Vertigo is a symptom rather than a condition itself. It is the sensation that you, or the environment around you, is moving.
Vertigo is a symptom rather than a condition itself. It's the sensation that you, or the environment around you, is moving.
If you have vertigo, you may feel as if you're moving even when you're standing completely still.
Other symptoms of vertigo include:
- feeling sick
- difficulty standing
The symptoms of vertigo can be barely noticeable or so severe that the loss of balance prevents you from perfoming everyday tasks.
Depending on the cause, an episode of vertigo may last several seconds, minutes, hours or days.
Vertigo is not a fear of heights.
What causes vertigo?
Vertigo is commonly caused by a problem with the balance mechanisms in the inner ear. However, it can also be caused by problems in certain parts of the brain.
Possible causes of vertigo include:
- benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo
- Ménière's disease – a condition that also causes tinnitus (ringing in your ears) and hearing loss
- migraines – severe headaches
- vestibular neuronitis – inflammation of the vestibular nerve which runs into the inner ear and sends messages to the brain that help control balance
Mild vertigo is common and not usually serious. However, vertigo that reoccurs or persists may be caused by an underlying health condition.
Without establishing what's causing your vertigo and receiving appropriate treatment, you may keep having episodes of vertigo for many months or even years.
See your GP if you have recurrent or persistent vertigo. They'll be able to confirm or rule out a more serious cause and recommend appropriate treatment, which may include:
- vestibular rehabilitation – a special exercise programme that encourages your brain to adapt to the abnormal messages sent from your ears
See Vertigo - treatment for more information.
If you have vertigo, your surroundings will appear to be moving vertically or horizontally, or you may feel that you are spinning.
If you have vertigo, your surroundings will appear to be moving vertically or horizontally, or you may feel that you're spinning.
The effect of vertigo may be slight and 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.
As well as the sensation that your surroundings are moving or spinning, the symptoms of vertigo may include:
- loss of balance
- nausea (feeling sick)
- vomiting (being sick)
- difficulty standing
- difficulty walking
Several different conditions can cause vertigo. Depending on the underlying cause, you may also experience:
Vertigo is often caused by a problem with the balance mechanisms in the inner ear. It can also be caused by brain or nerve problems.
Vertigo is most commonly caused by a problem with the balance mechanisms of the inner ear. However, it can also be due to a problem within the brain or the nerves.
The different causes of vertigo are explained in more detail below.
Labyrinthitis is an inner ear infection that causes a delicate structure deep inside your ear (the labyrinth) to become inflamed. The labyrinth is a maze of fluid-filled channels that control hearing and balance.
If the labyrinth becomes inflamed, the information it sends to your brain will be different from the information that's sent from your unaffected ear and your eyes. This difference can make you feel dizzy or that you're moving when you're still (vertigo).
Vertigo that's caused by an infection may be accompanied by other symptoms, such as a high temperature or severe earache.
Vestibular neuronitis, also known as vestibular neuritis, is an inner ear condition that causes nerve pain and inflammation. It can also cause attacks of vertigo that can last for several hours or days.
A viral infection can sometimes lead to vestibular neuronitis if the infection spreads to your vestibular nerve. The vestibular nerve is one of the nerves in your ear that's used for balance.
If your vertigo attacks are caused by vestibular neuronitis, they will often come on suddenly and can cause:
- nausea (feeling sick)
- vomiting (being sick)
You won't usually have any hearing problems.
Benign paroxysmal positional vertigo (BPPV)
Short, intense, recurrent attacks of vertigo (usually lasting less than 30 seconds) are often the result of benign paroxysmal positional vertigo (BPPV).
BPPV can occur when you:
- turn your head suddenly
- roll over in bed
- look up
- stand up
- bend over
BPPV is often accompanied by nausea, although vomiting is rare. During the attack, you may also experience brief nystagmus. This is where your eyes move uncontrollably, usually from side to side.
Light-headedness and a loss of balance can last for several minutes or hours after the attack. You won't have tinnitus (ringing in your ears) or hearing loss.
BPPV is thought to be caused by small fragments of debris which, for unknown reasons, 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 where they brush against the sensitive hairs that line the canal. This sends extra, confusing messages to your brain, which responds by causing vertigo.
BPPV usually affects older people, with most cases occurring at around 50 years of age. However, it can sometimes affect younger people. 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
Attacks of BPPV can clear up within a few days, but many cases require treatment because it can keep reoccurring.
Severe vertigo is sometimes caused by a rare condition called Ménière's disease. As well as vertigo, the symptoms of Ménière's disease include:
- hearing loss
- aural fullness (a feeling of pressure in your ear)
If you have Ménière’s disease, you may experience sudden attacks of vertigo that last from 20 minutes to 24 hours. The attacks often cause nausea and vomiting.
Vertigo can sometimes develop after a head injury. If you have symptoms following a head injury, such as dizziness or vertigo, you should visit your GP as soon as possible. Alternatively, go to your nearest hospital’s accident and emergency (A&E) department.
A migraine is a severe headache that's usually felt as a throbbing pain at the front, or on one side, of your head. Some people also experience other symptoms, such as nausea and sensitivity to light (photophobia).
It's thought that migraines may be one of the most common causes of vertigo.
As well as the conditions described above, vertigo may also 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.
Less common causes of vertigo include:
- a stroke or transient ischaemic attack (TIA or 'mini-stroke’) – the blood supply to part of the brain is cut off or reduced
- 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 control hearing and balance
- a brain tumour in the cerebellum (which is located at the bottom of the brain)
To confirm that you are experiencing vertigo, and to rule out other possible causes, your GP will ask you to describe your symptoms in detail.
General dizziness is a symptom that's associated with several conditions. In order to confirm that you're having vertigo, and to rule out other possible causes, your GP will ask you to describe your symptoms in detail.
To make an accurate diagnosis of vertigo, your GP will want to know:
- what symptoms you have – for example, whether you feel light headed or if your surroundings are spinning
- how often your symptoms occur
- how long your symptoms usually 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
You may be asked a number of further questions to help determine the cause of your vertigo, such as whether you:
- are taking any medication
- have a family history of migraines (severe headaches) or Ménière's disease (a rare disorder that affects the inner ear)
- have recently had an ear infection or head injury
Your GP may 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 seeing whether you can stand unaided.
Other tests may also be carried out, depending on the underlying cause (see Vertigo - causes). Some of the tests that you may have are briefly explained below.
Hallpike’s manoeuvre is a test that brings on the symptoms of vertigo. It's often used to confirm cases of benign paroxysmal positional vertigo (BPPV).
The test involves moving quickly from a sitting to a lying position, with your head below the horizontal line of the surface that you're lying on. As you lie back, you'll be asked to rotate your head towards the person testing you, keeping your eyes open.
In cases of BPPV, the symptoms of vertigo may appear for several seconds before disappearing.
- an ear X-ray
- balance tests
- hearing tests
Some possible hearing tests that you might have are described below.
- 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. It can be placed next to your ear, against the bone behind your ear (called a Rinne test) and on the centre of your forehead or on the bridge of your nose (called a Weber test).
Read more about how hearing tests are carried out.
A magnetic resonance imaging (MRI) scan is sometimes used to diagnose an acoustic neuroma (a non-cancerous brain tumour). A MRI scan uses a strong magnetic field and radio waves to produce a detailed image of the inside of your head.
Treatment for vertigo will depend on the cause and severity of your symptoms.
Treatment for vertigo will depend on the cause and severity of your symptoms.
During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea that you have and reduce the sensation of spinning. You should also avoid stressful situations as anxiety can make the symptoms of vertigo worse.
Labyrinthitis is an inner ear infection that causes the labyrinth (a delicate structure deep inside your ear) to become inflamed. It's usually caused by a viral infection and clears up on its own without treatment. In rare cases, where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed.
If you have lost your hearing in one ear, your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular physician. This is a doctor who specialises in hearing and balance disorders. You may need emergency treatment to restore your hearing.
Labyrinthitis may also be treated with vestibular rehabilitation, also called vestibular rehabilitation training or VRT (see box, left).
See Labyrinthitis - treatment for more information about treating this condition.
Vestibular neuronitis, also known as vestibular neuritis, is inflammation of the vestibular nerve (one of the nerves in your ear that's used for balance). It's usually caused by a viral infection. The symptoms of vestibular neuronitis usually get better without treatment over several weeks. However, you may need to rest in bed if your symptoms are severe.
You may find that your balance is particularly affected if you:
- drink alcohol
- are tired
- have another illness as well
Vestibular neuronitis may also be treated with vestibular rehabilitation (see box, left) and medication (see below).
Benign paroxysmal positional vertigo (BPPV)
Like vestibular neuronitis, benign paroxysmal positional vertigo (BPPV) often clears up without treatment after several weeks or months. It's thought that the small fragments of debris in the ear canal that cause vertigo either dissolve or become lodged in a place where they don't cause symptoms. However, BPPV sometimes reoccurs.
To avoid triggering BPPV, you should:
- get out of bed slowly
- avoid activities that involve looking upwards, such as painting and decorating or looking for something on a high shelf
BPPV can be treated using a procedure called the Epley manoeuvre (see below).
The Epley manoeuvre
The Epley manoeuvre is often very effective in resolving the symptoms of vertigo. It's been shown to cure up to 89% of BPPV cases.
The Epley manoeuvre involves performing four separate head movements to move the fragments to a place where they can't cause symptoms. Each head position is held for at least 30 seconds. You may experience some vertigo during the movements.
In the past, after performing the Epley manoeuvre, patients were given instructions to follow, such as not lying flat for 48 hours. However, this is now considered to be unnecessary.
Your symptoms should improve shortly after the Epley manoeuvre is performed, although it may take up to two weeks for a complete recovery. Return to your GP if your symptoms haven't improved after four weeks. The Epley manoeuvre can be repeated.
If the Epley manoeuvre doesn't work or if it's not suitable – for example, because you have neck or back problems, you can try the Brandt-Daroff exercises. These are a series of movements that you can do unsupervised at home to treat BPPV.
Your GP will need to teach you how to do the exercises. You repeat them three or four times a day for two days in a row. Following the exercises, your symptoms may improve for up to two weeks.
Referral for BPPV
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 very rare cases, where the symptoms of vertigo last for many months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist will be able to advise you further about this.
If your vertigo is caused by Ménière’s disease (a rare condition that affects the inner ear), there are a number of treatment options for both the vertigo and the other symptoms caused by the condition.
Possible treatments for Ménière’s disease include:
- dietary advice, particularly a low salt diet
- medication to treat attacks of Ménière's disease
- medication to prevent attacks of Ménière's disease
- treatment for tinnitus (ringing in your ears), such as sound therapy (therapy that works by reducing the difference between tinnitus sounds and background sounds to make the tinnitus sounds less intrusive)
- treatment for hearing loss, such as using hearing aids
- physiotherapy to deal with balance problems
- treatment for the secondary symptoms of Ménière's disease (stress, anxiety and depression)
See Ménière’s disease - treatment for more information about treating the condition.
The medications that are used to treat vertigo that's caused by Ménière’s disease are described below.
Central vertigo is caused by problems in part of your brain, such as the cerebellum (which is 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 migraine headaches and, less commonly, brain tumours (see Vertigo - causes for more information).
If your GP suspects that you have central vertigo they may:
- admit you to hospital if your symptoms are severe – particularly if you have severe nausea and vomiting and can't keep fluids down
- refer you to a specialist for further tests to confirm the diagnosis – this may be a neurologist (a specialist in treating conditions that affect the nervous system) or an audiovestibular physician (a specialist in hearing and balance disorders)
While you're waiting to be admitted to hospital or seen by a specialist, you may be given medication to treat your vertigo (see medicines below).
If you've already been diagnosed with vertigo that's caused by migraines, you may already have a treatment plan in place, such as medication that you can take at home. See Migraines - treatment for more information. You may also be referred to a specialist for further tests.
Vertigo with an unknown cause
If the cause of your vertigo is unknown, you may be admitted to hospital if:
- you have severe nausea and vomiting and can't keep fluids down
- your vertigo comes on very suddenly and was not caused by you changing position
- you possibly have central vertigo
- you have sudden hearing loss but it's not thought to be Ménière’s disease
Alternatively, you may be referred to a specialist such as:
- a neurologist – a specialist in treating conditions that affect the nervous system
- an ENT specialist – a specialist in conditions that affect the ear, nose or throat
- an audiovestibular physician – a specialist in hearing and balance disorders
While waiting to see a specialist, you may be treated with medication (see below).
Medicines can be used to treat:
- vertigo that's caused by vestibular neuronitis
- vertigo that's caused by Ménière’s disease
- central vertigo
- vertigo with an unknown cause
The medicines are usually prescribed for 3 to 14 days, depending on which condition they're for. The two medicines that are usually prescribed are:
- prochlorperazine, or
- an antihistamine
If these medicines are successful in treating your symptoms, you may be given a supply to keep at home so that you can take them the next time you have an episode of vertigo.
Prochlorperazine can help to relieve the severe nausea and vomiting that's associated with vertigo. It works by blocking the effect of a chemical in the brain called dopamine.
Prochlorperazine can cause side effects, including:
- tremors (shaking)
- abnormal or involuntary body and facial movements
It can also make some people feel sleepy. For the full list of possible side effects, check the patient information leaflet that comes with your medicine or see prochlorperazine medicines information.
If you're vomiting, there's a type of prochlorperazine called Buccastem that dissolves on your tongue and is absorbed by your body so that you don't have to keep down tablets that you swallow.
Antihistamines can be used to help relieve less severe nausea, vomiting and vertigo symptoms. They work by blocking the effects of a protein called histamine.
Possible antihistamines that may be prescribed include:
- promethazine teoclate
Like prochlorperazine, antihistamines can also make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.
Depending on the cause of your vertigo, your GP or specialist may be able to give you some self-help advice to relieve or prevent your symptoms.
Depending on what's causing your vertigo, your GP or the specialist treating you may be able to give you some self-help advice to relieve or prevent your symptoms. For example, this may include:
- sleeping with your head slightly raised on two or more pillows
- getting up slowly when getting out of bed and sitting on the edge of the bed for a minute or so before standing
- avoiding bending down to pick up items
- avoiding extending your neck – for example, while reaching up to a high shelf
- moving your head carefully and slowly during daily activities, when your neck is extended and when your head is positioned horizontally, such as when lying flat
Betahistine is a medicine that can help to prevent vertigo caused by Ménière's disease (a rare disorder that affects the inner ear). Betahistine is thought to reduce the pressure of the fluid in your inner ear, relieving the symptoms of Ménière's disease.
Research into betahistine hasn't found enough evidence to confirm whether it is effective. However, your GP may suggest trying it.
Betahistine is usually available as tablets to be taken three times a day. Your GP will discuss how long you need to take them for, which could be a few weeks or up to a year. Possible side effects include:
- an upset stomach