Vertigo is a symptom, rather than a condition itself. It's the sensation that you, or the environment around you, is moving or spinning.
This feeling may be barely noticeable, or it may be so severe that you find it difficult to keep your balance and do everyday tasks.
Attacks of vertigo can develop suddenly and last for a few seconds, or they may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult.
Other symptoms associated with vertigo may include:
- loss of balance – which can make it difficult to stand or walk
- feeling sick or being sick
Seeking medical help
You should see your GP if you have persistent signs of vertigo or it keeps coming back.
Your GP will ask about your symptoms and can carry out a simple examination to help determine some types of vertigo. They may also refer you for further tests.
What causes vertigo?
Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain.
Causes of vertigo may include:
- benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo
- migraines – severe headaches
- labyrinthitis – an inner ear infection
- vestibular neuronitis – inflammation of the vestibular nerve, which runs into the inner ear and sends messages to the brain that help to control balance
Depending on the condition causing vertigo, you may experience additional symptoms, such as a high temperature, ringing in your ears (tinnitus) and hearing loss.
How is vertigo treated?
Some cases of vertigo improve over time, without treatment. However, some people have repeated episodes for many months, or even years, such as those with Ménière's disease.
There are specific treatments for some causes of vertigo. A series of simple head movements (known as the Epley manoeuvre) is used to treat BPPV.
Medicines, such as prochlorperazine and some antihistamines, can help in the early stages or most cases of vertigo.
Many people with vertigo also benefit from vestibular rehabilitation training (VRT), which is a series of exercises for people with dizziness and balance problems.
Depending on what's causing your vertigo, there may be things you can do yourself to help relieve your symptoms. Your GP or the specialist treating you may advise you to:
- do simple exercises to correct your symptoms
- sleep with your head slightly raised on two or more pillows
- get up slowly when getting out of bed and sit on the edge of the bed for a minute or so before standing
- avoid bending down to pick up items
- avoid extending your neck – for example, while reaching up to a high shelf
- move your head carefully and slowly during daily activities
- do exercises that trigger your vertigo, so your brain gets used to it and reduces the symptoms (do these only after making sure you won't fall, and have support if needed)
Fear of heights
The term vertigo is often incorrectly used to describe a fear of heights. The medical term for a fear of heights and the dizzy feeling associated with looking down from a high place is "acrophobia".
Causes of vertigo
Vertigo is a symptom of several different conditions. There are two types of vertigo, known as peripheral and central, depending on the cause.
Peripheral vertigo is the most common type, often caused by a problem with the balance mechanisms of the inner ear. The most common causes include:
- benign paroxysmal positional vertigo (BPPV)
- head injury
- vestibular neuronitis
- Ménière's disease
- taking certain types of medication
Benign paroxysmal positional vertigo (BPPV)This is one of the most common causes of vertigo. It can occur during specific head movements, while standing up or bending over, crossing the road, or turning in bed.
BPPV involves short, intense, recurrent attacks of vertigo (usually lasting a few seconds to a few minutes). It is often accompanied by nausea, although vomiting is rare. You may also experience your eyes briefly moving uncontrollably (nystagmus).
Lightheadedness and a loss of balance can last for several minutes or hours after the attack.
BPPV is thought to be caused by small fragments of debris (calcium carbonate crystals), which break off from the lining of the channels in your inner ear. The fragments don't usually cause a problem, unless they get into one of the ear's fluid-filled canals.
When your head is still, the fragments sit at the bottom of the canal. However, certain head movements cause them to be swept along the fluid-filled canal, which sends confusing messages to your brain, causing vertigo.
BPPV usually affects older people, with most cases occurring in people older than 50 years of age.
BPPV may occur for no apparent reason, or it may develop after:
- an ear infection
- ear surgery
- a head injury
- prolonged bed rest – for example, while recovering from an illness
Vertigo can sometimes develop after a head injury. If you have symptoms of dizziness or vertigo following a head injury, seek medical attention.
Labyrinthitis is an inner ear infection that causes a structure deep inside your ear (the labyrinth) to become inflamed. The labyrinth is a maze of fluid-filled channels that control hearing and balance.
When the labyrinth becomes inflamed, the information it sends to your brain is different from the information sent from your unaffected ear and your eyes. These conflicting signals cause vertigo and dizziness.
Labyrinthitis is usually caused by a viral infection, such as the common cold or flu, which spreads to the labyrinth. Less commonly, it's caused by a bacterial infection.
Vertigo caused by labyrinthitis may be accompanied by nausea, vomiting, hearing loss, tinnitus and sometimes a high temperature and ear pain.
Vestibular neuronitis, also known as vestibular neuritis, is an inner ear condition that causes inflammation of the nerve connecting the labyrinth to the brain. In some cases, the labyrinth itself can also be inflamed.
The condition is usually caused by a viral infection. It usually comes on suddenly and can cause other symptoms, such as unsteadiness, nausea (feeling sick) and vomiting (being sick). You won't normally have any hearing problems.
It usually lasts a few hours or days, but it may take three to six weeks to settle completely.
Severe vertigo is sometimes caused by a rare condition that affects the inner ear, called Ménière's disease. This can cause vertigo, as well as hearing loss, tinnitus and aural fullness (a feeling of pressure in your ear).
If you have Ménière's disease, you may experience sudden attacks of vertigo that last for hours or days. The attacks often cause nausea and vomiting.
The cause is unknown, but symptoms can be controlled by diet and medication. Rarely, you may need further treatment in the form of surgery.
Vertigo may occur as a side effect of some types of medication. Check the patient information leaflet that comes with your medicine to see if vertigo is listed as a possible side effect.
Don't stop taking prescribed medication without your doctor's advice, but speak to your GP if you're worried about the side effects. They may be able to prescribe an alternative medication.
Central vertigo is caused by problems in part of your brain, such as the cerebellum (located at the bottom of the brain) or the brainstem (the lower part of the brain that's connected to the spinal cord). Causes of central vertigo include:
- migraines – a severe headache that's usually felt as a throbbing pain at the front or on one side of your head, which is especially common in younger people
- multiple sclerosis – a condition that affects the central nervous system (the brain and spinal cord)
- acoustic neuroma – a rare, non-cancerous (benign) brain tumour that grows on the acoustic nerve, which is the nerve that helps to control hearing and balance
- a brain tumour in the cerebellum, located at the bottom of the brain
- a transient ischaemic attack (TIA) or a stroke – where part of the blood supply to the brain is cut off
- taking certain types of medication
Your GP will ask about your symptoms and carry out some simple tests to help them make an accurate diagnosis.
In some cases, you may be referred for some further tests.
Your GP will first want to know:
- details of the first episode of your symptoms and what they were – for example, whether you felt lightheaded or if your surroundings were spinning
- if you also experience other symptoms – such as hearing loss, tinnitus, nausea, vomiting or fullness in the ear
- how often your symptoms occur and how long they last for
- if your symptoms are affecting your daily activities – for example, whether you're unable to walk during an episode of vertigo
- whether anything triggers your symptoms or makes them worse, such as moving your head in a particular direction
- what makes your symptoms better
Your GP may also carry out a physical examination to check for signs of conditions that may be causing your vertigo. This could include looking inside your ears and checking your eyes for signs of uncontrollable movement (nystagmus).
Your GP may check your balance or try to recreate your symptoms by asking you to move quickly from a sitting to a lying position.
Depending on your symptoms, your GP may refer you to a hospital or specialist for further tests.
Referral to a specialist
Your GP may refer you to a specialist, such as an ear, nose and throat (ENT) specialist if:
the Epley manoeuvre doesn't work or can't be performed
you still have symptoms after four weeks
you have unusual signs or symptoms
In rare cases, where the symptoms of vertigo last for months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist can give more advice on this.
If you have vertigo, there are some safety issues to consider. For example:
- you should inform your employer if your job involves operating machinery or climbing ladders
- you may be at increased risk of falls – see preventing falls for advice on making your home safer and reducing your risk
Vertigo could also affect your ability to drive. You should avoid driving if you've recently had episodes of vertigo and there's a chance you may have another episode while you're driving.