Vertigo

Vertigo is a symptom, rather than a condition itself. It is the feeling that you or your surroundings are moving or spinning.

What is vertigo?

Vertigo is a feeling of dizziness. It is the sensation that you or your surroundings are moving when there is no actual movement. Some people describe it as the room spinning around, or a feeling of falling or tilting. You may be unsteady, it may be hard to walk or stand, and you may lose your balance.

Different people experience different intensities of vertigo: 

  • Mild vertigo – this occurs now and again for a short time and goes away on its own. You may feel a bit sick (nauseous).
  • Moderate vertigo – this requires that you lie down and lie still (no head motion) to stop the feeling of movement. You may feel sick (nauseous) and you may throw up (vomit). 
  • Severe vertigo – this occurs when the feeling of movement is ongoing even when lying down. Nausea and vomiting are quite severe. 

Vertigo could be a sign of a more serious medical condition such as stroke, circulation problems, or infections. It is important to seek medical help if you experience any of the following:

  • vertigo together with headache
  • changes in eye movement, such as quick eye movements.  
  • vertigo together with changes in muscle movement — loss of muscle control and tone.
  • your hearing becomes increasingly worse.  
  • you have difficulty speaking (speech difficulty), or difficulty swallowing.

What causes vertigo?

The following are the most common causes of vertigo. For some people, the cause of vertigo is unknown. 

Benign paroxysmal positional vertigo
  • This 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. It can increase your risk of falls.
  • Vertigo tends to last for a minute or less and settles if the head is kept still. 
  • This type of vertigo is usually caused by small calcium deposits in your inner ear.
Vestibular neuronitis
  • Vestibular neuronitis is the inflammation of the vestibular nerve. This nerve carries messages from the 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.
  • Vertigo lasts from hours to days but usually improves within a week. 
Meniere's disease
  • This is a disorder of the inner ear where you get the feeling of vertigo, ringing in the ear and hearing loss. 
  • Vertigo lasts from 1 to 24 hours.
Migraine
  • Some people get the feeling of dizziness and the sensation of motion or spinning, during or just before a migraine headache. Read more about migraine.
Other causes
  • anxiety disorder 
  • ongoing infection of the middle ear (chronic otitis media)
  • following a head injury
  • some medications such as some antibiotics, phenytoin, carbamazepine, water tablets (diuretics)
  • alcohol.

How is vertigo diagnosed?

To diagnose vertigo, your doctor will ask you to describe your symptoms and will carry out tests. Your doctor may ask you:

  • to describe your symptoms such as whether you felt lightheaded or if your surroundings were spinning
  • if you also experience other symptoms such as hearing loss, ringing in the ears, nausea (feeling sick), vomiting (throwing up) or fullness in the ear
  • how often your symptoms occur and how long they last for
  • if your symptoms are affecting your daily activities such as whether you're unable to walk during an episode of vertigo
  • whether anything starts your symptoms (called triggers) or makes them worse, such as moving your head in a particular direction what makes your symptoms better.

Your doctor will also examine your ears, examine your eyes, and check your balance. Because vertigo could be a symptom of another medical condition, your doctor may also conduct a variety of different tests.

How is vertigo treated?

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

  • During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea and reduce the sensation of spinning. 
  • You should also try to avoid stressful situations, as anxiety can make the symptoms of vertigo worse. Read more about how to deal with stress and anxiety.
  • If you have vertigo and vomiting, your doctor may prescribe motion sickness medication such as prochlorperazine or hyoscine hydrobromide (scopolamine).
  • For vertigo caused by Meniere's disease, your doctor may prescribe betahistine.   
  • Depending on the cause of your vertigo, your doctor may also recommend some special exercises that involve specific movements:
    • The Epley manoeuvre – this involves head movements.
    • Brandt-Daroff exercises – this involves movement of the upper body.  

Read more about treatment for vertigo, including detailed information about how to do the exercise movements.

Self care

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

  • Avoid head movements or head positions that can trigger an attack.
  • If you find that one side of your ear or head is more affected than the other, avoid sleeping on the affected side.
  • Raise your head on two pillows when resting.
  • When getting out of bed, do so slowly and sit on the edge of the bed for a minute, before standing up.

Safety

Because vertigo can affect your balance and may make you feel unsteady, you are at risk of falls. If you find that your vertigo tends to happen again, it is important to protect yourself from falls and other dangers. Here are some useful tips to reduce your risk of falling:

  • 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. Also, apply adhesive strips to the shower or tub floor.
  • Use a walking aid if needed.
  • If you become dizzy or disoriented while driving, you could hurt yourself and others. It is best to avoid driving until symptoms subside. 
  • At work, let your employer know about your symptoms, especially if your job involves operating machinery or climbing ladders.

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 NHS Choices, UK

Credits: Editorial team.