Comprehensive Guide to Vertigo

If you’ve ever experienced the sensation that your surroundings are spinning, you know firsthand how disturbing and incapacitating vertigo can be. This movement is typically perceived as a spinning or wheeling sensation; however, some people feel like they’re being pulled to one side. While vertigo is highly challenging, it may be reassuring to know you’re not alone. Dizziness, vertigo, and disequilibrium are common symptoms experienced by adults. 

What is Vertigo?

Vertigo is not a diagnosis. It’s a description of a sensation and symptom of an underlying vestibular disorder. The Vestibular Disorders Association defines vertigo as ‘the perception of movement or whirling – either of the self or surrounding objects.’ To understand vertigo, basic knowledge of the vestibular system is helpful. This is the primary neurologic system involved in controlling balance and eye movements. Parts of the vestibular system include:

  • The vestibular apparatus of your inner ear including the labyrinth, which consists of three semicircular canals and two otolith organs (the saccule and utricle)
  • The eighth cranial (vestibulocochlear) nerve, which conducts signals from the vestibular apparatus to the central components of the system
  • The vestibular nuclei in your brainstem and cerebellum

Types of Vertigo

The two primary types of vertigo are peripheral and central. Peripheral vertigo is associated with problems impacting the vestibular labyrinth and sometimes the vestibular nerve between your inner ear and brainstem. Central vertigo is due to a problem in the brain, frequently involving the brainstem or cerebellum (part of the brain at the back of the skull).

Benign paroxysmal positional vertigo (BPPV) is often listed as a type of vertigo. Clinically, it is the most common cause of vertigo and a subtype of peripheral vertigo. Tiny calcium carbonate crystals that normally reside in the utricle help you maintain your balance. When these particles break free and travel into the three semicircular canals of your inner ear, BPPV can occur. BPPV is triggered by position, so moving your head in certain ways (e.g., bending forward with your head down) can cause the crystals to move and provoke an episode.

Vertigo & Dizziness Facts & Stats

The following statistics provide insights about risk factors and who is most impacted by vertigo.

  • A recent large epidemiological study estimated that as many as 69 million adults aged 40 years or older in the U.S. have experienced some form of vestibular dysfunction. 
  • The estimated lifetime prevalence of vertigo and dizziness is 17–30%.
  • Nearly 80% of surveyed individuals with vertigo reported an interruption in daily activities, including employment and needing additional medical attention.
  • An estimated 8 million American adults have chronic problems with balance, while an additional 2.4 million have chronic dizziness alone.
  • An estimated 80% of people aged 65 years and older have experienced dizziness.
  • About 50% of dizziness cases in older adults are attributed to BPPV.
  • Nearly 40% of adults in the U.S. experience vertigo at least once in their lifetime.
  • Vertigo impacts both genders; however, it is about two-thirds more common in women than men.

Vertigo Causes

Regardless of the cause, vertigo results from sudden asymmetrical neural activity. This can arise from anywhere in the vestibular system—from the inner ear to your brain. In addition to BPPV being the most common cause, the following disorders often cause vertigo.

Ménière’s disease is an inner ear condition that results from a buildup of fluid in the inner ear. The disease can cause episodes of peripheral vertigo that last a few minutes to 24 hours. This condition is often accompanied by fluctuating, low-frequency hearing loss, tinnitus (ringing in the ears), and a feeling of fullness or pressure in the ears (aural fullness).

Labyrinthitis (inflammation of the labyrinth) occurs when a viral or bacterial infection affects and inflames both branches of the vestibulocochlear nerve. This can cause balance and hearing issues, including peripheral vertigo attacks that last hours to days. This condition is rare and is considered a true medical emergency that should be treated by a doctor as soon as possible.

Vestibular neuritis is a disorder that affects the vestibulocochlear nerve. When this becomes swollen and inflamed, how the brain normally interprets information is disrupted, which can result in vertigo, dizziness, balance problems, nausea, and vomiting. This often mimics labyrinthitis.

Vestibular migraines can cause a combination of vestibular attacks, visual aura, or sensitivity to visual stimulation and motion at different times, with or without a headache. This type of migraine may be linked to overlapping pathways that modulate pain and vestibular inputs into the brain.

Other underlying causes of vertigo are often classified as neurological or non-neurological.

Neurological Causes

  • Brain tumors
  • Head trauma
  • Strokes
  • Transient ischemic attacks (TIAs)
  • Multiple sclerosis

Non-Neurological Causes

  • Diabetes
  • Heart arrhythmias
  • Hyperventilation
  • Hormonal fluctuations (e.g., during pregnancy) 
  • Orthostatic hypotension (a sudden decrease in blood pressure when you stand up)
  • Psychiatric or emotional problems (e.g., panic attacks and anxiety)
  • Taking multiple prescription and non-prescription medications

What Causes Dizziness?

Dizziness is defined as a sensation of distortion of one’s spatial orientation but without any perception of abnormal movement or unsteadiness. Dizziness can include sensations such as lightheadedness and disorientation.

Although vertigo can be accompanied by dizziness, the underlying causes of dizziness without vertigo are harder to pinpoint. Typically, these disorders are not associated with the inner ear and are caused by the effects of drugs, especially those that impact the central nervous system. Multiple factors can play a role; however, many cases are idiopathic (no cause can be found). Non-neurologic disorders that may cause dizziness alone include hypotension (low blood pressure), hypoxemia (abnormally low oxygen levels in the blood), hypoglycemia (excessively low blood sugar levels), and anemia.

Vertigo Symptoms

An accurate diagnosis is based on the onset, duration, and severity of symptoms. Common symptoms include:

  • Sensation of spinning
  • Tinnitus
  • Ear pressure
  • Hearing loss 
  • Nausea and vomiting


If you experience loss of vision, slurred speech, or loss of consciousness, this could indicate a central nervous system or cerebrovascular disorder, which is a major medical emergency that should be treated immediately. Call an ambulance if necessary. 

Diagnostic Tests

The following tests can help confirm a diagnosis of vertigo and pinpoint the underlying cause.

  • Otologic and neurologic examinations are fundamental. When you’re lying down, the doctor will check your eyes for the presence, direction, and duration of spontaneous abnormal eye movements (nystagmus). This is a clue that an underlying mechanism is causing fluid to move in your inner ear canal.
  • A neurological exam, including assessing your gait, a finger-nose test, and the Romberg test will help determine if a neurological problem is to blame. During the latter test, you stand with your two feet together, close your eyes, and are scored by how many seconds you can stand in this manner.
  • Brain imaging such as MRI or CT scans are typically only recommended if symptoms suggest a central lesion, and for people with a high risk of stroke. 

Vertigo Treatment

Medical treatment of vertigo depends on the diagnosis. You can manage dizziness and vertigo with vestibular suppressants during the acute phase. These include anticholinergics, antihistamines, and benzodiazepines. Vestibular suppressants should only be used for a few days at most and with great caution in older adults. Other medications that may be prescribed include steroids and antiviral drugs, while antibiotics are used if a middle ear infection is the cause of vertigo. Vestibular rehabilitation is very useful for treating many types of vertigo.

While hearing aids aren’t a treatment for vertigo in individuals without hearing loss, the results of a 2015 study indicated that they might be a novel treatment modality for imbalance issues caused by vestibular problems in older adults.

The Epley maneuver (also called the particle repositioning procedure) is the gold standard treatment for BPPV. This painless and easy-to-perform procedure consists of a series of four quick movements of the head and body from sitting to lying, rolling over, and back to sitting. These movements allow the crystals to migrate out of the semicircular canals back to the utricle. About 85–90% of people experience complete relief after just one or two treatment sessions.

Although vertigo is debilitating, the majority of cases are harmless. Nevertheless, it’s crucial to get an accurate diagnosis because vertigo may be a symptom of a severe underlying disease that requires additional treatment. If you’re suffering from vertigo, don’t delay and see a healthcare professional as soon as possible.

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