Vertigo: Symptoms, Causes and Treatment

Vertigo is more than just a feeling of dizziness—it's a disruptive sensation that can dramatically impact daily life. Whether it comes as a sudden spinning sensation or a lingering imbalance, vertigo often leaves individuals searching for answers about its symptoms, causes, and how best to find relief. In this article, we’ll explore the key aspects of vertigo, drawing on the latest research to help you understand what it is, why it happens, and what you can do about it.

Symptoms of Vertigo

Vertigo manifests in various ways, leaving those affected with more than just a fleeting sense of dizziness. Recognizing the symptoms is essential for both timely diagnosis and effective management. The experience can range from short, mild episodes to long-lasting and severe attacks that interfere with daily activities.

Symptom	Description	Associated Features	Source(s)
Spinning	False sensation of movement or rotation	Can last seconds to hours	1,5,7
Imbalance	Feeling unsteady or off-balance	Often worsened by movement	3,7,13
Nausea/Vomiting	Gastrointestinal discomfort	May follow vertigo attacks	1,5
Hearing Issues	Hearing loss, tinnitus, aural fullness	Especially in Ménière’s disease	4,7

Table 1: Key Symptoms

Understanding Vertigo Symptoms

Vertigo is not a disease itself, but a symptom that something is amiss—usually in the inner ear or brain’s balance centers. The following breakdown gives a clearer picture of what people with vertigo typically experience:

Spinning Sensation and False Movement

The hallmark of vertigo is a sensation that either you or your surroundings are spinning or moving, even when you are perfectly still. This sensation can be brief or prolonged, and its intensity can vary from mild to incapacitating. Many people describe it as feeling like being on a merry-go-round that they can’t get off 5,7.

Imbalance and Unsteadiness

Beyond spinning, vertigo frequently causes a feeling of imbalance or an inability to maintain steady posture. This unsteadiness is often aggravated by head movements or changes in position, such as turning over in bed or standing up quickly 3,7,13. Some individuals report feeling as though they are being pulled to one side.

Nausea and Vomiting

Nausea is a common companion to vertigo. In more severe cases, vomiting can occur, especially during acute attacks. The gastrointestinal symptoms are thought to arise from the close connection between the brain’s balance centers and those that control nausea 1,5.

Hearing Disturbances

In specific types of vertigo, such as Ménière’s disease, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear often accompany the spinning sensation 4. These symptoms help distinguish Ménière’s disease from other causes of vertigo.

Other Associated Symptoms

• Anxiety: Vertigo can be distressing and is often linked with anxiety or panic, particularly if attacks are recurrent or unpredictable 1.
• Autonomic Symptoms: Sweating, palpitations, and flushing may occur during intense vertigo episodes 1.
• Visual Disturbances: Some people experience blurred vision or oscillopsia (the illusion that stationary objects are moving).

Causes of Vertigo

Understanding what causes vertigo is key to managing and treating it. Vertigo can result from a variety of conditions, ranging from benign problems in the inner ear to more serious neurological issues.

Cause	Description	Prevalence/Notes	Source(s)
Benign Paroxysmal Positional Vertigo (BPPV)	Brief vertigo with head movement	Most common cause, especially in elderly	2,7,9
Ménière’s Disease	Inner ear disorder, fluctuating hearing loss	Characterized by vertigo attacks	4,9
Vestibular Migraine	Migraine variant with vertigo	Most common in children, also adults	6,8,9
Vestibular Neuritis	Inflammation of vestibular nerve	Acute, can last days	2,7,9
Psychiatric Causes	Anxiety, panic, persistent postural perceptual dizziness	Common, under-recognized	1,9
Central Causes	Strokes, tumors, multiple sclerosis	Require urgent attention	7,8
Trauma	Head or neck injury leading to vestibular damage	Variable presentation	12

Table 2: Main Causes of Vertigo

Peripheral vs. Central Vertigo

Vertigo is broadly classified as either peripheral (originating from the inner ear or vestibular nerve) or central (arising from the brainstem or cerebellum). Most cases are peripheral, but distinguishing between the two is crucial as central causes often require urgent intervention 7,8.

Peripheral Causes

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most frequent cause of vertigo. It is triggered by changes in head position, such as rolling over in bed or looking up. The underlying issue is dislodged calcium crystals (otoconia) moving within the inner ear canals, sending false signals of motion to the brain 2,9.

Ménière’s Disease

This is a chronic inner ear disorder marked by episodes of vertigo, hearing loss, tinnitus, and aural fullness. It is associated with excessive fluid buildup (endolymphatic hydrops) in the inner ear. The attacks can last from 20 minutes to several hours 4,9.

Vestibular Neuritis

This condition involves sudden inflammation of the vestibular nerve, leading to intense, prolonged vertigo often accompanied by nausea but without hearing loss. It is usually caused by viral infections 2,7,9.

Vestibular Migraine

Vestibular migraine is increasingly recognized as a leading cause of episodic vertigo in both children and adults. Symptoms include vertigo attacks lasting from minutes to hours, often alongside classic migraine features like headache or sensitivity to light and sound. However, vertigo may occur alone in some cases 6,8,9.

Central Causes

Central vertigo arises from disorders within the brain’s balance centers, such as strokes, multiple sclerosis, or tumors. These causes often present with additional neurological symptoms (e.g., double vision, severe imbalance, difficulty speaking), and require prompt medical evaluation 7,8.

Psychiatric and Functional Causes

Persistent postural perceptual dizziness (PPPD)—previously called psychogenic vertigo—is a common but under-recognized cause. Anxiety, panic disorders, and somatization can all manifest as chronic dizziness or vertigo, sometimes in conjunction with physical causes 1,9.

Trauma and Other Causes

Head or neck injuries can damage the vestibular system, leading to posttraumatic vertigo. The onset can be immediate or delayed, and a thorough diagnostic approach is essential to identify treatable underlying disorders 12.

Treatment of Vertigo

The good news is that most forms of vertigo are treatable, and many people recover fully. Treatment depends on the underlying cause, the severity of symptoms, and individual patient needs.

Treatment Type	Examples/Methods	Main Indications	Source(s)
Physical Maneuvers	Epley maneuver, vestibular rehab	BPPV, vestibular dysfunction	11,13
Medications	Antihistamines, benzodiazepines, betahistine, diuretics	Acute attacks, Ménière’s, migraine	5,11,13
Surgery/Procedures	Gentamicin injections, decompression surgery	Refractory Ménière’s, trauma	4,10,12
Lifestyle Modifications	Salt restriction, migraine prophylaxis	Ménière’s, vestibular migraine	4,11
Psychological Therapies	Cognitive-behavioral therapy	Psychogenic/PPPD	1,13

Table 3: Main Treatment Approaches

Physical Therapy and Maneuvers

Canalith Repositioning (Epley) Maneuver

For BPPV, the most effective treatment is a series of head and body movements that reposition the dislodged crystals in the inner ear. These maneuvers often provide immediate relief and can be performed in a clinic or at home with guidance 13.

Vestibular Rehabilitation

This specialized form of physical therapy helps retrain the brain to adapt to balance disturbances. Exercises are tailored to each individual and are especially useful for those with chronic imbalance or after vestibular neuritis 11,13.

Medications

A variety of medications are used to manage vertigo, depending on the cause:

• Vestibular Suppressants: Drugs such as antihistamines (e.g., meclizine), anticholinergics, and benzodiazepines can reduce the intensity of acute vertigo and associated nausea. However, they should be used for short periods to avoid delaying recovery 11,13.
• Betahistine: Commonly prescribed for Ménière’s disease and other vertigo, betahistine may help reduce the frequency and severity of attacks, though evidence quality is low and results should be interpreted cautiously 5.
• Diuretics and Salt Restriction: Used in Ménière’s disease to reduce fluid buildup in the inner ear 4,11.
• Migraine Prophylaxis: For vestibular migraine, medications like calcium channel blockers, tricyclic antidepressants, or beta-blockers can reduce attack frequency 11.
• Corticosteroids: May be given for vestibular neuritis or via intratympanic injection for refractory Ménière’s disease 10.

Surgical and Procedural Treatments

When conservative measures fail, more invasive options may be considered:

• Intratympanic Injections: Gentamicin (an antibiotic) or corticosteroids can be injected into the middle ear to control severe vertigo, particularly in Ménière’s disease. Both have shown effectiveness, though there are differences in side effect profiles 4,10.
• Surgical Procedures: In rare cases, decompression surgery or other surgical interventions are recommended, especially for structural problems or severe trauma 4,12.

Lifestyle and Psychological Approaches

• Lifestyle Changes: Dietary modifications (e.g., salt restriction), stress reduction, and avoiding triggers are important in Ménière’s disease and migraine-associated vertigo 4,11.
• Psychological Therapies: Cognitive-behavioral therapy or other psychological interventions can be effective for patients whose vertigo is linked to anxiety, panic, or PPPD 1,13.

Prognosis

Most vestibular disorders have a good prognosis, with many patients experiencing spontaneous recovery due to the brain’s ability to compensate for vestibular deficits. Individualized care, targeted therapy, and patient education are key to optimal outcomes 13.

Conclusion

Vertigo is a complex and often distressing symptom, but understanding its features, causes, and treatment options can empower patients and clinicians alike. Here’s what we covered:

• Key symptoms include spinning sensation, imbalance, nausea, and—sometimes—hearing disturbances.
• Leading causes are BPPV, Ménière’s disease, vestibular migraine, vestibular neuritis, psychiatric factors, and trauma.
• Treatment is highly individualized, ranging from physical maneuvers and rehabilitation to medications, surgical options, and psychological therapies.
• Most cases have a good prognosis with appropriate, cause-targeted management.

If you or someone you know experiences vertigo, seek medical advice for a proper evaluation and tailored treatment plan. Vertigo may feel overwhelming, but with the right approach, most people find relief and a return to normal life.