If you've experienced dizziness for no obvious reason, you are probably famililar with vertigo.
Most adults don’t enjoy the feeling when it strikes out of the blue, especially when the dizziness is accompanied by nausea or vomiting.
The good news is that most types of vertigo are treatable, and some types will go away on their own without any treatment at all.
The not-so-great news is that there are many different types of vertigo, and you may need extensive testing to determine which type you have and what the best treatment method will be.
If you're experiencing vertigo right now and need to speak with a doctor about your symptoms, you can speak with one online right now.
Here’s a basic rundown on what you need to know about the various types and treatments of vertigo.
What is Vertigo?
Vertigo is not a condition. It’s a symptom of a condition. It’s the feeling of being off balance, like you or the world around you is spinning, even when you are standing completely still.
Vertigo may be so mild that it’s barely noticeable, or it may be so severe that it affects your balance and even makes you vomit.
Moving your head during situations like the process of lying down or standing up can make the symptoms of vertigo worse.
Many types of vertigo are due to problems with the inner ear, since the inner ear is largely responsible for balance and knowing where the head is in relationship to gravity.
The inner ear is a complex place that is full of canals, cartilage and small bones.
Surfers and swimmers who rupture their eardrum often experience vertigo symptoms, since the inner ear is exposed to the elements once the eardrum is compromised
Many different conditions can cause vertigo, and each condition may need different treatment.
Vertigo symptoms may range from mild to severe, may last anywhere from a few minutes to several days or more, and may include:
- Loss of balance, possibly so severe that it’s difficult to stand or walk
- Nausea or vomiting
- Ringing in the ears or hearing loss
- Unusual or jerking eye movements (called nystagmus)
- Sensations of spinning, tilting, swaying, being unbalanced or being pulled in one direction
What Causes Vertigo?
Vertigo is typically caused by a problem with the inner ear. There are a variety of different things that can affect the inner ear, and some problems are easier to treat than others.
The inner ear tells your brain where your head and body are moving in relation to gravity. Your inner ear is the main system in your body responsible for balance, which is why inner ear problems can have such a great effect on a person’s balance.
The most common causes of vertigo are divided into two different types: peripheral vertigo and central vertigo.
Peripheral vertigo refers to causes of vertigo that are related to the inner ear. Some of the causes of peripheral vertigo include:
- Benign Paroxysmal Positional Vertigo (BPPV) happens when tiny particles of calcium (canaliths) clump up in the inner ear canals. When your head is still, the particles will lie still in the bottom of your ear canal, but head movements can cause the particles to float in the fluid of your inner ear, confusing it. BPPV is one of the most common causes of vertigo and is commonly triggered by specific head movements or position changes such as standing up, lying down, bending over, or walking. Each vertigo attack may last anywhere from several seconds to several minutes or longer. It’s often accompanied by nausea (vomiting is rare, though) and uncontrollable jerky eye movements (called nystagmus).
- Head injuries can cause vertigo and may be a sign that something is seriously wrong. If you experience dizziness after a head injury, you need to get immediate medical attention.
- Labyrinthitis is an inflammation of the labyrinth, which is a structure inside your inner ear. If the word “labyrinth” brings to mind a maze, you’re correct – the labyrinth is a maze of fluid-filled channels in your inner ear that helps control balance and hearing. When the labyrinth in one ear is inflamed, it sends different signals to your brain than the normal labyrinth in your healthy ear and conflicts with information coming from your eyes. This confuses your brain, causing dizziness and vertigo.
- Viral infections such as the common cold are the typical cause of labyrinthitis, although it can also be caused by bacteria. Labyrinthitis may also cause nausea, vomiting, hearing loss, ringing in the ears (tinnitus), or a high temperature and ear pain.
- Vestibular neuronitis, also known as vestibular neuritis, is an inflammation of the nerve running from the labyrinth to the brain. The labyrinth itself may also be inflamed. It’s typically caused by a viral infection and comes on suddenly. It can cause other symptoms like unsteadiness, nausea, and vomiting. It does not usually cause any hearing loss. While vestibular neuronitis typically clears up within a few hours to a few days, it may take as long as three to six weeks to settle down completely.
- Ménière's disease is a rare condition that affects the inner ear. Not only can it be responsible for severe cases of vertigo, but it can also cause hearing loss, ringing in the ears, and a feeling of pressure inside the ear. It can cause sudden severe attacks of vertigo that are accompanied by nausea and vomiting and may last anywhere from a few hours to a few days. Scientists aren’t sure what causes Ménière's disease, but it can be controlled with medication and diet changes. Occasionally, surgery may be required.
- Some medications can cause vertigo as a side effect. The patient information booklet that came with your prescription will tell you if vertigo is a known side effect. If you believe your medication is causing vertigo, talk to your doctor. There may be an alternative medicine they can prescribe that won’t cause vertigo. Never stop taking any medication before talking to your doctor first.
Central vertigo is vertigo caused by areas of the brain such as the brain stem or the cerebellum is called central vertigo. Causes of central vertigo include:
- Migraines, which are severe headaches that are typically felt as a throbbing in the front or on one side of the head. Young people are especially prone to migraines.
- Multiple Sclerosis is a condition that affects the brain and spinal cord.
- Acoustic neuroma is a rare, non-cancerous brain tumor that grows on the nerve that helps to control hearing and balance (the acoustic nerve).
- A brain tumor in the bottom of the brain (the cerebellum) can cause vertigo.
- Transient ischemic attacks (TIA) or strokes, where part of the blood supply to the brain is cut off, can lead to symptoms of vertigo.
- Certain types of medication can have central vertigo as a side effect. Talk to your doctor about switching medications. Never stop taking a prescription without talking to your doctor first.
How Does Your Doctor Diagnose the Problem Causing Vertigo?
Your doctor may have a pretty good idea of what’s causing your vertigo based on your symptoms and history, but sometimes more extensive testing is required. Your doctor will first want to rule out life-threatening problems such as a stroke.
During your initial appointment, you should be prepared to answer questions about:
- The first time you experienced vertigo. Did you feel lightheaded?
- Was the room spinning?
- Did you experience other symptoms such as nausea, vomiting, ringing in the ears, hearing loss, or a sense of fullness in the ear?
- How frequently your symptoms occur and how long they last.
- Whether or how much your symptoms impact your daily living. For example, do you have a hard time walking while experiencing vertigo?
- What triggers your symptoms or makes them worse, like turning your head in a specific direction.
- What makes your symptoms improve?
Your doctor may also do a physical exam to check for or rule out conditions that can cause vertigo. They may look inside your ears, check your eyes for signs of uncontrolled movement, check your balance, or try to recreate your symptoms by having you sit up or lay down quickly.
Your doctor may perform additional testing or refer you to a specialist for additional testing. These tests may include:
- Hearing tests done by an ear, nose, and throat specialist (ENT) may be suggested if you are experiencing ringing in the ears (tinnitus) or hearing loss. The ENT may use a tuning fork or a machine that produces beeps at certain pitches to check for any hearing loss.
- Videonystagmography (VNG) helps look for signs of uncontrolled eye movements (nystagmus) in more detail. Nystagmus may indicate a problem with any of the systems that help you balance. You will be asked to wear special goggles and look at still or moving images. Video cameras inside the goggles record your eye movements and check for abnormalities.
- Caloric testing involves running warm or cool air or water into the ear for about 30 seconds. The sudden change in temperature stimulates the balance organ in your ear to see how well it’s working. While the test isn’t painful, it can cause dizziness that may take a while to wear off once the test is complete.
- Posturography uses a machine to test your balance. It gives useful information about how you are using your vision, proprioception (sensations from your feet and joints), and the input from your ear to maintain balance. This machine may also be used to track progress during rehabilitation.
- Scans can help check for structural problems in your brain such as tumors. A magnetic resonance imaging (MRI) scan uses a magnetic field and radio waves to show the inside of your head. A computerized tomography (CT) scan uses a series of x-rays to show the inside of your head.
Vertigo treatment will vary based on the cause. In general, lying still in a dark, quiet room can help ease the symptoms of spinning and nausea. Your doctor may also prescribe medication.
Stress and anxiety can make vertigo worse, so learning to manage those things can lead to a reduced amount of vertigo episodes.
More specific treatments may include:
Treatment For Labyrinthitis
Vertigo that is caused by a virus will usually clear up on its own without treatment. If a bacteria causes it, antibiotics can help speed up your recovery (please note that antibiotics will not be effective against a virus).
If you have any hearing loss as the result of labyrinthitis, your doctor may refer you to an ear, nose, and throat (ENT) specialist or audiovestibular physician (a doctor who specializes in hearing and balance disorders). You may require emergency treatment to get your hearing back.
Vestibular rehabilitation training (VRT) can also help improve vertigo symptoms due to labyrinthitis.
Vestibular neuronitis may improve without treatment, although severe symptoms may require bed rest. You should see your doctor if your symptoms don’t improve within a week or if they get worse at any point in time.
Drinking alcohol, being tired, or suffering from another illness can make balance problems worse and should be avoided when possible while you are suffering from vestibular neuronitis.
Medication and Vestibular rehabilitation training (VRT) may improve symptoms.
Benign Paroxysmal Positional Vertigo (BPPV) Treatment and Medication
This form of vertigo often goes away without treatment within a few weeks or months.
The tiny particles of calcium (canaliths) either dissolve or become lodged somewhere they can no longer cause problems. BPPV occasionally returns.
While waiting for your symptoms to clear up, you should get out of bed slowly and avoid looking up, as quick movements or tilting your head up can make symptoms worse.
BPPV symptoms may also be alleviated by the Epley Maneuver (also called the canalith repositioning procedure), which is a series of 4 separate head movements, with each head position being held for at least 30 seconds, in order to reposition the particles so that they become stable and no longer cause problems.
The Epley Maneuver may cause vertigo while being performed and often needs to be repeated after a period of time. While symptoms should improve shortly after the procedure, it may take up to two weeks for them to completely clear up. If you haven’t noticed a significant improvement within four weeks, you should talk to your doctor.
If you can’t do the Epley Maneuver due to back or neck problems or if you don’t get adequate symptom relief, Brandt-Daroff exercises are a series of movements that you can do at home.
Your doctor will show you how to do the exercises. You will do them at home three to four times a day for at least two days in a row. Symptom relief may last at least two weeks.
Your doctor may refer you to an ear, nose, and throat (ENT) specialist if the Epley maneuver doesn’t work or can’t be performed, your symptoms don’t improve within four weeks, or if you have unusual symptoms. The ENT may recommend surgery if you suffer from symptoms for several months or years.
Ménière's Disease Treatment
While causes of Ménière's disease aren't well understood, treating it is much better understood. Treatments include:
- Dietary advice such as a low-salt diet
- Medication, such as a diuretic to reduce fluid buildup
- Treatment for tinnitus (ringing in your ears) like sound therapy, which works by reducing the difference between tinnitus sounds and background sounds, which makes the tinnitus sounds seem less intrusive.
- Treatment for hearing loss such as using hearing aids
- Physiotherapy to deal with balance problems
- Treatment for secondary symptoms of Ménière's disease like stress, anxiety, and depression
Central vertigo affects the brain instead of the inner ear. Migraines are a common cause of central vertigo and can be treated with migraine medication. Your doctor or specialist may order additional tests such as brain imaging to formulate an appropriate treatment plan.
There are three medications that are typically prescribed to help ease symptoms of vertigo depending on the cause. It’s important to note that medications only treat the symptoms of vertigo and will not cure it.
Prochlorperazine blocks dopamine in your brain to ease symptoms of severe nausea and vomiting associated with vertigo. It can cause side effects such as sleepiness, tremors, and involuntary movements of the face or body.
Antihistamines block histamine to relieve symptoms of dizziness and nausea. Antihistamines that are typically prescribed for vertigo include cinnarizine, cyclizine, and promethazine teoclate. Side effects of antihistamines can include sleepiness, headaches, and upset stomach.
Betahistine works like an antihistamine and is often prescribed to help with Ménière's disease and other balance problems. It may need to be taken for long periods of time (whereas antihistamines and prochlorperazine are typically short-term treatments) and effectiveness will vary from person to person.
While it’s impossible to guarantee that you will never develop vertigo, there are some lifestyle changes you can make that should help reduce your chances of experiencing vertigo.
Generally speaking, any lifestyle changes you would make to reduce your odds of having a stroke can help prevent vertigo.
These changes include improving your blood pressure, cholesterol, weight, and blood glucose levels.