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
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.
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,
erosion caused by a cyst in the inner ear
- otosclerosis, or abnormal bone
growth in the middle ear
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
- 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:
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
Treatment depends on the cause. Vestibular blocking agents (VBAs) are the
most popular type of medication used.
Vestibular blocking agents include:
Treatments for specific causes of vertigo include:
- acute vertigo attack: bed rest, VBAs, antiemetic
- BPPV: Epley repositioning
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
- 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.