Dizziness is one of the commonest reasons to visit a doctor, and vertigo — the illusion that you or the room is spinning — is its most dramatic form. The good news: most vertigo comes from the inner ear and responds excellently to treatment, sometimes in a single session.
What causes vertigo?
The balance system compares signals from the inner ears, eyes, and joints. When one inner ear misfires — from displaced crystals (BPPV), inflammation (vestibular neuritis), or fluid pressure (Menière's disease) — the brain receives conflicting signals and the world spins. Less commonly, the cause is central: vestibular migraine or, rarely, stroke.
Common patterns
- Seconds of spinning when turning in bed or looking up → BPPV
- Hours of vertigo with ear fullness or hearing change → Menière's
- Days of constant vertigo with nausea after a viral illness → vestibular neuritis
- Recurrent vertigo with headache or light sensitivity → vestibular migraine
- Chronic unsteadiness without spinning → often multifactorial, needs assessment
Risk factors
Age, head position changes, migraine history, viral infections, and vascular risk factors (for central causes).
How is it diagnosed?
Bedside examination identifies most causes without machines: the Dix-Hallpike test for BPPV, head-impulse testing, and eye-movement examination. Hearing assessment helps; MRI is reserved for central features.
Treatment options
BPPV: particle-repositioning (Epley) manoeuvres — often curative the same day. Vestibular neuritis: brief symptom relief then vestibular rehabilitation exercises. Menière's: salt moderation and preventive medication. Vestibular migraine: migraine prevention. Long-term "dizziness tablets" are discouraged — they delay the brain's natural compensation.
Natural ways to help
Vestibular rehabilitation exercises, adequate hydration, sleep, and limiting caffeine and salt (Menière's) genuinely help recovery.
When should you see a neurologist?
For recurrent or persistent vertigo, vertigo with headache, imbalance with falls, or when "dizziness" has never been properly examined.
Emergency warning signs: vertigo with double vision, slurred speech, weakness, severe imbalance, or a new severe headache — call 998; these suggest a brain cause.
Key takeaways
- Most vertigo is inner-ear in origin and very treatable.
- BPPV can be cured with a repositioning manoeuvre — no long-term tablets.
- Vestibular migraine is the most missed diagnosis in vertigo clinics.
- Chronic dizziness medication often delays recovery.
- Sudden vertigo with neurological signs is an emergency.
References
Bhattacharyya, N., et al. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3S), S1–S47. Cleveland Clinic. (2024). Vertigo: Causes & treatment. https://my.clevelandclinic.org NHS. (2023). Vertigo. https://www.nhs.uk