Vertigo

What is vertigo?

A person experiencing vertigo has the false feeling that they are moving, or that objects around them are moving, usually spinning, when they are not. It is different from dizziness, which is the sensation of feeling giddy or lightheaded.

Vertigo symptoms

Vertigo can last just for a short period of time (seconds to minutes) or can last for hours or even days. It can be accompanied by a feeling of ear fullness, tinnitus (ringing in the ear), sickness (nausea) and balance problems, which can interfere with daily activities. Vertigo can also cause a person to be sick (vomit).

Vertigo is a symptom and not a diagnosis in itself. In most cases there is a medical condition that causes vertigo such as a head injury or an inner ear problem. However, sometimes the cause is unknown.

Note: vertigo is sometimes referred to as a 'fear of heights' - this is not correct. The right term for the fear of heights is acrophobia.

Who does vertigo affect?

Vertigo can affect people of any age (including children), and of either sex.

What causes vertigo?

When we move our head, the inner part of the ear is a balance organ and tells us where our head is. If there are problems with the inner part of the ear then this can cause us to feel sick (nausea) and experience vertigo.

Inner ear causes

The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV). This is more common in older people. It usually causes short, intense episodes of vertigo with head movements or when the position of the head is changed (for example, when rolling over from one side to the other in bed). It is caused by the movement of tiny crystals in the inner ear balance organ.

Infection or inflammation affecting the inner ear can also cause vertigo, for example vestibular neuritis and labyrinthitis.

Other conditions that can affect the inner ear and causes episodes vertigo include:

• Ménière's disease (although this is rare compared to BPPV, vestibular neuritis and labyrinthitis).

• Ear infections or ear surgery - that damage the inner ear.

Other causes

Vertigo may be also caused by conditions affecting certain parts of the brain - for example:

• A stroke.

• Migraine, specifically vestibular migraine.

• Multiple sclerosis.

• Head injury.

• A growth in the brain (acoustic neuroma).

• Double vision (diplopia).

• Drinking too much alcohol.

See the separate feature Can stress cause vertigo?

How to tell which ear is causing vertigo

An examination by a doctor can sometimes tell which side the vertigo is coming from (particularly in cases of BPPV), but this cannot be worked out from symptoms alone.

Vertigo treatment

The treatment for vertigo depends on what has caused it - the treatment may be a specific set of movements used to treat BPPV, it may be tablets or it may be special exercises to do. The rest of this leaflet only discusses medicines that may help to ease the symptoms of dizziness and nausea caused by vertigo.

There are separate leaflets for different types of vertigo called Benign paroxysmal positional vertigo (BPPV), Ménière's disease, Vestibular neuritis and labyrinthitis, Dizziness and Migraine.

Medication for vertigo

A number of medicines can be prescribed to help with the symptoms of vertigo. They include prochlorperazine or antihistamines such as cinnarizine, cyclizine or promethazine.

These medicines are the same ones that are used to help treat any feeling of sickness (nausea) and motion sickness. They work by blocking certain chemicals in the brain. Prochlorperazine blocks a chemical called dopamine; this helps with severe sickness.

Antihistamines block histamine, which helps with mild sickness and being sick (vomiting) as well as vertigo. Betahistine is an antihistamine that may be prescribed specifically for patients with Ménière's disease, to prevent attacks from occurring. It is thought that this medicine improves the blood flow around the ear.

These medicines come in various brand names and are available as tablets, capsules, liquids and injections. Some are available as tablets that dissolve between the upper gum and lip (sublingual tablets).

How well do vertigo medicines work?

There are no good studies that tell us how well these medicines work. However, they have been prescribed to ease the symptoms of vertigo for many years. It is important to note that these medications are not used to cure vertigo, they only reduce the severity and length of time the vertigo lasts for.

What medicine is prescribed for vertigo?

The choice of medicine depends on what is causing your vertigo and how severe your symptoms are. If you have a severe feeling of sickness (nausea), your doctor may prescribe prochlorperazine. The advantage of this medicine is that it is available as an injection or as a tablet to dissolve between the upper gum and lip (a sublingual tablet). It may be more suitable for people who are very sick and being sick (vomiting).

If you have mild nausea, your doctor may prescribe an antihistamine such as cinnarizine, cyclizine or promethazine. These will also help to treat dizziness.

What is the usual length of vertigo treatment?

Medicines to treat vertigo and sickness are usually only taken for a very short time - normally around 3 to 4 days. If you have vertigo frequently and long term, your doctor may prescribe a short supply of these medicines to keep at home, to use when you have another attack.

Side-effects of vertigo treatment

It is not possible to list all the possible side-effects of each of these medicines in this leaflet. However, as with all medicines, there are a number of side-effects that have been reported. If you want more information specific to your medicine, see the information leaflet that came with your medicine.

Most side-effects of vertigo treatment are not serious and each person may react differently to these medicines. Common side-effects include:

• Drowsiness.

• Constipation.

• Headaches.

• Tiredness.

• Trouble with sleeping (insomnia).

• Indigestion.

Prochlorperazine can cause muscle twitching of the shoulders, face and neck. This usually goes away once this medicine is stopped.

Who cannot take medication for vertigo?

There are very few people who cannot take a medicine for vertigo. If for some reason one medicine has caused a side-effect or there is a reason you cannot take one, your doctor can choose a different type of medicine that will suit you.

Can vertigo medication be bought over the counter?

You can buy cinnarizine from your pharmacy but the pharmacist can only sell it to people who have motion sickness.

How long does vertigo last?

The length of a single vertigo attack, and the amount of time that passes before it completely resolves, depends on the underlying cause and what treatment can be provided. If the cause is unclear, you may be referred to another doctor (usually an ear specialist) for further assessment.