What is vertigo?
Vertigo is a symptom in which you feel as if you are moving, spinning or floating, even if you are stationary. Vertigo is often accompanied by other symptoms, such as dizziness, impaired balance, lightheadedness, and nausea. It is estimated that during their lifetime, four out of 10 Americans may have experienced an episode of vertigo symptoms causing them to seek medical attention.
There are many causes of vertigo, including medication side effects, infection, disorders, and injuries. In some cases, there is no known cause of vertigo. Vertigo may begin or end suddenly, or gradually worsen over time. Vertigo may be temporary or long-term, depending on the underlying cause.
Vertigo may be a symptom of serious or life-threatening condition, such as a traumatic brain injury. Seek immediate medical care (call 911) if you have vertigo and other serious symptoms, such as changes in consciousness, vomiting, severe headache, and abnormal behavior.
Seek prompt medical care if your vertigo is persistent or causes you concern.
What are the different types of vertigo?
There are two types of vertigo:
- Peripheral vertigo occurs as the result of a problem with the vestibular system, which controls balance. The vestibular system includes the inner ear and vestibular nerve. The inner ear detects when your head or body moves and the position of your body in space. It sends this information to the brain via the vestibular nerve.
- Central vertigo is the result of a problem related to the brain. The brain receives input from the vestibular system, your eyes, and your skin, muscles and joints. It integrates and interprets all of this information. Normally, the result is a sense of balance and equilibrium.
A problem with either the peripheral or central component of balance can cause vertigo.
What other symptoms might occur with vertigo?
Vertigo may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the vestibular system may also involve other body systems.
Common symptoms that may occur along with vertigo
Often, vertigo may accompany other symptoms including:
- Blurred or double vision
- Impaired balance and coordination
- Nausea with or without vomiting
- Ringing sound in the ears (tinnitus)
Less-common symptoms that may occur along with vertigo
Vertigo may accompany symptoms related to other body systems including:
- Abnormal movements of the eyes (nystagmus)
- Changes in hearing, taste or smell
- Confusion or loss of consciousness for even a brief moment
- Difficulty controlling or focusing the eyes
- Difficulty hearing or loss of hearing
- Facial weakness or paralysis
- Progressive weakness and numbness in the legs or arms
Serious symptoms that might indicate a life-threatening condition
In some cases, vertigo may occur with other symptoms that might indicate a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have vertigo along with other serious symptoms including:
- Abnormal pupil size or nonreactivity to light
- Change in level of consciousness or alertness, such as passing out or unresponsiveness
- Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
- Loss of muscle coordination
- Paralysis or inability to move a body part
- Severe headache
What causes vertigo?
There are two types of vertigo, peripheral vertigo and central vertigo. Peripheral vertigo occurs as the result of a problem with the vestibular system, which includes the inner ear and vestibular nerve that controls balance. Central vertigo is the result of a problem related to the brain.
The causes of vertigo depend on the type of vertigo—peripheral vertigo (problems with the vestibular system) or central vertigo (problems related to the brain). In many cases, the precise cause of vertigo is not identified.
Causes of peripheral vertigo
Conditions, damage and diseases affecting the inner ear and vestibular nerve causing peripheral vertigo include:
- Acoustic neuroma (benign tumor of the acoustic nerve)
- Benign paroxysmal positional vertigo or BPPV (vertigo that occurs only in certain head positions)
- Head injury
- Labyrinthitis (infection or inflammation of the inner ear)
- Meniere’s disease (disorder of the inner ear characterized by vertigo and ringing in the ears)
- Motion sickness
- Perilymphatic fistula (leakage of fluid from the inner ear to the middle ear)
- Medication side effects
- Secondary endolymphatic hydrops (an imbalance in the fluid of the inner ear)
- Vestibular neuritis (inflammation of the vestibular nerve)
Causes of central vertigo
Vertigo can also be caused by conditions, damage and diseases affecting the brain including:
- Brain injury
- Exposure to toxic substances or poisons
- Multiple sclerosis (disease that affects the brain and spinal cord causing weakness, coordination, balance difficulties, and other problems)
- Side effects of medications or drugs, including alcohol, anticonvulsants and aspirin
Serious or life-threatening causes of vertigo
In some cases, vertigo may be a symptom of a serious or life-threatening condition that should be evaluated immediately in an emergency setting. These include:
- Traumatic brain injury
What are the risk factors for vertigo?
The risk factors for vertigo will vary with the specific cause. In general, risk factors for vertigo include:
- Balance disorders or inner ear problems
- Brain or head injury
- Female sex
- Older age
- Previous episode of vertigo
- Use of medications and substances that can cause vertigo, including alcohol
Reducing your risk of vertigo
Reducing your risk of a disease or condition relies on managing risk factors that you can change. Unfortunately, it is not always possible to prevent vertigo. Most of the risk factors are beyond your control.
If you take medicine that increases your risk, talk with your doctor about possible alternatives. If you have had a previous episode of vertigo, ask your doctor how you can reduce the risk of recurrence based on the specific cause of your vertigo.
How do doctors diagnose the cause of vertigo?
In most cases, doctors will start to investigate vertigo with a physical exam and detailed medical history. The exam will concentrate on how well your nervous system is working.
Your doctor will look at your eyes and may ask you to walk or complete other balance challenges. Your doctor may also have you make certain eye, head or body movements. Watching how your eyes react and if you have vertigo with these movements gives your doctor information about possible causes.
Depending on the results of the exam, your doctor may order testing including:
- Balance testing, including posturography where you test your balance on a moving platform and rotary chair testing where a chair moves through specific motions
- Blood tests to check electrolytes, glucose levels, blood cell counts, and thyroid hormone levels
- Eye movement testing, including tracking objects with your eyes and electronystagmography (ENG) or videonystagmography (VNG), which tests how your eyes react to different head positions or air or water in your ear
- Hearing tests
- Imaging exams, including MRI (magnetic resonance imaging) and X-rays
Questions for diagnosing the cause of vertigo
To diagnose your condition, your doctor or licensed healthcare practitioner will ask you several questions related to your vertigo including:
- How long have you felt the symptoms of vertigo?
- Do you feel lightheaded or faint?
- Do you feel as if the room is spinning or moving?
- What, if anything, seems to trigger your symptoms or make them better?
- Have you ever lost your balance or fallen since your vertigo symptoms began?
- What medications are you taking?
- Have you experienced an injury or trauma to the head or neck?
- Do you have any other symptoms?
- What other medical conditions do you have?
What are the treatments for vertigo?
When possible, vertigo treatment aims to cure the underlying condition. Treatment can also help improve vertigo symptoms, even if it does not eliminate the cause. Vertigo treatment options may include:
- Canalith repositioning procedures: This treatment for BPPV involves slow head position maneuvers to put the inner ear crystals back in place. Your doctor or physical therapy can teach you how to do these vertigo exercises at home.
- Medicines: Examples include antihistamines to ease dizziness, corticosteroids to decrease inflammation, diuretics to reduce fluids, and migraine medications to prevent or treat migraines.
- Positive pressure therapy: This treatment reduces fluid buildup in the inner ear.
- Talk therapy: This form of psychotherapy may help people dealing with anxiety related to vertigo.
- Vestibular rehabilitation therapy (VRT): This form of physical therapy retrains the brain and helps it adapt to balance problems. Therapists will give you balance exercises specific to your needs to do at home.
In rare cases, doctors may recommend surgery to treat certain causes of vertigo, such as BPPV, when they are resistant to other treatments.
At-home treatments for vertigo
If you have BPPV, your doctor or therapist will give you information about when and how to do canalith repositioning at home. Likewise, if you use VRT, your therapist will develop a specific balance exercise plan for you to use at home.
Other strategies you can use to manage vertigo include:
- Avoiding movements that trigger vertigo and sitting down when symptoms occur
- Getting rid of busy or distracting décor
- Keeping social settings and gatherings low-key
- Limiting alcohol, caffeine, salt and tobacco use
- Not reading or engaging in other activities during travel
- Practicing activities and exercises that support balance, such as yoga, Pilates or Tai Chi
- Resting adequately and staying hydrated
- Wearing sunglasses and anti-reflective glasses to reduce glare
What are the diet and nutrition tips for vertigo?
A healthy, balanced diet is important for everyone, including those suffering with vertigo. However, specific dietary changes may help people with certain kinds of vertigo. In particular, people with Meniere’s disease, secondary endolymphatic hydrops, or migraine-associated vertigo should consider the following tips:
- Avoid foods and beverages with high sugar content, especially simple sugars, which can cause fluid levels to fluctuate and can trigger migraines.
- Consume meals, snacks and liquids consistently throughout the day to even out blood sugar and stabilize fluids levels.
- Drink enough liquids to stay well-hydrated and keep fluid levels balanced—water is the best choice.
- Eat a low-sodium diet to reduce fluid retention.
- Limit alcohol and caffeine, which can affect fluid balance.
Ask your healthcare provider for guidance before making significant changes to your diet or adding supplements.
How does vertigo affect quality of life?
Research shows that people with dizziness or vertigo report a markedly reduced health-related quality of life. Both physical and mental well-being suffers in people with ongoing dizziness or vertigo. Completing everyday activities are among the challenges, along with dealing with the risk of falls. These issues may lead people to restrict their activities, which adds to the emotional distress. Not surprisingly, more serious problems with dizziness or vertigo have a greater negative effect on quality of life.
Like many other chronic conditions, ongoing dizziness or vertigo can lead to isolation. People often find themselves limiting social interactions or missing work due to their symptoms. Learning to cope and finding support can be a vital part of living with vertigo.
Educate yourself as much as you can about your condition. Join a support group of people who share your condition. You will find understanding, resources, and tips for coping with the challenges of vertigo. Ask your doctor or therapist about groups in your area or visit the Vestibular Disorders Association website.
What are the potential complications of vertigo?
Because vertigo can be due to serious diseases, not seeking treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare provider design specifically for you to reduce the risk of potential complications including:
- Adverse effects of treatment
- Brain damage
- Difficulty performing daily tasks
- Diminished overall quality of life
- Impaired balance and coordination
- Nerve problems that cause pain, numbness or tingling
- Permanent hearing loss
- Permanent loss of sensation
- Spread of cancer
- Spread of infection
- Traumatic injuries from falls
- Unconsciousness and coma