Overview
Vertigo is the feeling that you or your surroundings are spinning, strong enough to upset your balance. It is more than mild dizziness. It is a symptom, not a disease, and attacks can last from seconds to hours, or in severe cases days or months.
It usually comes from a problem in the inner ear or the nerve that carries balance signals to the brain. It often improves without treatment.
Symptoms
Vertigo can come with other symptoms:
- A spinning, tilting or swaying feeling
- Loss of balance and trouble walking straight
- Nausea or vomiting, and sweating
- Ringing in the ears (tinnitus) or hearing loss, in some conditions
- Blurred vision
In BPPV the spells are brief and are triggered by head movements such as bending down, tilting the head back or rolling over in bed.
When to see a doctor
Ask for an urgent appointment if vertigo comes with a severe headache, vomiting or a high temperature. See a doctor if vertigo does not go away or keeps coming back, or if you have fallen.
Causes
Common causes include:
- BPPV (benign paroxysmal positional vertigo): tiny calcium particles in the inner ear move into one of its canals and confuse the signals about head position. It is the most common cause and may follow a head injury or come with age
- Labyrinthitis and vestibular neuritis: inflammation of the inner ear or its nerve, usually after a viral illness such as a cold or flu
- Meniere's disease: a rare inner ear condition that can also cause ringing in the ears and hearing loss
- Migraine
- Some medicines that list dizziness as a side effect
Sometimes no cause is found.
Risk factors
- Older age
- A recent head injury or ear surgery
- A recent cold, flu or ear infection
- Migraine
- Taking medicines that can cause dizziness
Complications
- Falls and injuries from loss of balance
- Anxiety, which can make symptoms worse
- Difficulty driving, working or doing everyday tasks during spells
- Balance problems that last for months or years after an inner ear infection, which need specialist assessment
Prevention
There is no sure way to prevent most causes of vertigo, but these steps lower the chance of falls and of bringing on a spell:
- Move your head slowly and carefully
- Get up slowly, sitting on the edge of the bed first
- Squat, rather than bend over, to pick things up, and avoid stretching your neck
- Sleep with your head raised on two or more pillows
- Turn on the light when you get up at night, and use a walking stick if you may fall
Diagnosis
A doctor asks about the spells and may do a simple balance test, such as moving you quickly from sitting to lying down to see whether it brings on vertigo. You may be referred to an ear, nose and throat (ENT) specialist. If the cause is unclear, tests can include hearing tests, blood tests, eye movement tests, balance tests and scans.
Treatment
Treatment depends on the cause, and many people recover without it. For BPPV, a trained clinician can do the Epley manoeuvre, a series of head movements that moves the loose particles out of the canal. One session may be enough, though some people need several.
For an inner ear infection, a doctor may give antihistamine or anti-sickness tablets for a few days at most, as longer use can slow recovery, and only if a bacterial infection is suspected. Balance exercises (vestibular rehabilitation) led by a physiotherapist or audiologist help long-lasting problems. During an attack, lie still in a quiet, dark room.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Vertigo just means weakness or low blood pressure.”What is true?
Fact
Vertigo is a spinning feeling, and its most common cause is a problem in the inner ear. Low blood pressure, dehydration and standing up too quickly can cause dizziness, which is a different feeling. A doctor can tell which one it is.
Myth“Vertigo always means something is seriously wrong with the brain.”What is true?
Fact
Most vertigo comes from the inner ear, and many cases improve without treatment. But vertigo together with double vision, difficulty speaking, hearing loss, or weakness or numbness in an arm or leg can be a stroke and needs emergency care.
Myth“Nothing can be done for vertigo. You just have to live with it.”What is true?
Fact
Treatment depends on the cause. BPPV can often be treated with the Epley manoeuvre, a series of head movements. One session may work, though some people need several. Balance exercises and medicines help others.
Myth“The longer you stay in bed, the faster vertigo will settle.”What is true?
Fact
Lying still in a quiet, dark room helps during a severe spell. After an inner ear infection, though, doctors advise moving about as soon as you can, with someone nearby if needed. Balance exercises can speed recovery, and anti-sickness or antihistamine tablets are meant for only a few days, as longer use can slow it down.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
What is the difference between vertigo and dizziness?
Dizziness is a general word for feeling lightheaded or unsteady. Vertigo is the feeling that you or the room is spinning when nothing is moving. Dizziness can come from a drop in blood pressure, dehydration or standing up too quickly, while vertigo most often comes from the inner ear.
What is BPPV?
BPPV is brief, intense vertigo triggered by certain head movements, such as bending down or rolling over in bed. It happens when tiny particles in the inner ear move out of place. It is a common and treatable cause of vertigo.
Can I drive with vertigo?
No. Do not drive, cycle or use machinery while you feel dizzy. Talk to your doctor about when it is safe to start again.
How long does vertigo last?
It depends on the cause. Spells can last seconds to hours, and in severe cases days or months. After an inner ear infection, balance usually returns within 2 to 6 weeks, though it can take longer. See a doctor if it lasts for months.
