when they’re accompanied by nausea or vomiting? Read on to discover more about potential causes, possible remedies, and when to see a doctor.

There are many reasons why you may suddenly feel dizzy. Most often, though, sudden dizziness occurs due to problems in your inner ear.

Your inner ear is important for maintaining balance. However, when your brain receives signals from your inner ear that don’t line up with the information your senses are reporting, it can result in dizziness and vertigo.

Other factors may also cause sudden dizzy spells, including:

Sudden intense dizziness, which is often accompanied by nausea and even vomiting, is the hallmark symptom of certain specific conditions. Below, we’ll explore each of these conditions in more detail.

BPPV is a condition that causes sudden, intense feelings of dizziness. The sensation often feels like everything around you is spinning or swaying, or that your head is spinning on the inside.

When dizziness is severe, it’s often accompanied by nausea and vomiting.

With BPPV, symptoms almost always occur when you change the position of your head. An episode of BPPV usually lasts less than a minute. Even though the dizziness is short-lived, the condition can become disruptive to daily activities.

BPPV happens when crystals in a specific part of your inner ear become dislodged. Often the exact cause of BPPV is unknown. When a cause can be established, it’s often the result of:

  • injury to the head
  • inner ear disorders
  • damage during ear surgery
  • unnatural positioning on your back for extended periods, like lying in a dentist’s chair

When these crystals are dislodged, they move into another part of your inner ear where they don’t belong. Because the crystals are sensitive to gravity, changes in the position of your head can cause intense dizziness that seems to come out of nowhere.

Treatment typically involves your doctor maneuvering your head in specific directions to reposition the dislodged crystals. This is called canalith repositioning, or the Epley maneuver. Surgery may be necessary when this isn’t effective. Sometimes, BPPV may go away on its own.

Meniere’s disease also affects the inner ear. It typically only affects one ear. People with this condition can experience severe vertigo, which may lead to feelings of nausea. Other symptoms of Meniere’s disease include:

The symptoms of Meniere’s disease can come on suddenly or after a short episode of other symptoms like muffled hearing or ringing in your ears. Sometimes, episodes may be spaced apart, but other times they can happen closer together.

Meniere’s disease happens when fluid accumulates in your inner ear. What causes this fluid buildup is unknown, although infections, genetics, and autoimmune reactions are suspected.

The treatment options for Meniere’s disease include:

  • medications to treat the symptoms of dizziness and nausea
  • salt restriction or diuretics to help reduce the amount of fluid your body retains
  • injections with steroids or the antibiotic gentamicin to alleviate dizziness and vertigo
  • pressure treatment, during which a small device delivers pulses of pressure to prevent dizziness
  • surgery, when other treatments aren’t effective

These two conditions are closely related. Both have to do with inflammation in your inner ear.

With both conditions, dizziness and vertigo can come on suddenly. This can lead to nausea, vomiting, and problems with balance. People with labyrinthitis may also experience ringing in the ears and hearing loss.

It’s unknown what causes labyrinthitis and vestibular neuritis. However, it’s believed that a viral infection may be involved.

Treatment often involves medications that can relieve symptoms like dizziness and nausea. If balance problems persist, treatment may involve a type of therapy called vestibular rehabilitation. This therapy uses various exercises to help you adjust to changes in balance.

People with vestibular migraine experience dizziness or vertigo in association with migraine attacks. Other symptoms can include nausea and sensitivity to light or sound. In some cases, a headache may not even be present.

The length of these symptoms can vary anywhere from several minutes to several days. Like other types of migraine, symptoms may be triggered by stress, lack of rest, or some foods.

It’s unknown what causes vestibular migraine, although genetics may play a role. Additionally, conditions like BPPV and Meniere’s disease have been associated with vestibular migraine.

Treatment involves using over-the-counter (OTC) or prescription medications to ease migraine pain and symptoms of dizziness or nausea. Vestibular rehabilitation may also be used.

Orthostatic hypotension is a condition in which your blood pressure suddenly drops when you change positions quickly. It can happen when you go from lying down to sitting up or from sitting up to standing.

Some people with this condition have no noticeable symptoms. However, others may experience symptoms like dizziness and lightheadedness. Other symptoms may include nausea, headache, or even fainting episodes.

The drop in blood pressure means less blood flows to your brain, muscles, and organs, which can lead to symptoms. Orthostatic hypotension has been linked to neurological conditions, heart disease, and certain medications.

Orthostatic hypotension can be managed through lifestyle changes. This includes:

  • changing positions slowly
  • sitting down while performing daily tasks
  • changing medications, if possible

Often called a ministroke, a transient ischemic attack (TIA) is like a stroke, but the symptoms typically only last a few minutes. It happens when there’s a temporary lack of blood flow to part of the brain.

Unlike a stroke, a TIA usually doesn’t cause lasting damage. But it can be a warning sign of a more serious stroke.

Although rare, a TIA can be the cause of sudden dizziness. According to a 2006 study, about 3 percent of emergency department patients who have sudden dizziness are diagnosed with a TIA.

Sometimes, a sudden onset of dizziness is the only symptom of a TIA. Other times, there may be other symptoms. These include:

Although less common, sudden dizziness can also be caused by a stroke, specifically a brain stem stroke. With a brain stem stroke:

  • Dizziness lasts longer than 24 hours.
  • Dizziness, vertigo, and imbalance usually occur together.
  • Weakness on one side of the body isn’t typically a symptom.
  • In more severe cases, symptoms can include slurred speech, double vision, and a decreased level of consciousness.

If you have any symptoms of a TIA or stroke, it’s important to get immediate medical attention. Your doctor will determine if you’ve had a TIA or a stroke, or if your symptoms have a different cause.

If you have a sudden onset of dizziness or vertigo, consider taking the following steps:

  • Sit down as soon as the dizziness comes on.
  • Try to avoid walking or standing until the dizziness passes.
  • If you must walk, move slowly and use a supportive device like a cane, or hold onto furniture for support.
  • Once your dizziness has passed, be sure to get up very slowly.
  • Consider taking an OTC medication like dimenhydrinate (Dramamine) to ease your nausea.
  • Avoid caffeine, tobacco, or alcohol, which can worsen your symptoms.

Make an appointment to see your doctor or healthcare provider if you have sudden dizziness that:

  • happens frequently
  • is severe
  • lasts a long time
  • can’t be explained by another health condition or a medication

To help diagnose the cause of your dizziness, your doctor will ask about your medical history and perform a physical examination. They’ll also perform a variety of tests. These may include:

  • balance and movement testing, which can help determine if specific movements lead to symptoms
  • eye movement testing to detect abnormal eye movements associated with inner ear conditions
  • hearing tests to check if you have any hearing loss
  • imaging tests like MRIs or CT scans to generate a detailed image of your brain

Seek emergency medical care if you experience sudden dizziness that occurs with any of the following symptoms:

  • feelings of numbness, weakness, or tingling
  • severe headache
  • slurred speech or trouble talking
  • chest pain
  • rapid heartbeat
  • trouble breathing
  • frequent vomiting
  • changes in your hearing, such as ringing in your ears or hearing loss
  • blurry or double vision
  • confusion
  • fainting

Many people experience dizziness for one reason or another. However, in some cases, dizziness may seem to come out of nowhere and be intense. In these cases, you may also experience symptoms like nausea or vomiting.

Many of the causes of this type of dizziness are associated with inner ear problems. Examples include BPPV, Meniere’s disease, and vestibular neuritis.

See your doctor if you have dizziness or vertigo that’s frequent, severe, or unexplained. Other symptoms like severe headache, numbness, or confusion could indicate another condition, such as a stroke, and require emergency medical attention.