What Is vertigo?
Vertigo is the sensation that either you or the environment around you is spinning uncontrollably. The feeling might come on abruptly and last anywhere from several seconds to a few minutes, possibly triggering nausea and vomiting.
There are two types of vertigo: peripheral vertigo and central vertigo. Peripheral vertigo is caused by a problem with the inner ear, a small organ that communicates with the brain to control balance, and can be caused by certain medications and head injuries. Central vertigo is often caused by a problem in the region of the brain called the cerebellum (which also controls balance) or the brain stem, which transmits messages between the cerebellum and the spinal cord; this can be triggered by a stroke, migraine, and other causes.
Signs and symptoms of vertigo
The main symptom of vertigo is the feeling of spinning—it feels as if either you or the room is moving, but you’re standing still. For some people, vertigo can feel like “the childhood game of spinning round and round, then suddenly stopping,” according to the Merck Manual; other people may “simply feel pulled to one side.”
People sometimes experience vertigo when they roll over in bed or lift up their head. During an episode, people can experience nausea and vomiting, have trouble keeping their balance, and may also develop a vision condition called nystagmus, in which the eyes move uncontrollably, throwing off depth perception.
If you’re experiencing vertigo, try staying completely still—this may help relieve the symptoms. Moving your head, changing your position, or standing up can all make the dizziness worse. If you’re experiencing vertigo for the first time, experts recommend calling a doctor or 911; if you need to go to the hospital, you may need help walking and should also avoid driving.
Other symptoms of peripheral and central vertigo can include:
- Hearing loss
- Tinnitus (ringing in the ears)
- Loss of balance
- Facial paralysis
- Limb weakness
- Double vision
- Slurred speech
- Trouble swallowing
What causes vertigo?
Peripheral vertigo stems from a problem in the inner ear, the part of the body that controls balance. There are multiple types of peripheral vertigo, including:
- Benign positional vertigo or benign paroxysmal positional vertigo (BPPV): the most common type of vertigo. Fluid-filled tubes in the inner ear help you keep your balance. When small, calcium-containing deposits break off and float inside the tubes, they throw off your balance. About one in 50 people will develop BPPV, including those who’ve sustained head injuries or had labyrinthitis, an inner ear infection. If you have a family history of BPPV, you may also be more at risk.
- Ménière’s disease: an inner ear disorder that triggers problems with balance and hearing. People with Ménière’s disease can experience episodes of severe vertigo that can last for minutes to hours. Experts aren’t sure what, exactly, causes Ménière’s disease, but it may be related to fluid buildup and subsequent pressure in the inner ear. There is no cure for Ménière’s disease. It is possible, however, to treat the symptoms with anti-nausea medications, lifestyle changes, and in some cases, ear surgery.
- Labyrinthitis: an irritation or swelling in the inner ear that is caused by a virus or bacterial infection, throwing off your balance and triggering vertigo and hearing loss. Labyrinthitis should go away within a few weeks; taking antihistamines and anti-nausea medications can help in the meantime.
People who get migraines may develop migraine-associated vertigo, although the symptoms often subside after the headaches are treated.
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How is vertigo diagnosed?
It can be difficult for doctors to pinpoint what, exactly, is causing a person’s vertigo. For starters, some people might not realize that they’re experiencing vertigo at all—or, they may confuse it with feeling lightheaded or faint. In fact, even though dizziness accounts for approximately 5% of all primary care visits, about 20% of people will never identify the cause of their dizziness, according to a 2010 report in the journal of American Family Medicine.
Your doctor will likely start by taking your medical history and a list of your current medications. (This is important, because vertigo can be a side effect of some medications.) During the exam, the doctor may ask you specific questions about your symptoms to try to narrow down whether you have vertigo or another type of dizziness. Common tests include blood tests, an electroencephalogram (EEG), which measures electrical activity in the brain, or a magnetic resonance imaging (MRI) test or computerized tomography (CT) scan, both of which can spot tumors or other abnormalities in the brain or around the inner ear that might be triggering your symptoms.
To combat the spinning sensation, try lying down and remaining as still as possible. It also helps to turn off any bright lights, including the TV, and avoid stimulating activities like reading. As a general rule, you should consider calling 911 or going to the emergency room if you have vertigo (or dizziness) and symptoms like weakness, fainting, and continuous vomiting.
When possible, doctors will also try to treat the underlying cause of your vertigo. For example, people with central vertigo will be treated for the disease that’s triggering the symptom, like stroke or blood vessel disease. Likewise, people who experience migraine-associated vertigo often see an improvement in their symptoms after treating their headaches with medications like benzodiazepines or selective serotonin reuptake inhibitors (SSRIs) or cutting out alcohol and dietary triggers.
For those with BPPV, a doctor can often relieve vertigo by performing a movement called the Epley maneuver, which involves rotating the head to move the deposits in the inner ear tubes to a different part of the ear. Those who develop labyrinthitis—which can be triggered by a cold, flu, or ear infection, and last for a few weeks—can treat vertigo with antihistamines and medications that relieve nausea and vomiting. People with Ménière’s disease may also be prescribed a diuretic or advised to start a low-sodium diet; cutting back on salt can lower the fluid buildup in the inner ear, reducing your chances of experiencing an episode of vertigo.
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To help combat vertigo and its symptoms, your doctor might prescribe one of the following medications:
1. Meclizine: Taken in chewable or capsule form, meclizine is an antihistamine that’s used to prevent and quell nausea, vomiting, and dizziness. Some side effects include dry mouth, drowsiness, or fatigue.
2. Benzodiazepines (including diazepam and lorazepam): Commonly used to help relieve anxiety, benzodiazepines can also quell vertigo that’s caused by a problem in the inner ear. These drugs carry both short- and long-term risks, however; common side effects include lethargy and fatigue, and over time, can cause dependence and withdrawal.
3. Dimenhydrinate: Used to treat Ménière’s disease, dimenhydrinate is an antihistamine that helps prevent and relieve nausea, vomiting, and dizziness by heading off balance problems. The medicine is available in tablet or chewable form, and can cause side effects like drowsiness and headaches.
A type of treatment called the Epley maneuver can help relieve the symptoms of vertigo for people with BPPV. A doctor will perform the movement, which involves changing the position of your head and tilting it back. The goal is to move the small, calcium deposits out of the canals in your inner ear. Although the short-term effects can include nausea and dizziness (and it may not be safe for people with neck problems), a 2014 Cochrane review found that the Epley maneuver was both safe and effective.
Are vertigo home remedies effective?
In general, vertigo is treated with medication. (The Epley maneuver is another doctor-administered treatment.) At home, practicing relaxation techniques like yoga or meditation can help counter the stress of experiencing episodes of vertigo.
How long does vertigo last?
Vertigo lasts anywhere from a few minutes to a few days, but because it may also be a sign of a more serious health condition like migraines or a side-effect of a medication, you may want to talk to your doctor about the episode.
Vertigo can also be dangerous on its own: If it triggers a fall, you could sustain a serious injury, like a hip fracture. That’s one reason why you may want to wait at least a week after a severe spell before doing any potentially dangerous activities—you don’t want to risk a return of your symptoms during, for example, a hike or long drive.