What Is Vertigo? Causes, Symptoms, Diagnosis and Treatment

Created: 17.04.2024 · Last Updated: 18.08.2026 · Category: Ear, Nose and Throat · Prepared by the Academic Hospital Web and Editorial Board.

What Is Vertigo?

Vertigo is a false sensation that you or your surroundings are moving, spinning or swaying.

Vertigo is a symptom rather than a single disease. It can result from disorders affecting the inner-ear balance system, vestibular nerve or central nervous system.

The duration of attacks, triggering movements, associated hearing symptoms and neurological findings help determine the underlying cause.

Are Vertigo and Dizziness the Same?

The term dizziness can describe several different sensations, including imbalance, light-headedness, near-fainting and unsteadiness.

Vertigo specifically describes an illusion of movement.

Feeling faint because of a fall in blood pressure, for example, is therefore different from true vertigo.

Vertigo is not always caused by the inner ear. Disorders affecting the brainstem or cerebellum, including stroke, can also cause vertigo.

What Causes Vertigo?

Important causes include:

  • Benign paroxysmal positional vertigo (BPPV)
  • Ménière's disease
  • Vestibular neuritis
  • Labyrinthitis
  • Vestibular migraine
  • Vestibular effects of certain medicines
  • Vestibular schwannoma and other disorders affecting the vestibular nerve
  • Brainstem or cerebellar stroke
  • Certain neurological disorders such as multiple sclerosis

The timing and pattern of symptoms are often highly informative. Attacks lasting seconds, minutes, hours or days can suggest different diagnostic possibilities.

What Is the Difference Between Peripheral and Central Vertigo?

Peripheral vertigo originates from the inner-ear vestibular system or vestibular nerve.

BPPV, Ménière's disease and vestibular neuritis are examples.

Central vertigo originates from the brainstem, cerebellum or central vestibular pathways.

Stroke, some demyelinating disorders and vestibular migraine can cause vertigo through central mechanisms.

What Is Benign Paroxysmal Positional Vertigo?

BPPV occurs when small calcium carbonate particles called otoconia become displaced and enter one of the semicircular canals of the inner ear.

Head movement then causes these particles to move, creating an abnormal vestibular signal and brief episodes of vertigo.

Common triggers include rolling over in bed, lying down, getting out of bed, looking upward or bending forward.

Episodes are usually brief but may recur whenever the provoking head position is repeated.

What Is Ménière's Disease?

Ménière's disease is an inner-ear disorder characterised by recurrent vertigo attacks and auditory symptoms.

Definite Ménière's disease typically involves:

  • At least two spontaneous vertigo attacks lasting 20 minutes to 12 hours
  • Audiometrically documented sensorineural hearing loss
  • Tinnitus, fluctuating hearing or a sensation of fullness in the affected ear
  • No better alternative diagnosis

Endolymphatic hydrops is associated with Ménière's disease, but the disorder cannot simply be explained by inadequate removal of water from the body or low blood pressure.

What Are Vestibular Neuritis and Labyrinthitis?

Vestibular neuritis can produce acute severe vertigo lasting hours to days, often with nausea, vomiting and imbalance.

New significant hearing loss is not typical of isolated vestibular neuritis.

Labyrinthitis can produce similar vestibular symptoms together with cochlear symptoms such as hearing loss or tinnitus.

Not every prolonged episode of vertigo should automatically be assumed to be a viral inner-ear disorder because stroke and other central causes can present similarly.

What Is Vestibular Migraine?

Vestibular migraine is a disorder in which migraine is associated with recurrent episodes of vertigo or dizziness.

A headache does not necessarily occur during every attack.

Episodes may be associated with light sensitivity, sound sensitivity, migraine-type headache and increased symptoms with movement or complex visual environments.

How Is Vertigo Diagnosed?

A detailed history is one of the most important parts of the assessment.

The clinician may ask about:

  • How long each episode lasts
  • Whether symptoms are triggered by head movement
  • Whether attacks are recurrent or new
  • Hearing loss, tinnitus or ear fullness
  • Migraine history
  • Neurological symptoms such as weakness, numbness, double vision or speech difficulty
  • Current medicines

Ear examination, eye movements, balance, gait and neurological findings may then be assessed.

Which Tests May Be Used for Vertigo?

Testing is selected according to the suspected cause.

  • Dix-Hallpike test: For posterior-canal BPPV
  • Supine roll test: For horizontal-canal BPPV
  • Audiometry: When hearing loss or Ménière's disease is suspected
  • Video head impulse testing
  • Videonystagmography
  • Caloric testing
  • VEMP testing in selected vestibular disorders

Not every patient requires every vestibular test.

Is MRI or CT Always Required for Vertigo?

No. Imaging depends on the clinical presentation.

Routine CT or MRI is generally not required when a patient has typical BPPV without additional neurological features.

Imaging may be considered when there are neurological abnormalities, concern for stroke or another central cause, atypical nystagmus, new unilateral hearing loss or concern for a tumour.

The HINTS examination can help trained clinicians distinguish central from peripheral causes in appropriate patients with acute vestibular syndrome. It is a clinician-performed bedside examination and is not intended as a self-test.

How Is BPPV Treated?

The main treatment is a canalith repositioning procedure, which aims to move displaced otoconia out of the affected semicircular canal.

The Epley manoeuvre is commonly used for posterior-canal BPPV.

The appropriate manoeuvre depends on the affected ear and semicircular canal.

Routine long-term treatment with vestibular suppressant medication is not recommended for typical BPPV because these medicines do not reposition the displaced particles.

BPPV can recur even after successful treatment.

How Is Ménière's Disease Treated?

Treatment is individualised to reduce vertigo attacks, monitor hearing and preserve quality of life.

Options may include lifestyle and dietary measures, short-term symptomatic medicines during attacks, maintenance treatment, selected intratympanic treatments, hearing rehabilitation and surgery in resistant cases.

What Is Motion Sickness?

Motion sickness is thought to arise largely from a mismatch between visual, vestibular and body-position information during motion.

For example, when reading inside a moving vehicle, the eyes may report a relatively stationary visual scene while the vestibular system detects movement.

Symptoms can include nausea, vomiting, cold sweating, pallor, dizziness, yawning and drowsiness.

Motion sickness is not explained by reduced “fluidity” of inner-ear fluid.

Looking towards the horizon or direction of travel and reducing reading or screen use can reduce visual-vestibular conflict in some people.

Medication may be used in selected individuals before travel, but some treatments can cause drowsiness and may impair driving or other safety-sensitive activities.

When Is Vertigo an Emergency?

Urgent medical assessment is required when vertigo occurs with:

  • New weakness or numbness of the face, arm or leg
  • Speech difficulty
  • New double vision or major visual disturbance
  • Difficulty swallowing
  • Inability to stand or walk
  • A new severe headache
  • Altered consciousness
  • New unilateral hearing loss with severe vertigo
  • Sudden persistent vertigo in a person at high risk of stroke

Acute vestibular syndrome — persistent new vertigo with nausea or vomiting, nystagmus and gait instability — can result from either a peripheral vestibular disorder or posterior-circulation stroke and requires appropriate clinical assessment.

Not Every Episode of Dizziness Has the Same Cause

The duration and triggers of vertigo, eye movements, hearing symptoms and neurological examination can help distinguish BPPV, Ménière's disease, vestibular migraine and other peripheral or central causes.

Frequently Asked Questions

What is vertigo?
Vertigo is a false sensation that you or your surroundings are moving, spinning or swaying. Vertigo is a symptom rather than a single disease and can result from different vestibular or neurological disorders.
Is vertigo always caused by the inner ear?
No. Inner-ear and vestibular nerve disorders such as BPPV, Ménière's disease and vestibular neuritis can cause vertigo, but stroke affecting the brainstem or cerebellum and other neurological disorders can also produce vertigo.
What is BPPV?
BPPV occurs when small calcium carbonate particles in the inner ear move into a semicircular canal and produce brief episodes of vertigo with certain head movements.
How is positional vertigo treated?
The main treatment for BPPV is a canalith repositioning procedure. The Epley manoeuvre is commonly used for posterior-canal BPPV, with the manoeuvre selected according to the affected ear and canal.
What are the symptoms of Ménière's disease?
Ménière's disease can cause recurrent vertigo together with fluctuating hearing loss, tinnitus or a sensation of fullness in the affected ear. In definite Ménière's disease, vertigo attacks typically last 20 minutes to 12 hours.
Does every patient with vertigo need an MRI?
No. Routine imaging is generally unnecessary in clinically typical BPPV. MRI or other imaging may be needed when neurological findings, a suspected central cause, new unilateral hearing loss or atypical features are present.
What causes motion sickness?
Motion sickness can occur when visual, vestibular and body-position signals do not match during movement. It is not caused by reduced fluidity of inner-ear fluid.
When is vertigo dangerous?
Urgent medical assessment is required when vertigo occurs with new weakness or numbness, speech difficulty, double vision, inability to walk, altered consciousness or a new severe headache.
Academic Hospital note: Vertigo is not a single disease. Causes range from brief positional BPPV to Ménière's disease, vestibular migraine and, less commonly, stroke. Diagnosis depends on the timing and triggers of symptoms together with vestibular and neurological examination. You can book an appointment.

References

  1. Academic Hospital. Vertigo
  2. American Academy of Otolaryngology–Head and Neck Surgery. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo
  3. American Academy of Otolaryngology–Head and Neck Surgery. Clinical Practice Guideline: Ménière's Disease
  4. Centers for Disease Control and Prevention. CDC Yellow Book: Motion Sickness
  5. PubMed. Using the HINTS Family to Diagnose Stroke in Acute Vestibular Syndrome