Vertigo
Vertigo is a sensation of spinning or movement when you are completely still — as though the room is rotating around you. It is most commonly caused by inner ear problems and can be sudden and intensely disabling. The good news is that most causes of vertigo respond very well to targeted treatment once the underlying cause is identified.
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This page provides general health information only. Sudden vertigo with headache, double vision, or weakness requires emergency assessment to rule out stroke.
Causes of vertigo
Inner ear causes (most common)
- Benign paroxysmal positional vertigo (BPPV) — the most common cause; caused by displaced calcium crystals in the semicircular canals; triggered by head movements; treated with the Epley manoeuvre repositioning technique
- Vestibular neuritis — inflammation of the vestibular nerve, often following a viral infection; causes severe prolonged vertigo lasting days to weeks
- Labyrinthitis — similar to vestibular neuritis but also involves hearing loss and tinnitus
- Ménière's disease — episodes of severe vertigo with fluctuating hearing loss, tinnitus, and ear fullness; caused by excess endolymph pressure in the inner ear
Central causes (less common but serious)
- Cerebellar or brainstem stroke — sudden severe vertigo with neurological symptoms requires emergency assessment
- Multiple sclerosis — demyelinating plaques affecting the brainstem or cerebellum
- Acoustic neuroma — a benign tumour on the vestibular nerve causing progressive imbalance and hearing loss
Symptoms
- Sensation that the room is spinning or tilting — often intense and nauseating
- Loss of balance and unsteadiness on the feet
- Nausea and vomiting — often severe in acute vestibular neuritis
- Abnormal eye movements (nystagmus)
- Hearing changes or tinnitus — suggests labyrinthitis or Ménière's disease
- In BPPV: brief (seconds to 1 minute) episodes triggered specifically by head position changes
When to see a doctor
See a doctor for any new or recurrent vertigo — even if it resolves. If vertigo is accompanied by sudden severe headache, double vision, facial weakness, arm or leg weakness, or difficulty speaking, call 112 immediately as these may indicate a stroke. Vertigo from BPPV can be definitively diagnosed and treated at your first consultation.
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Treatment options
- Epley manoeuvre — a simple head repositioning technique that resolves BPPV in the majority of cases at the first or second attempt; can be performed by a doctor or taught to the patient
- Vestibular rehabilitation exercises — structured exercises that accelerate recovery from vestibular neuritis by promoting central compensation
- Prochlorperazine or cyclizine — anti-emetics for acute vertigo attacks; reduce nausea and help with acute management
- Betahistine — for Ménière's disease; reduces endolymphatic pressure and frequency of attacks
- Low-salt diet and diuretics — for Ménière's disease management
- Corticosteroids — for severe vestibular neuritis to speed recovery
How eMedClinic can help
Our doctors and ENT specialists assess vertigo, identify the cause, and provide appropriate treatment — including guidance on the Epley manoeuvre, prescriptions for anti-nausea medication, and referrals for vestibular rehabilitation or further neurological assessment where needed.
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