Table of ContentsView AllTable of ContentsSymptomsPeripheral VertigoCentral VertigoOther CausesDiagnosisTreatmentWhen to See a Provider
Table of ContentsView All
View All
Table of Contents
Symptoms
Peripheral Vertigo
Central Vertigo
Other Causes
Diagnosis
Treatment
When to See a Provider
Vertigo is the sensation that you are spinning or the world around you is spinning. The condition may be mild and barely noticeable or so severe that you are unable to keep your balance and feel like you’re going to vomit.
Vertigo may be due to problems with theinner earor parts of thecentral nervous system.Examples include benign paroxysmal positional vertigo (BPPV) andMénière’sdisease, both of which involve the inner ear, and brain tumors and migraines, which involve the brain. Some causes resolve on their own over time, while others can be managed with medications like antihistamines and steroids.
The article describes the symptoms and various causes of vertigo. It also explains how vertigo is diagnosed and treated.
Vertigo Symptoms
Vertigo differs from dizziness in that dizziness encompasses a variety of sensations ranging from lightheadedness and fainting to unsteadiness and wooziness. Vertigo implies a spinning sensation, either with you at the center of the spinning or the world spinning around you.
In addition to a spinning sensation, vertigo can also cause:
Depending on the underlying cause, you might also experience symptoms like:
The spinning episodes can last anywhere from a few seconds to several hours, depending on what is causing your vertigo.
1:57Click Play to Learn Everything You Need to Know About Vertigo
1:57
Click Play to Learn Everything You Need to Know About Vertigo
The function of the vestibular system is to provide a sense of balance and enableproprioception(an awareness of our body’s position in space) so that you can navigate and move around.Metaphorically, it functions as a three-dimensional GPS in our brains.
There are a variety of conditions that can affect the inner ear and vestibular system:
Benign Paroxysmal Positional Vertigo
Typically, a person with BPPV will describe a brief spinning sensation when moving their head in certain ways (such as tilting the head to the sky). Nausea may also be present, but rarely vomiting.
The vestibulocochlear nerve is comprised of the vestibular nerve which regulates balance and thecochlear nervewhich regulates hearing.
Ménière’s Disease
Ménière’s diseaseis a condition that causes the abnormal buildup of fluid in the inner ear. The cause of the condition is unknown, but it typically affects one ear initially. Over time, both ears may be impacted.
Ménière’s disease is associated with episodes of severe vertigo that can last for minutes to hours. In addition to nausea, vomiting, and imbalance, there may be one-sided tinnitus, hearing loss, and ear fullness.
Less Common Causes
Several other, less common conditions can cause peripheral vertigo. These include:
Verywell / Gary Ferster
Central vertigo involves the central nervous system, consisting of your brain and spinal cord.
It is less common than peripheral vertigo and mainly involves two parts of the brain called thebrainstem(which regulates balance, coordination, and reflexes) and thecerebellum(which is responsible for muscle control, including balance and movement).
Vestibular Migraine
Vestibular migrainerefers to vertigo that occurs as a result of amigraine. In addition to vertigo and headache, nausea and sensitivity to light or sound may occur.
Stroke
Astroke, especially in the brainstem or cerebellum, can cause vertigo. Abrainstem strokemay also cause double vision and slurred speech. A cerebellum stroke can affect walking, speaking, chewing, hearing, and vision.
Vestibular Schwannoma
Vestibular schwannoma, also calledacoustic neuroma, is a benign (noncancerous) tumor that develops on the vestibulocochlear nerve. In addition to vertigo, tinnitus and hearing loss may occur.
Because this type of tumor is slow-growing, the vertigo may be subtle, often described as a vague feeling of swaying, tilting, or imbalance.
Multiple Sclerosis
Multiple sclerosisis an autoimmune disease in which a person’s immune system attacks the protective coating of nerves in the brain, causing them to misfire. If the autoimmune damage occurs in certain parts of the brainstem or cerebellum, vertigo can regularly occur.
Epileptic Vertigo
Epileptic vertigo, also known as vestibular epilepsy, affects the temporal lobe, which receives information from the ears, and the parietal association cortex, which aids in spatial recognition from the eyes.
Vertigo is a common feature of certain heart conditions that can suddenly alter or limit the flow of blood to the inner ear or brain. These include:
Besides heart problems, other possible causes of vertigo include:
What to Know About Cervical Vertigo (Cervicogenic Dizziness)
How Vertigo Is Diagnosed
Medical History
During your appointment, your healthcare provider will ask you several questions to help characterize your vertigo, such as:
Physical Examination
The physical exam will typically include an evaluation of your ears, heart, eyes, and nervous system. Two of the more common in-office procedures include:
Your blood pressure and pulse will also be taken. Your ears will be examined with anotoscopewhile thelymph nodes of your neckwill be checked for signs of an ear infection.
Lab Tests
Based on the initial findings, certain blood tests and lab procedures may ordered to help pinpoint the possible causes of your vertigo:
Imaging Tests
The diagnosis of vertigo may require medical imaging studies if the cause of your condition is not readily apparent:
Treating Peripheral and Central Vertigo
Thetreatment of vertigodepends on the underlying cause. While many diagnoses are benign, some are very serious and require emergent medical attention, most notably a stroke.
For most other diagnoses, lifestyle changes, medications, and/or vestibular rehabilitation remain the mainstay of treatment.
Lifestyle Changes
If you experience vertigo, there are things you can do to reduce your risk of future attacks:
During vertigo, to minimize spinning sensations and reduce the risk of vomiting or falling:
Medications
Various vertigo-related conditions may be treated with medications. These include:
Can Medications Help Treat Dizziness?
Epley Maneuver
A technique called theEpley maneuveris used to treat people with BPPV. The purpose of the maneuver is to remove the calcium debris from the semicircular canal of the inner ear and return them to the uticle where they belong. Studies suggest that the maneuver is safe and effective for short-term relief of BPPV.Note that your vertigo may get worse during the exercise.
To do the Epley maneuver for your right ear:
To do the Epley maneuver for your left ear:
Vertigo might go away immediately after the maneuver or it may take a few times for it to work. Mild vertigo might continue for a few weeks, but once it stops, you can discontinue the Epley maneuver.
Vestibular Rehabilitation
Vestibular rehabilitationis a type of physical therapy. People with peripheral vertigo may benefit from various head, eye, and balance exercises that aim to ease vertigo symptoms and improve proprioception and balance.
In addition to techniques like the Epley maneuver, the therapist may teach you:
A general exercise program can also help improve issues like muscle weakness, decreased range of motion of the neck, and other problems that contribute to falls and injury during vertigo.
Complementary and Alternative Therapies
Some people incorporate complementary and alternative therapies into their treatment plans for vertigo. Among those shown to have some benefit are:
When to See a Healthcare Provider
Vertigo is an unpleasant symptom that can be debilitating. While most cases of vertigo are benign, due to the many possible causes behind vertigo—some of which are serious—it’s important to see a healthcare provider, especially if you develop vertigo for no apparent reason or have recurrent episodes. This is particularly true if you have an underlying heart condition, a history of a stroke, orrisk factors for a stroke.
Summary
Vertigo can be diagnosed with a physical exam, a review of your medical history, lab tests, and imaging studies. Some cases resolve on their own, while others need to be managed with lifestyle changes, medications, and vestibular rehabilitation.
21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dommaraju S, Perera E.An approach to vertigo in general practice.Aust Fam Physician.2016 Apr;45(4):190-4.Konrad H.Chapter 123 - vertigo and associated symptoms. In:Clinical Methods: The History, Physical, and Laboratory Examinations (3rd Edition).Boston, MA: Butterfield–Heinemann.Omron R.Peripheral vertigo.Emerg Med Clin North Am.2019 Feb;37(1):11-28. doi:10.1016/j.emc.2018.09.004National Institute on Deafness and Other Communication Disorders.Ménière’s disease.National Institute on Deafness and Other Communication Disorders.Otosclerosis.Rosenfeld RM, Shin JJ, Schwartz SR, et al.Clinical practice guideline: otitis media with effusion (update).Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. doi:10.1177/0194599815623467Meldrum JA, Prinsley PR.Perilymph fistula: the patients’ experience.J Laryngol Otol. 2016;130:526–531. doi:10.1017/S002221511600030XNational Organization for Rare Disorders.Ramsay Hunt Syndrome.Choi JY, Lee SH, Kim JS.Central vertigo.Curr Opin Neurol. 2018 Feb;31(1):81-89. doi:10.1097/WCO.0000000000000511Sohn JH.Recent advances in the understanding of vestibular migraine.Behav Neurol. 2016;2016:1801845. doi:10.1155/2016/1801845National Multiple Sclerosis Society.Dizziness and vertigo.Jilek C, Lewalt T.Dizziness as a symptom of cardiac diseases.Dtsch Med Wochenschr. 2019 Jun;144(12):807-820.. doi:10.1055/a-0799-2451Health in Aging Foundation.Dizziness: lifestyle & management.Hussain K, Murdin L, Schilder AG.Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome.Cochrane Database Syst Rev. 2018;12:CD012173. doi:10.1002/14651858.CD012173.pub2Raymond MJ, Vivas EX.Current and emerging medical therapies for dizziness.Otolaryngol Clin North Am. 2021 Oct;54(5):1037-1056. doi:10.1016/j.otc.2021.05.019Hilton MP, Pinder DK.The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.Cochrane Database Syst Rev.2014;(12):CD003162. doi:10.1002/14651858.CD003162.pub3Johns Hopkins Medicine.Home Epley Maneuver.Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises.J Clin Neurol. 2011;7(4):184-96. doi:10.3988/jcn.2011.7.4.184Chiu C-W et al.Efficacy and safety of acupuncture for dizziness and vertigo in emergency department: a pilot cohort study.BMC Complement Altern Med. 2015; 15: 173. doi:10.1186/s12906-015-0704-6Webster KE, Dor A, Galbraith K, et al.Non-pharmacological interventions for prophylaxis of vestibular migraine.Cochrane Database Syst Rev.2023 Apr 12;4(4):CD015321. doi:10.1002/14651858.CD015321.pub2Nunes CP, De Campos Rodriguez C, Cardosa CAF.Clinical evaluation of the use of ginger extract in the preventive management of motion sickness.Curr Ther Res Clin Exp.2020;92:100591. doi:10.1016/j.curtheres.2020.100591
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dommaraju S, Perera E.An approach to vertigo in general practice.Aust Fam Physician.2016 Apr;45(4):190-4.Konrad H.Chapter 123 - vertigo and associated symptoms. In:Clinical Methods: The History, Physical, and Laboratory Examinations (3rd Edition).Boston, MA: Butterfield–Heinemann.Omron R.Peripheral vertigo.Emerg Med Clin North Am.2019 Feb;37(1):11-28. doi:10.1016/j.emc.2018.09.004National Institute on Deafness and Other Communication Disorders.Ménière’s disease.National Institute on Deafness and Other Communication Disorders.Otosclerosis.Rosenfeld RM, Shin JJ, Schwartz SR, et al.Clinical practice guideline: otitis media with effusion (update).Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. doi:10.1177/0194599815623467Meldrum JA, Prinsley PR.Perilymph fistula: the patients’ experience.J Laryngol Otol. 2016;130:526–531. doi:10.1017/S002221511600030XNational Organization for Rare Disorders.Ramsay Hunt Syndrome.Choi JY, Lee SH, Kim JS.Central vertigo.Curr Opin Neurol. 2018 Feb;31(1):81-89. doi:10.1097/WCO.0000000000000511Sohn JH.Recent advances in the understanding of vestibular migraine.Behav Neurol. 2016;2016:1801845. doi:10.1155/2016/1801845National Multiple Sclerosis Society.Dizziness and vertigo.Jilek C, Lewalt T.Dizziness as a symptom of cardiac diseases.Dtsch Med Wochenschr. 2019 Jun;144(12):807-820.. doi:10.1055/a-0799-2451Health in Aging Foundation.Dizziness: lifestyle & management.Hussain K, Murdin L, Schilder AG.Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome.Cochrane Database Syst Rev. 2018;12:CD012173. doi:10.1002/14651858.CD012173.pub2Raymond MJ, Vivas EX.Current and emerging medical therapies for dizziness.Otolaryngol Clin North Am. 2021 Oct;54(5):1037-1056. doi:10.1016/j.otc.2021.05.019Hilton MP, Pinder DK.The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.Cochrane Database Syst Rev.2014;(12):CD003162. doi:10.1002/14651858.CD003162.pub3Johns Hopkins Medicine.Home Epley Maneuver.Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises.J Clin Neurol. 2011;7(4):184-96. doi:10.3988/jcn.2011.7.4.184Chiu C-W et al.Efficacy and safety of acupuncture for dizziness and vertigo in emergency department: a pilot cohort study.BMC Complement Altern Med. 2015; 15: 173. doi:10.1186/s12906-015-0704-6Webster KE, Dor A, Galbraith K, et al.Non-pharmacological interventions for prophylaxis of vestibular migraine.Cochrane Database Syst Rev.2023 Apr 12;4(4):CD015321. doi:10.1002/14651858.CD015321.pub2Nunes CP, De Campos Rodriguez C, Cardosa CAF.Clinical evaluation of the use of ginger extract in the preventive management of motion sickness.Curr Ther Res Clin Exp.2020;92:100591. doi:10.1016/j.curtheres.2020.100591
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dommaraju S, Perera E.An approach to vertigo in general practice.Aust Fam Physician.2016 Apr;45(4):190-4.Konrad H.Chapter 123 - vertigo and associated symptoms. In:Clinical Methods: The History, Physical, and Laboratory Examinations (3rd Edition).Boston, MA: Butterfield–Heinemann.Omron R.Peripheral vertigo.Emerg Med Clin North Am.2019 Feb;37(1):11-28. doi:10.1016/j.emc.2018.09.004National Institute on Deafness and Other Communication Disorders.Ménière’s disease.National Institute on Deafness and Other Communication Disorders.Otosclerosis.Rosenfeld RM, Shin JJ, Schwartz SR, et al.Clinical practice guideline: otitis media with effusion (update).Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. doi:10.1177/0194599815623467Meldrum JA, Prinsley PR.Perilymph fistula: the patients’ experience.J Laryngol Otol. 2016;130:526–531. doi:10.1017/S002221511600030XNational Organization for Rare Disorders.Ramsay Hunt Syndrome.Choi JY, Lee SH, Kim JS.Central vertigo.Curr Opin Neurol. 2018 Feb;31(1):81-89. doi:10.1097/WCO.0000000000000511Sohn JH.Recent advances in the understanding of vestibular migraine.Behav Neurol. 2016;2016:1801845. doi:10.1155/2016/1801845National Multiple Sclerosis Society.Dizziness and vertigo.Jilek C, Lewalt T.Dizziness as a symptom of cardiac diseases.Dtsch Med Wochenschr. 2019 Jun;144(12):807-820.. doi:10.1055/a-0799-2451Health in Aging Foundation.Dizziness: lifestyle & management.Hussain K, Murdin L, Schilder AG.Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome.Cochrane Database Syst Rev. 2018;12:CD012173. doi:10.1002/14651858.CD012173.pub2Raymond MJ, Vivas EX.Current and emerging medical therapies for dizziness.Otolaryngol Clin North Am. 2021 Oct;54(5):1037-1056. doi:10.1016/j.otc.2021.05.019Hilton MP, Pinder DK.The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.Cochrane Database Syst Rev.2014;(12):CD003162. doi:10.1002/14651858.CD003162.pub3Johns Hopkins Medicine.Home Epley Maneuver.Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises.J Clin Neurol. 2011;7(4):184-96. doi:10.3988/jcn.2011.7.4.184Chiu C-W et al.Efficacy and safety of acupuncture for dizziness and vertigo in emergency department: a pilot cohort study.BMC Complement Altern Med. 2015; 15: 173. doi:10.1186/s12906-015-0704-6Webster KE, Dor A, Galbraith K, et al.Non-pharmacological interventions for prophylaxis of vestibular migraine.Cochrane Database Syst Rev.2023 Apr 12;4(4):CD015321. doi:10.1002/14651858.CD015321.pub2Nunes CP, De Campos Rodriguez C, Cardosa CAF.Clinical evaluation of the use of ginger extract in the preventive management of motion sickness.Curr Ther Res Clin Exp.2020;92:100591. doi:10.1016/j.curtheres.2020.100591
Dommaraju S, Perera E.An approach to vertigo in general practice.Aust Fam Physician.2016 Apr;45(4):190-4.
Omron R.Peripheral vertigo.Emerg Med Clin North Am.2019 Feb;37(1):11-28. doi:10.1016/j.emc.2018.09.004
National Institute on Deafness and Other Communication Disorders.Ménière’s disease.
National Institute on Deafness and Other Communication Disorders.Otosclerosis.
Rosenfeld RM, Shin JJ, Schwartz SR, et al.Clinical practice guideline: otitis media with effusion (update).Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. doi:10.1177/0194599815623467
Meldrum JA, Prinsley PR.Perilymph fistula: the patients’ experience.J Laryngol Otol. 2016;130:526–531. doi:10.1017/S002221511600030X
National Organization for Rare Disorders.Ramsay Hunt Syndrome.
Choi JY, Lee SH, Kim JS.Central vertigo.Curr Opin Neurol. 2018 Feb;31(1):81-89. doi:10.1097/WCO.0000000000000511
Sohn JH.Recent advances in the understanding of vestibular migraine.Behav Neurol. 2016;2016:1801845. doi:10.1155/2016/1801845
National Multiple Sclerosis Society.Dizziness and vertigo.
Jilek C, Lewalt T.Dizziness as a symptom of cardiac diseases.Dtsch Med Wochenschr. 2019 Jun;144(12):807-820.. doi:10.1055/a-0799-2451
Health in Aging Foundation.Dizziness: lifestyle & management.
Hussain K, Murdin L, Schilder AG.Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome.Cochrane Database Syst Rev. 2018;12:CD012173. doi:10.1002/14651858.CD012173.pub2
Raymond MJ, Vivas EX.Current and emerging medical therapies for dizziness.Otolaryngol Clin North Am. 2021 Oct;54(5):1037-1056. doi:10.1016/j.otc.2021.05.019
Hilton MP, Pinder DK.The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.Cochrane Database Syst Rev.2014;(12):CD003162. doi:10.1002/14651858.CD003162.pub3
Johns Hopkins Medicine.Home Epley Maneuver.
Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises.J Clin Neurol. 2011;7(4):184-96. doi:10.3988/jcn.2011.7.4.184
Chiu C-W et al.Efficacy and safety of acupuncture for dizziness and vertigo in emergency department: a pilot cohort study.BMC Complement Altern Med. 2015; 15: 173. doi:10.1186/s12906-015-0704-6
Webster KE, Dor A, Galbraith K, et al.Non-pharmacological interventions for prophylaxis of vestibular migraine.Cochrane Database Syst Rev.2023 Apr 12;4(4):CD015321. doi:10.1002/14651858.CD015321.pub2
Nunes CP, De Campos Rodriguez C, Cardosa CAF.Clinical evaluation of the use of ginger extract in the preventive management of motion sickness.Curr Ther Res Clin Exp.2020;92:100591. doi:10.1016/j.curtheres.2020.100591
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