Vertigo is that unsettling sensation that the room is moving when you are not. It is relatively common, but it can feel alarming in the moment. Research suggests around 40% of adults will experience vertigo at some point. It can also have many different triggers, including migraines and inner ear infections.
So what is happening in the body during an episode?
“Usually, there is a stimulation of the inner ear balance organ that leads to it,” explains otolaryngologist and neurotologist Dr Hamid Djalilian. “It can also occur due to changes affecting the nerve centers for balance in the back part of the brain,” he says.
Vertigo is not a condition by itself. It is usually a symptom of something else going on. Here is what vertigo actually means, what else you might notice alongside it and when it is time to get checked.
What is vertigo?
Vertigo happens when you experience “the sensation of movement or of surrounding objects moving when they are not,” explains board-certified internist Jared Braunstein. “Patients often feel as if the room is spinning.”
Unlike general lightheadedness, vertigo has a distinct movement quality. It can feel like spinning, swaying, tilting or being pulled to one side. Episodes may last seconds, minutes or longer depending on the cause.
Vertigo symptoms
Vertigo is rarely a stand-alone condition. It is usually a symptom of a broader diagnosis. Professor of otolaryngology Dr Neil Bhattacharyya said that vertigo typically points to something else driving the sensation.
Alongside the spinning or swaying feeling, people commonly report nausea and vomiting, says Braunstein. Hearing changes can also show up, including hearing loss and ringing in the ears. Trouble walking or feeling unsteady is another common flag, Braunstein says.
Other symptoms can include blurred vision, balance issues, ear fullness, headaches and lightheadedness, adds physical therapist Daniel Flaherty.
Vertigo causes
Vertigo often comes down to mixed signals between the inner ear, brain and eyes. “The inner ear is connected through the brain stem with nerves that direct eye motion,” says Dr Djalilian. “When the inner ear is stimulated abnormally, it sends a signal to the brain, and the brain interprets that as motion. The brain subsequently sends a signal, moving the eyes to adjust for that head motion. However, the brain realizes that motion has not occurred and then corrects that eye motion back. This can repeat a few times or many times. That movement of the eyes is what creates the sensation of motion to the patient.”
The most common causes, according to Flaherty and Braunstein, include:
Benign paroxysmal positional vertigo (BPPV)
“The most benign cause of vertigo is benign paroxysmal positional vertigo,” says Braunstein. This happens when tiny calcium carbonate crystals in the inner ear that help with balance shift out of place. Certain head movements can trigger symptoms.
BPPV tends to be more common in people aged 50 and older and it appears more often in women, Flaherty adds.
Vestibulopathy
Vestibulopathy describes a problem with the vestibular system in one ear, which helps the brain understand head position and movement. When that system misfires, the brain can interpret motion when none is happening. Symptoms often feel worse when standing or moving, rather than when sitting or lying down.
Migraines
“Vestibular migraine is a form of migraine that affects the inner ear and can cause symptoms of short or long episodes of vertigo,” says Dr Djalilian. In some cases, vertigo can linger for weeks or months, he adds.
Inner ear infection
Inner ear infections and inflammation in the inner ear can disrupt balance and trigger vertigo. If vertigo arrives with hearing changes, ear pain, fever or a feeling of fullness in the ear, it is worth getting checked.
Vertigo treatments
Vertigo treatment depends on the cause. Once the underlying issue is identified, care usually focuses on either correcting the balance signal, calming symptoms or treating an infection.
If it is BPPV, a common approach for benign paroxysmal positional vertigo is the Epley manoeuvre, Flaherty explains. This involves specific head movements designed to guide displaced inner ear crystals back into place so balance can reset. “In some cases, people can learn to safely do these movements at home,” Flaherty adds.
Vestibulopathy is often treated with vestibular rehabilitation. This therapy helps the brain adapt to faulty signals coming from one ear, Flaherty says. Over time, it can reduce dizziness and improve stability.
Medications such as antihistamines can be used to ease dizziness and nausea, Braunstein says. Antibiotics may be prescribed if a bacterial inner ear infection is involved, he adds.
For vertigo linked to vestibular migraine, treatment can involve “using a combination of medications, supplements, and lifestyle changes to optimize sleep, diet, and reduce stress,” says Dr Djalilian. “This condition occurs more frequently around menopause time, so sometimes patients may need hormone replacement to help improve their symptoms.”
When to see a doctor about vertigo
Vertigo can be benign but it can also signal a more serious condition. “Vertigo can be a sign of something more serious like tumors or acoustic neuroma, multiple sclerosis, head trauma, or Meniere’s disease (fluid build-up in the inner ear),” says Braunstein. He recommends evaluation by a neurologist or ear, nose and throat specialist when needed.
Flaherty recommends seeking medical care if vertigo happens alongside any of the following:
- hearing loss
- vision loss
- facial drooping
- speech problems
- loss of consciousness
- shortness of breath
- chest pain
- head injury
- seizures
“Vertigo can lead to falls, accidents, and a decreased quality of life,” Flaherty warns. “You should talk with your health care provider if you experience symptoms consistent with vertigo.”
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