table of contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Have you ever had a dizzying sensation that made you feel like the world around you is spinning? This often unpleasant sensation is known as vertigo.
Around 40% of people will experience vertigo at least once in their lives. Though vertigo isn’t usually cause for serious concern, the symptoms can feel distressing. For people who get vertigo often, it often disrupts your ability to function on a daily basis, preventing you from reading, driving, or watching TV.
What is vertigo?
Vertigo is distinct from dizziness, which is where you feel generally unbalanced. People with vertigo, on the other hand, experience themselves or their surroundings spinning even though they aren’t moving (Nguyen, 2021).
While dizziness can be caused by motion sickness, dehydration, or a drop in blood pressure, vertigo is usually caused by an imbalance in the inner ear. Vertigo is more common in older people and women (Stanton, 2021).
Vertigo is technically a symptom, not a condition. That means that there is some sort of underlying cause, whether identifiable or not. Our sense of balance is controlled by communication between the inner ear, our eyes, and our brains.
Inside the ear are tiny fluid-filled tubes (called semicircular canals) that act like levels you would use to make sure a picture is straight on a wall. Based on the movement of the fluid in the canal (which is affected by the position of your head and things like movement and gravity), your ears send signals to your brain that tell you which way is up. Typically, it’s not something we think about much until something goes wrong.
There can be problems anywhere in the system: in the canals themselves, in the sensors that send signals to the brain, or in the brain.
Vertigo can be triggered by a change in position, such as when sitting up, lying down, or turning over in bed. Vertigo can also potentially be a reaction to stress. People with vertigo describe it as feeling like you’re unbalanced, spinning, tilting, or swaying. It can last anywhere from a few minutes to hours. In severe cases, it may last even longer (Stanton, 2021).
Tinnitus: what is it, symptoms, causes, and treatment
Other signs of vertigo include:
- Uncontrolled eye movements (nystagmus)
- Ringing in the ears (tinnitus)
- Temporary hearing loss
Types of vertigo
There are two main types of vertigo (Baumgartner, 2021; Lui, 2021):
- Peripheral vertigo: This is the more common type, making up 80–90% of cases. It’s associated with more severe, sudden episodes of vertigo. People report experiencing dizziness, spinning, difficulty focusing their eyes, hearing loss, and ringing in one or both ears. This type of vertigo is caused by problems with parts of the inner ear (namely, the peripheral vestibular system and semicircular canals), which help maintain your sense of balance.
- Central vertigo: This type is less common. People with central vertigo describe feeling that their surroundings are spinning, even though they’re standing still. While peripheral vertigo is related to the inner ear, central vertigo is caused by issues with parts of the brain that communicate with that system. Things like tumors, trauma, and strokes that impact the brainstem, cranial nerves, or cerebellum can result in central vertigo.
Common causes of vertigo
The underlying cause of vertigo depends on the type. As we mentioned, central vertigo is connected to issues with the brain brought on by things like stroke, multiple sclerosis, or migraines. Other less common causes of central vertigo include a traumatic brain injury, infection, or brain tumor (Lui, 2021).
How to relieve stress: proven tips and techniques
Peripheral vertigo can be triggered by a number of inner ear issues including (Baumgartner, 2021):
- Benign paroxysmal positional vertigo (BPPV): This represents over half of peripheral vertigo cases. The semicircular canals of the inner ear contain calcium carbonate crystals, called otoconia, which help the body understand where the head is positioned in relation to gravity. When these get dislodged, it can cause vertigo. Most cases of BPPV have no identifiable cause, although migraines, inner ear surgery, and head injury or trauma may contribute (Palmeri, 2022).
- Meniere’s disease: This is an inner ear disorder associated with vertigo, hearing loss, ringing in the ears, nausea, and vomiting. It’s caused by an excess of fluid in the inner ear, specifically the cochlea and vestibular organs (Koenen, 2021).
- Vestibular neuritis: Inflammation of the inner ear may be brought on by a viral infection like a cold. People with vestibular neuritis experience sudden episodes of vertigo with severe nausea and vomiting.
- Labyrinthitis: This is another inner ear infection similar to vestibular neuritis, with the addition of hearing loss. If someone experiences sudden vertigo with hearing loss in one ear, it’s likely labyrinthitis.
- Cholesteatoma: Cholesteatomas are cysts lined with keratin, the protein found in your skin, hair, and nails. These can grow in the middle ear and lead to vertigo.
Medications that affect the function of the cochlea or vestibular system can cause vertigo. Examples are antibiotics (like gentamicin) and anticonvulsants like phenytoin and salicylates (Altissimi, 2020; Stanton, 2021).
Antidepressants: types, side effects, uses, and risks
Vertigo can be a side effect of a wide range of other medications, including antidepressants, contraceptives, sedatives, anti-inflammatories, and heart drugs. Medications for pain, diabetes, low blood pressure, and cancer can also trigger vertigo (Chimirri, 2013).
How to treat vertigo
Vertigo often goes away on its own. Our brains can adapt to these inner ear changes and find a way to feel balanced again. That said, treatment may be recommended in some cases. Depending on the underlying cause and severity, vertigo treatment may include a combination of physical therapy, medication, and lifestyle changes.
Vertigo is often caused by an issue with the vestibular system, which tells the brain where your head is in relation to the ground. Vestibular rehabilitation is a form of physical therapy that helps people train their other senses to adjust to vertigo. A physical therapist will walk you through specific exercises designed to improve balance, stabilize your gait, and steady your vision.
For people with BPPV, what’s called the Epley maneuver (also known as canalith repositioning procedure) may be recommended. These body movements are designed to move calcium deposits out of the inner ear canals and back to where they belong.
These head movements are performed in a specific order and held for a certain amount of time. A physical therapist will work you through them and explain how to perform the maneuver at home. The Epley maneuver is very effective, relieving vertigo in 50–90% of people (Stanton, 2021).
Different medications may be prescribed for vertigo, depending on the underlying cause. Betahistine, gentamicin, and diuretics are ones used to relieve symptoms of Meniere’s disease (Koenen, 2021).
Benzodiazepines: uses, side effects, and risks
Due to the sudden onset of vertigo episodes, people with BPPV may not benefit from long-term medication. For short-term relief, antihistamines (like meclizine), benzodiazepines (like diazepam), and anti-nausea drugs can help. For inner ear infections that cause vertigo, such as vestibular neuritis, corticosteroids may be used (Palmeri, 2022; Stanton, 2021).
If you’re looking for a more natural remedy, clinical trial data suggests ginkgo biloba supplements may be as effective as prescription drugs with fewer side effects (Sokolova, 2014).
A healthcare provider may also recommend lifestyle changes to prevent vertigo, such as (Orji, 2014; Booth, 2015):
- Slowing down: Move more slowly and take extra care when manipulating your body in any way. Standing or sitting up, turning your head, or bending over can bring on vertigo. Try making other movements like squatting instead of bending down.
- Keeping your head elevated: Try to keep your head elevated by 45 degrees when sleeping or lying down. This was shown to relieve vertigo in people with BPPV who didn’t respond to medication or repositioning maneuvers (Horinaka, 2019).
- Minimizing stress: There’s no direct evidence that stress causes vertigo, but it can make it worse. Stress and anxiety may increase your risk of things like a stroke or aggravate symptoms of Meniere’s disease. Deep breathing, yoga, meditation, and therapy are all good examples of ways to reduce stress.
- Reducing salt, alcohol, and caffeine intake: Research indicates people with Meniere’s disease may be more sensitive to diets high in salt, caffeine, and alcohol (Stanton, 2021).
Stress eating: what is it and how do you stop it?
Surgery may be recommended for severe cases of vertigo, but the downside with this is it can lead to hearing loss. Surgery may be necessary to address something like a brain tumor or traumatic injury, and treating those conditions may help alleviate vertigo.
If you regularly experience symptoms of vertigo or dizziness, speak with a healthcare professional about treatment options.
- Altissimi, G., Colizza, A., Cianfrone, G., de Vincentiis, M., Greco, A., Taurone, S., et al. (2020). Drugs inducing hearing loss, tinnitus, dizziness and vertigo: An updated guide. European Review for Medical and Pharmacological Sciences, 24(15), 7946–7952. doi:10.26355/eurrev_202008_22477. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32767320/
- Baumgartner, B. & Taylor, R. S. (2021). Peripheral Vertigo. [Updated Jul 2, 2021]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28613548/
- Booth, J., Connelly, L., Lawrence, M., Chalmers, C., Joice, S., Becker, C., et al. (2015). Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis. BMC Neurology, 15, 233. doi:10.1186/s12883-015-0456-4. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26563170/
- Chimirri, S., Aiello, R., Mazzitello, C., Mumoli, L., Palleria, C., Altomonte, M., Citraro, R., & De Sarro, G. (2013). Vertigo/dizziness as a drugs’ adverse reaction. Journal of Pharmacology & Pharmacotherapeutics, 4(1), S104–S109. doi:10.4103/0976-500X.120969. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24347974/
- Horinaka, A., Kitahara, T., Shiozaki, T., Ito, T., Wada, Y., Yamanaka, T., & Nario, K. (2019). Head-up sleep may cure patients with intractable benign paroxysmal positional vertigo: A six-month randomized trial. Laryngoscope Investigative Otolaryngology, 4(3), 353–358. doi:10.1002/lio2.270. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31236471/
- Koenen, L. & Andaloro, C. (2021). Meniere Disease. [Updated Sep 4, 2021]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30725640/
- Lui, F., Foris, L. A., Willner, K., & Tadi, P. (2021). Central Vertigo. [Updated Sep 29, 2021]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28722891/
- Nguyen, C. T. & Basso, M. (2021). Epley Maneuver. [Updated Oct 30, 2021]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33085434/
- Orji, F. (2014). The influence of psychological factors in Meniere’s disease. Annals of Medical and Health Sciences Research, 4(1), 3–7. doi:10.4103/2141-9248.126601. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24669323/
- Palmeri, R. & Kumar, A. (2022). Benign Paroxysmal Positional Vertigo. [Updated Jan 3, 2022]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29261987/
- Sokolova, L., Hoerr, R., & Mishchenko, T. (2014). Treatment of vertigo: A randomized, double-blind trial comparing efficacy and safety of ginkgo biloba extract EGb 761 and betahistine. International Journal of Otolaryngology, 2014. doi:10.1155/2014/682439. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25057270/
- Stanton, M. & Freeman, A. M. (2021). Vertigo. [Updated Apr 28, 2021]. In: StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29493978/
- Sulway, S. & Whitney, S. L. (2019). Advances in vestibular rehabilitation. Advances in Oto-Rhino-Laryngology, 82, 164–169. doi:10.1159/000490285. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30947180/
- Teggi, R., Manfrin, M., Balzanelli, C., Gatti, O., Mura, F., Quaglieri, S., et al. (2016). Point prevalence of vertigo and dizziness in a sample of 2672 subjects and correlation with headaches. Acta Otorhinolaryngologica Italica, 36(3), 215–219. doi:10.14639/0392-100X-847. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27214833/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.