Vertigo

Overview

Definition

Vertigo is a feeling of spinning when a person is standing still. It can be caused by many different health problems.

Causes

The inner ear and nerves sense the position of a person's head and body. Vertigo can happen when there are problems with these nerves and structures. It may also be due to problems in the brain, but this is not as common.

The two main types of vertigo are:

Peripheral Vertigo

Peripheral vertigo is common and caused by problems with the inner ear. Causes may be:

  • Benign paroxysmal positional vertigo (BPPV)
  • Meniere disease
  • Perilymphatic fistula—an abnormal canal or connection in the inner ear
  • Ototoxic medicines that disrupt the inner ear's ability to balance
  • Infection
  • Acoustic neuroma —a benign tumor of the nerve that helps with hearing and balance
  • Poor blood flow
  • Injury
  • Otosclerosis —a bony growth near the middle ear

Central Vertigo

Central vertigo is less common but more serious. It happens due to changes in the brainstem or the cerebellum. These parts of the brain control balance. Changes can be caused by:

  • Damage to the brain from diseases such as multiple sclerosis , stroke, or from tumors
  • Migraine headaches
  • Nervous system problems, such as Parkinson disease or multiple sclerosis
  • Epilepsy
  • Too much exposure to alcohol, heavy industrial metals, or poisons
  • Injury

Risk Factors

The conditions above will raise a person's risk of vertigo.

SymptomsandDiagnosis

Symptoms

Problems may be:

  • Sensation of rotation
  • Illusion of movement
  • Feeling of being pulled in one direction
  • Feeling of being off-balance

Vertigo is not the same as feeling lightheaded. A person who is lightheaded does not have a feeling of movement.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. Tests to look for a cause may include:

  • Blood tests
  • Hearing and vision tests
  • Head maneuvers—the doctor will move a person's head to help to ease symptoms
  • Blood pressure test, both lying down and standing up
  • Electronystagmogram (ENG)—to check for nystagmus , an abnormal eye movement
  • MRI scan
  • Rotatory chair test
  • Brainstem auditory evoked potential studies (BAEPS or BAERs)—to check the function of the brain auditory nerve and brain stem

Treatments

Treatment

Some lifestyle changes can help manage vertigo, such as using a cane to help with balance. Treating the cause may also stop the vertigo.

Some medicines that cause vertigo may need to be stopped or changed. Medicines that may ease or stop symptoms are:

  • Antihistamines
  • Benzodiazepines
  • Anticholinergics
  • Antiemetics

Prevention

There are no current guidelines to prevent vertigo.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Dizziness)

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org 

Vestibular Disorders Association http://www.vestibular.org 

CANADIAN RESOURCES

BC Balance and Dizziness Disorders Society http://www.balanceanddizziness.org 

Canadian Academy of Audiology http://www.canadianaudiology.ca 

References

Dizziness and vertigo. The Merck Manual Professional Edition. Available at: https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo?query=vertigo. Updated March 2019. Accessed April 8, 2020.

Dizziness—differential diagnosis. EBSCO DynaMed website. Available at:  https://www.dynamed.com/approach-to/dizziness-in-adults-approach-to-the-patient  . Accessed April 8, 2020.

Living with a vestibular disorder. Vestibular Disorders Association website. Available at: https://vestibular.org/living-vestibular-disorder/everyday-challenges. Accessed April 8, 2020.

Muncie HL, Sirmans SM, et al. Dizziness: Approach to Evaluation and Management. Am Fam Physician. 2017 Feb 1;95(3):154-162.