Vertigo, also called balance disorder, is the feeling of movement when no movement is occurring. This can be caused by a problem of the inner ear's balance mechanisms or by a problem in the brain. Although it usually is harmless, vertigo can be a sign of a serious condition if it is accompanied by difficulty in speaking or walking, severe headaches or double vision. Even when no other symptoms are present, it is recommended for anyone who is experiencing symptoms of this condition to consult a doctor. The same is true if the episodes worsen over time or if new symptoms appear.
Vertigo is most commonly caused by a problem with the balance mechanisms of the inner ear. However, it can also be due to a problem within the brain or the nerves. The different causes of vertigo are explained in more detail below.
Labyrinthitis is an inner ear infection that causes a delicate structure deep inside your ear (the labyrinth) to become inflamed. The labyrinth is a maze of fluid-filled channels that control hearing and balance. If the labyrinth becomes inflamed, the information it sends to your brain will be different from the information that's sent from your unaffected ear and your eyes. This difference can make you feel dizzy or that you're moving when you're still (vertigo).
Labyrinthitis is usually caused by a viral infection, such as the common cold or flu, which spreads to the labyrinth. Less commonly, it's caused by a bacterial inner ear infection. Vertigo that's caused by an infection may be accompanied by other symptoms, such as a high temperature or severe earache.
Vestibular neuronitis, also known as vestibular neuritis, is an inner ear condition that causes nerve pain and inflammation. It can also cause attacks of vertigo that can last for several hours or days.
A viral infection can sometimes lead to vestibular neuronitis if the infection spreads to your vestibular nerve. The vestibular nerve is one of the nerves in your ear that's used for balance. If your vertigo attacks are caused by vestibular neuronitis, they will often come on suddenly and can cause:
unsteadiness
nausea (feeling sick)
vomiting (being sick)
You won't usually have any hearing problems.
Short, intense, recurrent attacks of vertigo (usually lasting less than 30 seconds) are often the result of benign paroxysmal positional vertigo (BPPV).
BPPV can occur when you:
turn your head suddenly
roll over in bed
look up
stand up
bend over
BPPV is often accompanied by nausea, although vomiting is rare. During the attack, you may also experience brief nystagmus. This is where your eyes move uncontrollably, usually from side to side.
Light-headedness and a loss of balance can last for several minutes or hours after the attack. You won't have tinnitus (ringing in your ears) or hearing loss.
BPPV is thought to be caused by small fragments of debris which, for unknown reasons, break off from the lining of the channels in your inner ear. The fragments don't usually cause a problem unless they get into one of the ear’s fluid-filled canals.
When your head is still, the fragments sit at the bottom of the canal. However, certain head movements cause them to be swept along the fluid-filled canal where they brush against the sensitive hairs that line the canal. This sends extra, confusing messages to your brain, which responds by causing vertigo.
BPPV usually affects older people, with most cases occurring at around 50 years of age. However, it can sometimes affect younger people. BPPV may occur for no apparent reason, or it may develop after:
an ear infection
ear surgery
a head injury
prolonged bed rest – for example, while recovering from an illness
Attacks of BPPV can clear up within a few days, but many cases require treatment because it can keep reoccurring.
Severe vertigo is sometimes caused by a rare condition called Ménière's disease. As well as vertigo, the symptoms of Ménière's disease include:
hearing loss
tinnitus
aural fullness (a feeling of pressure in your ear)
If you have Ménière’s disease, you may experience sudden attacks of vertigo that last from 20 minutes to 24 hours. The attacks often cause nausea and vomiting. The tinnitus that's associated with Ménière’s disease often gets worse over time. Initially, the hearing loss comes and goes, but it may eventually become permanent.
Vertigo can sometimes develop after a head injury. If you have symptoms following a head injury, such as dizziness or vertigo, you should visit your GP as soon as possible. Alternatively, go to your nearest hospital’s accident and emergency (A&E) department.
A migraine is a severe headache that's usually felt as a throbbing pain at the front, or on one side, of your head. Some people also experience other symptoms, such as nausea and sensitivity to light (photophobia). It's thought that migraines may be one of the most common causes of vertigo.
As well as the conditions described above, vertigo may also occur as a side effect of some types of medication. Check the patient information leaflet that comes with your medicine to see if vertigo is listed as a possible side effect.
Less common causes of vertigo include:
a stroke or transient ischaemic attack (TIA or 'mini-stroke’) – the blood supply to part of the brain is cut off or reduced
multiple sclerosis – a condition that affects the central nervous system (the brain and spinal cord)
acoustic neuroma – a rare, non-cancerous (benign) brain tumour that grows on the acoustic nerve, which is the nerve that helps control hearing and balance
a brain tumour in the cerebellum (which is located at the bottom of the brain)
Vertigo implies that there is a sensation of motion either of the person or the environment, often perceived as if the room is spinning around you. This should not be confused with symptoms of lightheadedness or fainting. Vertigo differs from motion sickness in that motion sickness is a feeling of being off-balance and lacking equilibrium, caused by repeated motions such as riding in a car or boat.
If true vertigo exists, symptoms include a sensation of disorientation or motion. In addition, the individual may also have any or all of these symptoms:
nausea or vomiting,
sweating, and/or
abnormal eye movements.
The duration of symptoms can be from minutes to hours, and symptoms can be constant or episodic. The onset may be due to a movement or change in position. It is important to tell the doctor about any recent head trauma or whiplash injury as well as any new medications the affected individual is taking.
The person may have hearing loss and a ringing sensation in the ears.
The person might have visual disturbances, weakness, difficulty speaking, a decreased level of consciousness, and difficulty walking.
Home therapy should only be undertaken if you have already been diagnosed with vertigo and are under the supervision of a doctor.
The choice of treatment will depend on the diagnosis.
Vertigo can be treated with medicine taken by mouth, through medicine placed on the skin (a patch), or drugs given through an IV.
Specific types of vertigo may require additional treatment and referral:
Bacterial infection of the middle ear requires antibiotics.
For Meniere's disease, in addition to symptomatic treatment, people might be placed on a low salt diet and may require medication used to increase urine output.
A hole in the inner ear causing recurrent infection may require referral to an ear, nose, and throat (ENT) specialist for surgery.
In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.
Vestibular rehabilitation exercises, also referred to as Epley maneuvers, consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo no longer occurs.
Particle repositioning maneuver is a treatment based on the idea that the condition is caused by displacement of tiny stones in the balance center (vestibular system) of the inner ear. The head is repositioned to move the stones to their normal position. This maneuver is repeated until the abnormal eye movements are no longer visible.