Vertigo

Vertigo causes dizziness and makes you feel like you’re spinning when you’re not. It most commonly occurs when there’s an issue with your inner ear. But you can also develop it if you have a condition affecting your brain, like a tumor or stroke. Treatments vary and can include medication, repositioning maneuvers or surgery.

Overview

What is vertigo?

Vertigo is a sensation that the environment around you is spinning in circles. It can make you feel dizzy and off-balance. Vertigo is a symptom of lots of health conditions rather than a disease itself, but it can occur along with other symptoms.

Other symptoms you might experience when you have vertigo include:

• Nausea and vomiting.


• Dizziness.


• Balance issues.


• Hearing loss in one or both ears.


• Tinnitus (ringing in your ears).


• Headaches.


• Motion sickness.


• A feeling of fullness in your ear.


• Nystagmus (a condition that causes your eyes to move from side to side rapidly and uncontrollably).

Types of vertigo

There are two main types of vertigo: peripheral and central.

Peripheral vertigo is the most common type. It happens when there’s an issue with your inner ear or vestibular nerve. (Both help with your sense of balance.)

Subtypes of peripheral vertigo include:

• Benign paroxysmal positional vertigo (BPPV).


• Labyrinthitis.


• Vestibular neuritis.


• Ménière’s disease.

Central vertigo is less common. It occurs when you have a condition affecting your brain, like an infection, stroke or traumatic brain injury. People with central vertigo usually have more severe symptoms like severe instability or difficulty walking.

Possible Causes

What causes vertigo?

Vertigo causes vary from person to person and may include:

• Migraine headaches.


• Certain medications, including some antibiotics, anti-inflammatories and cardiovascular drugs.


• Stroke.


• Arrhythmia.


• Diabetes.


• Head injuries.


• Prolonged bed rest.


• Shingles in or near your ear.


• Ear surgery.


• Perilymphatic fistula (when inner ear fluid leaks into your middle ear).


• Hyperventilation (rapid breathing).


• Low blood pressure (your blood pressure decreases when you stand up).


• Ataxia (muscle weakness).


• Syphilis.


• Otosclerosis (a bone growth issue affecting your middle ear).


• Brain diseases.


• Multiple sclerosis (MS).


• Acoustic neuroma.

What are the possible complications of vertigo?

Vertigo can cause falls, which may result in bone fractures (broken bones) or other injuries. Vertigo can also interfere with your quality of life and hinder your ability to drive or go to work.

Care and Treatment

How do healthcare providers diagnose vertigo?

A healthcare provider will perform a physical exam and ask questions about your vertigo symptoms. They may also recommend one or more tests to confirm your diagnosis.

Vertigo diagnostic tests

Healthcare providers may perform some tests to diagnose vertigo. These tests can include:

• Fukuda-Unterberger test. Your healthcare provider will ask you to march in place for 30 seconds with your eyes closed. If you rotate or lean to one side, it could mean that you have an issue with your inner ear labyrinth. This could cause vertigo.


• Romberg’s test. During this assessment, your provider will ask you to close your eyes while standing with your feet together and your arms to your side. If you feel unbalanced or unsteady, it could mean that you have an issue with your central nervous system (your brain or spinal cord).


• Head impulse test. For this test, your provider will gently move your head to each side while you focus your eyes on a stationary target (for example a spot on the wall or your provider’s nose). As they move your head, they’ll pay close attention to your eye movements. This can tell them if there’s an issue with the balance system in your inner ear.


• Vestibular test battery. This includes several different tests to check the vestibular portion of your inner ear system. A vestibular test battery can help determine whether your symptoms are a result of an inner ear issue or a brain issue.


• Imaging tests: These may include CT (computed tomography) scans or MRI (magnetic resonance imaging).

How do healthcare providers treat vertigo?

Vertigo treatment depends on the underlying cause. Healthcare providers use a variety of treatments, which may include:

• Repositioning maneuvers.


• Vertigo medication.


• Vestibular rehabilitation therapy (vertigo exercises).


• Surgery.

Repositioning maneuvers

Benign paroxysmal positional vertigo (BPPV) occurs when tiny calcium carbonate crystals (canaliths) move out of the utricle in your inner ear (where they belong) into your semicircular canals. This can cause vertigo symptoms, especially when you change your head position.

Canalith repositioning procedures, like the Epley maneuver, can help shift the crystals out of your semicircular canals back into your utricle. These maneuvers consist of a series of specific head movements. A healthcare provider can perform a canalith repositioning procedure during an office visit. They can also teach you how to do it at home.

Vertigo medication

Medication may help in some cases of acute (sudden onset, short duration) vertigo. Healthcare providers may recommend motion sickness medications (like meclizine or dimenhydrinate) or antihistamines (like cyclizine) to ease vertigo symptoms.

Vestibular rehabilitation therapy (vertigo exercises)

Vestibular rehabilitation therapy usually involves a range of exercises to improve common vertigo symptoms like dizziness, unstable vision and balance issues. A healthcare provider will tailor your treatment according to your unique needs. Exercises may include stretching, strengthening, eye movement control and marching in place. Your provider can teach you how to do these exercises at home so you can manage your symptoms whenever you have a vertigo episode.

Surgery

It’s rare, but you might need surgery when a serious underlying health issue — like a brain tumor or neck injury — causes vertigo. Providers typically only recommend surgery when other treatments don’t work. Your provider or surgeon will tell you which type of procedure you need and what to expect.

How do you get vertigo to go away on its own?

It’s not always possible to get rid of vertigo without the help of a healthcare provider. But here are some things you can try at home to ease your symptoms:

• Move slowly when standing up, turning your head or performing other triggering movements.


• Sleep with your head elevated on two pillows.


• Lie in a dark, quiet room to reduce the spinning sensation.


• Sit down as soon as you feel dizzy.


• Squat down instead of bending over at the waist when picking something up.


• Turn on the lights if you get up during the night.


• Use a cane or walking stick if you feel like you might fall.

How to cure vertigo permanently

Unfortunately, there’s no surefire way to get rid of vertigo permanently and keep it from coming back. Some people have vertigo once and never have it again. Others experience recurring (returning) episodes.

If you have severe or frequent vertigo, talk to your healthcare provider about ways to manage your symptoms and improve your quality of life.

When To Call the Doctor

When should I see my healthcare provider?

If you have severe or frequent episodes of vertigo, it’s time to call your healthcare provider. There could be an underlying health condition causing your symptoms.

When should I go to the ER?

Call 911 (or your local emergency services number) or go to the nearest emergency room if you develop vertigo alongside:

• Chest pain.


• Heart palpitations.


• Sudden headache.


• Difficulty walking.


• A fever over 100.4 degrees Fahrenheit (38 degrees Celsius).


• Vision changes.


• Weakness in one arm or leg.

Don’t drive when you have vertigo. Call 911 (or your local emergency services number) if a loved one isn’t available to drive you.

A note from Cleveland Clinic

Vertigo can come on suddenly without warning. Though vertigo attacks can feel scary, they go away quickly most of the time. If you experience severe or prolonged vertigo, your symptoms could indicate another medical condition. Vertigo can interfere with your quality of life and hinder your ability to do the things you want. No matter which type of vertigo you experience, your healthcare provider can help you identify the root cause and determine personalized treatment based on your needs.

Resources

• American Speech-Language-Hearing Association. Balance System Disorders. Accessed 5/9/2023.


• Johkura K. [Vertigo and dizziness]. Rinsho Shinkeigaku. 2021 May 19;61(5):279-287. Japanese. Accessed 5/9/2023.


• Kim HJ, Park J, Kim JS. Update on benign paroxysmal positional vertigo. J Neurol. 2021 May;268(5):1995-2000. Accessed 5/9/2023.


• Saha K. Vertigo Related to Central Nervous System Disorders. Continuum (Minneap Minn). 2021 Apr 1;27(2):447-467. Accessed 5/9/2023.


• Voetsch B, Sehgal S. Acute Dizziness, Vertigo, and Unsteadiness. Neurol Clin. 2021 May;39(2):373-389. Accessed 5/9/2023.