Vertigo is one of the most common medical complaints. Vertigo is the feeling that you’re moving when you’re not. Or it might feel like things around you are moving when they aren’t. Vertigo can feel similar to motion sickness. People experiencing vertigo generally describe the sensation as “feeling dizzy” or feeling as if the room is spinning. Vertigo is not the same as lightheadedness.
The most common causes of vertigo are benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and acute onset vertigo.
Treatment depends on the cause. Popular treatments include certain physical maneuvers and, if necessary, special medications called vestibular blocking agents.
The outlook for vertigo-associated disease (VAD) depends on the cause. Acute onset vertigo attacks generally last less than 24 to 48 hours. Meniere’s disease doesn’t have a cure, but there are ways to manage the symptoms.
There are two categories of vertigo. Peripheral vertigo occurs as a result of a problem in the inner ear or the vestibular nerve. The vestibular nerve connects the inner ear with the brain.
Central vertigo occurs when there is a problem in the brain, particularly the cerebellum. The cerebellum is the part of the hindbrain that controls coordination of movements and balance.
Causes of peripheral vertigo
About 93 percent of vertigo cases are peripheral vertigo, caused by one of the following:
- Benign paroxysmal positional vertigo (BPPV) is vertigo brought on by specific changes in the position of your head. It’s caused by calcium crystals floating in the semicircular canals of the ear.
- Meniere’s disease is an inner ear disorder that affects balance and hearing.
- Acute peripheral vestibulopathy (APV) is inflammation of the inner ear, which causes a sudden onset of vertigo.
Rarely, peripheral vertigo is caused by:
- perilymphatic fistula, or abnormal communication between the middle ear and the inner ear
- cholesteatoma erosion, or erosion caused by a cyst in the inner ear
- otosclerosis, or abnormal bone growth in the middle ear
Causes of central vertigo
Causes of central vertigo include:
- a tumor in the cerebellum
- multiple sclerosis
Vertigo feels similar to motion sickness, or like the room is spinning.
Symptoms of VAD include:
- stumbling while walking
Diagnosis of VAD depends on whether:
- you have true vertigo
- the cause is peripheral or central
- life-threatening complications are present
Doctors can separate dizziness from vertigo by asking a simple question: “Is the world spinning, or are you lightheaded?”
If the world appears to be spinning, you have true vertigo. If you are lightheaded, you are experiencing dizziness.
Tests to determine the type of vertigo include:
- Head-thrust test: You look at the examiner’s nose, and the examiner makes a quick head movement to the side and looks for correct eye movement.
- Romberg test: You stand with feet together and eyes open, then close your eyes and try to maintain balance.
- Fukuda-Unterberger test: You’re asked to march in place with your eyes closed without leaning from side to side.
- Dix-Hallpike test: While on an examination table, you’re quickly lowered from a seated position to a supine position with your head pointed either slightly right or slightly left. A doctor will look at your eye movements to learn more about your vertigo.
Imaging tests for VAD include:
- CT scan
Warning signs of serious complications include:
- sudden vertigo not affected by change of position
- vertigo associated with neurological signs such as severe lack of muscle coordination or new weakness
- vertigo associated with deafness and no history of Meniere’s disease
Treatment depends on the cause. Vestibular blocking agents (VBAs) are the most popular type of medication used.
Vestibular blocking agents include:
- antihistamines (promethazine, betahistine)
- benzodiazepines (diazepam, lorazepam)
- antiemetics (prochlorperazine, metoclopramide)
Treatments for specific causes of vertigo include:
- acute vertigo attack: bed rest, VBAs, antiemetic medications
- BPPV: Epley repositioning maneuver, a specific movement which loosens the calcium crystals and clears them from the ear canal
- acute peripheral vestibulopathy: bed rest, VBAs
- Meniere’s disease: bed rest, antiemetic medications, diuretic medications, and VBAs
Factors that increase your risk of VAD include:
- cardiovascular diseases, especially in older adults
- recent ear infection, which causes imbalance in the inner ear
- history of head trauma
- medications, such as antidepressants and antipsychotics
The outlook for VAD depends on the cause. APV usually lasts less than 24 to 48 hours. Meniere’s disease has no cure, but its symptoms can be managed. Talk to your doctor to learn how best to manage the symptoms.