Vertigo

Vertigo is the false sensation that you or your surroundings are spinning or moving. It's different from general dizziness or lightheadedness — vertigo specifically involves a rotational or spinning component. **Key Facts:** - **Not a disease:** Vertigo is a symptom of various conditions - **Most common cause:** BPPV (benign paroxysmal positional vertigo) - **Inner ear origin:** Most vertigo comes from inner ear problems - **Treatable:** Many causes respond well to treatment - **Duration:** Episodes can last seconds to days depending on cause **Types of Vertigo:** **Peripheral Vertigo (Inner Ear):** - **BPPV:** Brief episodes triggered by head movements - **[Meniere's disease](/condition/menieres-disease):** Vertigo with hearing loss and tinnitus - **Vestibular neuritis:** Viral infection of balance nerve - **Labyrinthitis:** Inner ear infection **Central Vertigo (Brain):** - Less common but more serious - Caused by stroke, tumors, or multiple sclerosis - Usually accompanied by other neurological symptoms **Related Conditions:** - [Meniere's disease](/condition/menieres-disease) — vertigo with hearing loss - [Migraine](/condition/migraine) — can cause vestibular migraine - [Anxiety](/condition/anxiety) — can worsen or trigger dizziness - Often confused with general dizziness — see our [vertigo vs dizziness comparison](/compare/vertigo-vs-dizziness) **Important:** Sudden vertigo with headache, vision changes, weakness, or slurred speech could indicate stroke — seek emergency care.

**How Vertigo Occurs:** **1. The Balance System:** Your sense of balance depends on your inner ear (vestibular system), vision, and sensory nerves. The inner ear contains fluid-filled canals with tiny hair cells that detect head movement. **2. BPPV (Most Common):** Tiny calcium crystals (otoconia) become dislodged and float into the semicircular canals. When you move your head, these crystals shift and send false signals to your brain, creating the spinning sensation. **3. Vestibular Neuritis:** A viral infection inflames the vestibular nerve, disrupting balance signals to the brain. This causes severe, constant vertigo that gradually improves. **4. [Meniere's Disease](/condition/menieres-disease):** Excess fluid (endolymph) builds up in the inner ear, causing pressure that disrupts balance and hearing. Episodes come and go unpredictably. **5. Central Causes:** Problems in the brain (stroke, tumors, MS) can affect the areas that process balance information, causing vertigo with other neurological symptoms. **Triggers for BPPV:** - Rolling over in bed - Looking up or down - Quick head movements - Getting out of bed - Bending over

**Treatment by Cause:** **BPPV (Most Effective Treatment):** - **Epley maneuver:** Series of head movements to reposition crystals - **Success rate:** 80-90% with 1-2 treatments - **Semont maneuver:** Alternative repositioning technique - **Brandt-Daroff exercises:** Home exercises for ongoing management **Vestibular Neuritis/Labyrinthitis:** - **Vestibular rehabilitation:** Physical therapy exercises - **Medications:** Meclizine, promethazine for acute symptoms - **Corticosteroids:** May speed recovery (controversial) - **Time:** Most cases improve within weeks **[Meniere's Disease](/condition/menieres-disease):** - **Low-salt diet:** Reduces fluid retention - **Diuretics:** Decrease inner ear fluid - **Betahistine:** Common treatment (not FDA-approved in US) - **Injections:** Gentamicin or steroids into middle ear - **Surgery:** Rarely needed for severe cases **Vestibular Migraine:** - **Migraine preventive medications** - **Lifestyle modifications** - **Vestibular rehabilitation** **General Approach:** - Identify and treat underlying cause - Short-term medications for acute symptoms - Vestibular rehabilitation for persistent symptoms - Lifestyle modifications