Vertigo

Key points about vertigo

1. With vertigo, you may be unsteady, have difficulty walking or standing, and may lose your balance.
2. There are many causes of vertigo, but they are mainly due to problems with your inner ear.
3. Common causes include benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuronitis or labyrinthitis.
4. The treatment for vertigo depends on the cause and severity of your symptoms.
5. There are some things you can do to help prevent vertigo, such as avoiding situations that can trigger your symptoms.
6. It is also important not to drive if you are having vertigo attacks or are feeling dizzy.

What are the symptoms of vertigo?

Vertigo is a sensation of dizziness that comes from feeling that you or your surroundings are moving when there isn't actually any movement. Some people describe it as the room spinning around, or a feeling of falling or tilting. You may be unsteady, have difficulty walking or standing, and may lose your balance. Vertigo can start suddenly and may vary in intensity. It may stay or come and go.

You may also have other symptoms along with vertigo, including:

• nausea (feeling sick) and vomiting (being sick)
• tinnitus (ringing in your ears)
• impaired or reduced hearing
• ear pain or ear fullness.

Vertigo or lightheadedness?

Vertigo is not the same as lightheadedness. Lightheadedness is a feeling that you are going to faint or pass out. It is often caused by lack of oxygen to your brain rather than problems with your ear. When you say you have dizziness, your doctor will ask questions to work our whether you have vertigo or lightheadedness.

Note that nerve and muscle pressure around your neck and shoulder region may mimic vertigo.  

What are the causes of vertigo?

As well as sending sound waves to your brain so that you can hear, your inner ear helps to keep your balance when you turn your head, walk or even stumble. Vertigo is often caused by problems with your inner ear. 

The 2 types of vertigo, according to their cause, are peripheral and central.

Inner ear (peripheral) causes

Common causes of vertigo due to problems with your inner ear include:

• benign paroxysmal positional vertigo (BPPV)
• vestibular neuronitis
• Meniere’s disease
• labyrinthitis
• severe migraine headache. 

Benign paroxysmal positional vertigo

• Benign paroxysmal positional vertigo is usually caused by sudden changes in the position of your head, such as when you tip your head up or down, when you lie down or when you turn over or sit up in bed.
• Vertigo tends to last for a minute or less and settles if you keep your head still. 
• This type of vertigo is usually caused by small calcium deposits in your inner ear, which move as you do.
• It can increase your risk of falls.
• It is not serious.

Vestibular neuronitis

• Vestibular neuronitis is the inflammation of the vestibular nerve, part of what is called the eighth cranial nerve.
• This nerve carries messages from your inner ear about head movement.
• When the nerve is inflamed or infected, the sensation of dizziness or vertigo arises.
• It's usually caused by a viral infection.
• The vertigo may last from hours to days, usually improves within a week but but may last for several weeks. 
• Your hearing is not affected.

Meniere’s disease

• Meniere’s disease is a disorder of the inner ear where you get the feeling of vertigo and hearing loss, and possibly a feeling of pressure in your ears.
• It usually affects younger adults aged 20–50 years.
• The vertigo usually lasts from 1–24 hours, but may last for days.
• Tinnitus (ringing in your ears) is not uncommon.

Read more about Meniere’s disease.

Labyrinthitis

• Labyrinthitis usually affects adults between the ages of 30 and 60.
• It is inflammation of a part of your inner ear called the labyrinth, an organ including the cochlea and part of your balance mechanism.
• As well as vertigo, your hearing is impaired.
• It is usually caused by a common viral infection, such as measles or the flu, but can sometimes be caused by a bacterial infection.
• You may have fever (high temperature), nausea (feeling sick), vomiting (being sick) and tinnitus (ringing in your ears).

Tumour

A tumour in your inner ear can also cause vertigo, but this is rare.

Other causes (central causes)

Vertigo can be due to problems outside your inner ear, including:

• migraine – some people get the feeling of dizziness and the sensation of motion or spinning during or just before a migraine headache
• stroke or transient ischaemic attack (TIA), where symptoms are brief but repetitive 
• multiple sclerosis
• some medicines such as antibiotics, phenytoin, carbamazepine or diuretics (water tablets)
• anxiety
• following a head injury
• alcohol.

Sometimes, the cause of vertigo is unknown.

How is vertigo diagnosed?

Your doctor will ask you about the symptoms of your vertigo and any other symptoms you may have, such as nausea or vomiting, hearing loss or ear fullness. As dizziness means different things to different people, your doctor may ask you to describe your symptoms to find out whether you have vertigo or lightheadedness.

Your doctor will also examine your ears and eyes, check your balance and your nerves. You may be referred to a ENT (ear, nose and throat) specialist for further tests if the cause is not clear.

These may include a hearing test and caloric testing, in which warm or cool water is introduced into your ear canal to see how your inner ear responds. A posture machine is sometimes used to note how your balance system is receiving messages from your eyes and joints.

How is vertigo treated?

The treatment for vertigo depends on the cause and severity of your symptoms.

Some medicines may be prescribed to relieve your symptoms, including:

• prochlorperazine
• promethazine
• hyoscine hydrobromide (scopolamine)
• betahistine – this is normally used to treat Meniere’s disease.

Depending on the cause of your vertigo, your doctor may also recommend some special exercises that involve specific movements:

• The Epley manoeuvre involves head movements designed to move fragments of calcium into areas less likely to cause your symptoms.
• Brandt-Daroff exercise involves movement of your upper body.  
• Vestibular rehabilitation involves retraining your balance system not to respond to some messages your brain is receiving.

Very rarely, surgery may be needed to correct the cause of your vertigo.

How can I care for myself with vertigo?

Here are some things you can do at home to help prevent vertigo:

• Lie still in a quiet, darkened room – this may help to ease nausea and reduce the sensation of spinning.
• Avoid stressful situations – anxiety can make vertigo worse. Read more about how to deal with stress and anxiety.
• Avoid head movements or head positions that can trigger symptoms.
• Avoid sleeping on the affected side, if one side of your ear or head is more affected than the other.
• Raise your head on 2 pillows when resting.
• Get out of bed slowly and sit on the edge of the bed for a minute before standing up.
• Make sure your glasses are current, so you can avoid anything in your way.

How can I prevent accidents and falls with vertigo?

Because vertigo can affect your balance and may make you feel unsteady, you are at risk of falls or accidents.

To reduce your risk of a fall or accident:

• get out of a bed or chair slowly
• wear low-heeled shoes that fit properly
• use handrails on stairs
• install grab bars in the bathroom – don't use towel racks for balance
• use a shower stool and apply adhesive strips to the shower or tub floor
• use a walking aid if needed
• let your employer know about your symptoms, especially if your job involves operating machinery or climbing ladders.

Vertigo and driving

If you have vertigo, it can be extremely dangerous to drive. It is important to let your doctor know so they can find out the cause of your vertigo and treat it accordingly.

It is also a legal requirement for you to drive only when you are medically fit, which means not to drive if you are dizzy or experiencing vertigo. You need to stop driving until your condition has been treated and you have no more attacks of vertigo.  

Learn more

The following links provide further information on vertigo. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Vertigo Ministry of Health NZ
Vertigo HealthInfo Canterbury, NZ
Vertigo Health Direct, Australia
Dizziness and vertigo Better Health Channel, Australia
Vertigo NHS, UK
Vertigo Patient Info, UK
Brandt-Daroff exercises NHS, UK

References

1. Vertigo Auckland Regional HealthPathways, NZ, 2019
2. A delicate balance: managing vertigo in general practice BPAC, NZ, 2012
3. An approach to vertigo in general practice Australian Family Physician, 2016

Reviewed by

	After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.