What is vertigo?
Vertigo is dizziness with a spinning sensation. If you have vertigo you feel as if the world is spinning around you and you feel very unsteady. Often you will also feel sick or be sick (vomit). Vertigo tends to be eased by lying down flat, and made worse by sitting up or moving. See also the separate leaflet called Vertigo and How to Treat It.
Vertigo is often a problem of the inner ear, so it is helpful to understand what the inner ear is made up of. The inner ear includes the cochlea, vestibule and semicircular canals in which there is a system of narrow fluid-filled channels called the labyrinth. The cochlea is concerned with hearing. The three semicircular canals help to control balance and posture. Head movements are sensed because when you move your head, the fluid in the labyrinth within the semicircular canals moves too. The movement of the fluid moves tiny fine hairs that are on the inside lining of the labyrinth. When the hairs move, this triggers messages to be sent to the brain via a nerve called the vestibular nerve. This gives the brain information about the movement and position of your head, even when your eyes are closed.
What are the possible causes of vertigo?
Vertigo is most commonly caused by a problem in one of the inner ears when the labyrinth or vestibular nerve is inflamed, damaged, or not working properly. If the labyrinth or vestibular nerve sends the brain too many, too few, or wrong messages, and conflicts with other messages from the other ear, eyes, or body, the brain gets confused, resulting in vertigo.
There are various inner ear problems that can cause vertigo. These include the following:
Many people get vertigo for a short time if they spin around fast - for example, on some playground or fairground rides. Basically, the brain gets bombarded with nerve messages from the semicircular canals in the inner ears, due to the constantly changing position of the head. The brain can't cope with the constantly changing nerve messages. Symptoms usually settle soon after the spinning stops but, in some people, the symptoms can take several hours or longer to subside.
This is inflammation of the labyrinth in the inner ear. There are various causes. The most common is due to a viral infection (viral labyrinthitis). Typically, with viral labyrinthitis you develop vertigo, and often feel sick or vomit. You may have some mild hearing loss on the affected side too. You may also have other symptoms of a viral infection such as a sore throat, flu symptoms, or a cold. The vertigo can be intense and you often need to stay in bed until the condition eases. Symptoms of viral labyrinthitis can last anything from a few days to several weeks, and then usually clear completely. If symptoms last longer, or other symptoms develop in addition, then there may be a more serious cause of the labyrinthitis. See separate leaflet called Vestibular Neuritis and Labyrinthitis for more details.
This is similar to labyrinthitis but the inflammation is in the vestibular nerve coming from the inner ear rather than in the inner ear itself. Often it is impossible to tell the difference between vestibular neuritis and labyrinthitis. However, as with labyrinthitis, the common cause is thought to be a viral infection. Symptoms from this cause usually clear completely as the infection clears. See separate leaflet called Vestibular Neuritis and Labyrinthitis for more details.
Benign paroxysmal positional vertigo (BPPV)
If you have BPPV you develop sudden episodes of vertigo that last just a few seconds or minutes. Each episode typically occurs when you move your head in a certain way. A common example is when you turn over in bed, or when you get up from bed in the morning. The vertigo is caused by a tiny fragment of solid material that has come loose inside the labyrinth. This moves within the fluid inside the labyrinth when you move your head in a certain way. It may stimulate the sensitive hairs inside the semicircular canal part of the labyrinth. This sends wrong messages to the brain about the position of your head, resulting in vertigo. See separate leaflet called Benign Paroxysmal Positional Vertigo for more details.
This condition typically causes episodes of vertigo, hearing loss, and buzzing or ringing in your ear (tinnitus). The episodes can vary in severity and in how often they occur. Each episode can last from 20 minutes to several hours. Permanent hearing loss and tinnitus may eventually develop. It is thought that Ménière's disease is due to a build-up of fluid in the labyrinth from time to time. The build-up of fluid may increase the pressure within the labyrinth and cause swelling of the labyrinth, which leads to the symptoms. See separate leaflet called Ménière's disease for details.
Sometimes vertigo is due to a problem within the brain itself. This is sometimes called "central vertigo" (in contrast to "peripheral vertigo" due to one of the ear problems listed above). Examples of conditions that can cause central vertigo include the following:
Episodes of vertigo develop in some people who have migraine. These sometimes occur as part of the 'aura' that some people with migraine have before a headache develops. However, vertigo can also occur separately to headaches in some people who get migraines. The cause of migraine is thought to be due to changes in blood vessels in the brain and a similar mechanism may be the reason why vertigo develops. Each episode of vertigo due to migraine can last from several hours to several days. See separate leaflet called Migraine for more details.
An acoustic neuroma is a non-cancerous (benign) tumour that grows on the acoustic nerve. This nerve forms when the cochlear and vestibular nerve join up between the ear and the brain. It is a rare disorder but initial symptoms can include vertigo, hearing loss, and tinnitus. These are similar symptoms to Ménière's disease. However, unlike Ménière's disease which comes in episodes of symptoms, acoustic neuroma symptoms tend to be constant and get worse and worse. See separate leaflet called Acoustic Neuroma for more details.
Various conditions of the brain, blood vessels of the brain, and nerves can cause vertigo. For example, some people who have a stroke or multiple sclerosis develop vertigo. However, this will usually be in addition to other symptoms.
Further reading and references
Vertigo; NICE CKS, April 2010 (UK access only)
Huh YE, Kim JS; Bedside evaluation of dizzy patients. J Clin Neurol. 2013 Oct9(4):203-13. doi: 10.3988/jcn.2013.9.4.203. Epub 2013 Oct 31.
Kaski D, Bronstein AM; Making a diagnosis in patients who present with vertigo. BMJ. 2012 Sep 3345:e5809. doi: 10.1136/bmj.e5809.
Post RE, Dickerson LM; Dizziness: a diagnostic approach. Am Fam Physician. 2010 Aug 1582(4):361-8, 369.
Kerber KA, Baloh RW; The evaluation of a patient with dizziness. Neurol Clin Pract. 2011 Dec1(1):24-33.
I have been diagnosed with vestibular migraine. I’m now on my 2nd day of amiltriptaline. I have had the rocking sensation now for 12 months. I’m at my wits end. Will this med work??? I need this...Rboro1
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