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Vertigo

Vertigo is a symptom of several different conditions.

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

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
  • labyrinthitis
  • vestibular neuronitis
  • Ménière's disease
  • taking certain types of medication

These causes are explained in more detail below.

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

Head injury

Vertigo can sometimes develop after a head injury. If you have symptoms of dizziness or vertigo following a head injury, seek medical attention.

Read more about severe head injuries and minor head injuries.

Labyrinthitis

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

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.

Ménière's disease

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. 

Medication

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

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
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Vertigo

Your GP will ask you about your symptoms and carry out some simple tests to help differentiate between vertigo and general dizziness.

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.

Important questions

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 

Physical examination

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.

Further tests

Depending on your symptoms, your GP may refer you to a hospital or specialist for further tests.

Hearing tests

If you have tinnitus (ringing in your ears) or hearing loss, your GP may refer you to an ear, nose and throat (ENT) specialist, who can carry out some hearing tests.

These may include:

  • an audiometry test – a machine called an audiometer produces sounds of different volume and pitch. You listen to the sounds through headphones and signal when you hear a sound, either by raising your hand or pressing a button.
  • tuning fork test – a tuning fork produces sound waves at a fixed pitch when it's gently tapped. The tester will tap the tuning fork before holding it at each side of your head.

Read more about how hearing tests are carried out.

Videonystagmography 

Videonystagmography (VNG) is sometimes used to check for signs of nystagmus in more detail. Nystagmus can indicate a problem with the organs that help you to balance.

During this test, special goggles are placed over your eyes and you'll be asked to look at various still and moving targets. The goggles are fitted with a video camera to record the movements of your eyes.

Electronystagmography may also be used, where electrodes are placed around the eye instead of goggles.

Caloric testing

A caloric test involves running warm or cool water or air into your ear for about 30 seconds. The change in temperature stimulates the balance organ in the ear, allowing the specialist to check how well it's working.

This test isn't painful, although it's normal to feel dizzy during the test. This can sometimes continue for a few minutes afterwards.

Posturography

A machine to test your balance may be used to give valuable information about how you are using your vision, proprioception (sensations from your feet and joints) and the input from your ear to maintain balance. This may help to plan your rehabilitation and monitor your treatment.

Scans

In some cases, a scan of your head may be used to look for the cause of your vertigo, such as an acoustic neuroma (a non-cancerous brain tumour).

Usually, either a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan is used. An MRI scan uses a strong magnetic field and radio waves to produce a detailed image of the inside of your head, whereas a CT scan uses a series of detailed X-rays to create an image.

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