Vertigo

(Dizziness)

by Cynthia M. Johnson, MA

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.

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

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.

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.dyname... . 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.

Last reviewed February 2020 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 4/8/2020