Vertigo: Causes and Treatments

Vertigo causes dizziness, balance problems but can be overcome

A woman experiencing dizziness, a sign of vertigo.

Vertigo causes dizziness, balance problems but can be overcome

You’re dizzy and the room is spinning. Or maybe you feel off-balance, like you’re moving or swaying while you’re standing perfectly still. You’re not sure what triggered it, how long it will last or how to make it stop. These are classic signs of vertigo.

Episodes of vertigo can last several seconds to several minutes. In severe cases, it can last for several hours or longer.

“Vertigo, in general, is the sensation of movement and disorientation in space,” says Hessam Khalili Tabrizi, MD, a family medicine physician at Scripps Coastal Medical Center Solana Beach. “It can be a diagnosis, and it can be a symptom.”

Make an appointment to see your doctor if your vertigo is getting worse and affecting your daily activities. Avoid driving and activities that require your full balance, such as climbing a ladder, if you are experiencing vertigo symptoms.

What are types of vertigo?

The causes of vertigo fall into two categories: inner ear problems (peripheral vertigo) and brain disorders (central vertigo).

Treatment depends on the type of vertigo diagnosed.

Why is the inner ear so important?

Vertigo is often caused by an inner ear problem and triggered by head movements. The inner ear contains the vestibular system, which plays a major role in our sense of balance and spatial orientation.

The inner ear has five areas of balance sensory input. Three are related to angular movement, while the other two affect horizontal (forward and reverse) and vertical (up and down) movement.

What causes peripheral vertigo?

The first type of vertigo is related to a balance sensor in the inner ear and a nerve in the same area that can become inflamed. 

The most common cause of inner-ear or peripheral vertigo is benign paroxysmal positional vertigo (BPPV). It can cause dizziness, a spinning sensation, lightheadedness, loss of balance and nausea.

BPPV is usually triggered by certain head movements that cause displacement of calcium carbonite crystals. These crystals are found within the fluid-filled semicircular canals of the inner ear and affect balance.

Many cases of BPPV involve a head injury or an accident, such as whiplash. Often the cause is not known. BPPV can occur in older people with no history of accident or injury.

In many cases, BPPV resolves on its own. In other cases, a technique called the Epley maneuver resolves vertigo most of the time. It can be done in a doctor’s office or at home and involves a series of simple head movements. These are designed to reverse the actions that dislodged the calcium crystals and send them back to their original position.

What is Meniere’s disease?

Meniere’s disease is another common cause of vertigo. It typically affects people in their 30s, 40s and 50s and is caused by a buildup of fluids inside the ear.

It can cause bouts of intense vertigo, accompanied by nausea, hearing loss and tinnitus. After the initial attack, hearing may come back. But symptoms often will return.

What is treatment?

Meniere’s disease is often treated with dietary restrictions. Lowering sodium intake may help reduce the fluid in the inner ear suspected of causing the problem. Diuretic medications also may be effective. Surgery to correct the problem is a last resort.

What is labyrinthitis?

Some people report feeling dizzy when blowing their nose. A bad cold or influenza can trigger vertigo, sometimes weeks later, by causing an inner ear infection that affects balance. This is known as labyrinthitis, which can also cause headaches, ear pain, vision changes, tinnitus or hearing loss.

Vestibular neuritis is a similar condition caused by inflammation of the vestibular nerve that sends messages to the brain. Neuritis does not affect hearing, however. Both conditions often get better on their own but can also be treated with medications.

What causes central vertigo?

The central vertigo is related to the brain and nervous system. Although less common, vertigo can be caused by a growth or tumor on the hearing or balance nerve. Treatment may include surgical removal. A circulation problem, stroke, brain stem lesion or multiple sclerosis can also trigger vertigo symptoms.

Diagnosing vertigo

Your primary care physician can run a series of tests to check the cause of a dizziness or balance problem. “It’s super important to determine what type it is before we get to the treatment,” Dr. Tabrizi says.

Doctors look for signs of dizziness triggered by eye or head movements. If the cause of vertigo isn't clear, they may order further tests.

A test called electronystagmography uses electrodes to detect abnormal eye movement that can help determine if symptoms are caused by an inner ear disease. A videonystagmography is a similar test but uses special goggles with a camera to record eye movements. A water test may also be used to check if the ear systems are properly working.

Your doctor may also refer you to a specialist, including an ear, nose and throat doctor or a neurologist.

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