An episode of Vertigo causes a ‘spinning’ feeling while standing completely still – it is an illusion of movement. Vertigo can feel either like the things around you are spinning, or that you are spinning within the environment around you. Sometimes vertigo is very mild and you hardly notice it, but sometimes it can be so severe that it’s difficult to move or walk properly and you can even fall over.

Vertigo is often confused with other things. Real vertigo is worse than simply feeling fuzzy-headed or dizzy. And vertigo is not a fear of heights, as some people mistakenly believe. It’s true that looking down from heights can make you feel a bit strange and dizzy for a few moments but this is not vertigo. Vertigo can happen anywhere and attacks can keep happening for a long time – sometimes for years.

What causes vertigo and who can get it?

The most common cause of vertigo is a problem with the inner ear balance mechanisms. It can also involve the nerves that connect the brain and the inner ear.

If you have a cold or flu, or another viral infection, this can spread to the middle ear. Sometimes, but not often, a bacterial infection of the middle ear (otis media) will cause vertigo. If this is the case, the vertigo will be quite sudden and you will probably get earache earache along with a fever.

You can get also get vertigo with migraines
as a side-effect of certain medication and from drinking too much alcohol.

Sometimes if you have bad circulation, not enough blood gets to the part of the brain or inner ear that controls balance and this can cause the symptoms of vertigo.

Severe vertigo can be caused by Ménière's disease – a disorder of the balancing mechanisms in the inner ears. With this condition you usually get tinnitus (ringing in the ears) and have problems with your hearing. If you have Ménière's disease the vertigo attacks can last for hours, they can make you vomit and leave you completely wiped out.

Occasionally vertigo is caused by a stroke, multiple sclerosis or a tumour, but this is rare. With these conditions there are always other symptoms indicating something is wrong – such as visual or speech problems.

What are the signs and symptoms of vertigo?

Vertigo attacks can be short and sharp but clear up quickly. For others, attacks can come and go for days. For people with severe vertigo, the symptoms may be constant for days on end. This can make normal life difficult, and they may find themselves confined to their beds or unable to leave the house.

Symptoms of vertigo vary in severity and may include the following:

• a feeling your surroundings are moving or spinning
• nausea
• vomiting
• difficulty in staying upright
• feeling dizzy
• feeling like the floor is moving

How is vertigo normally diagnosed and treated?

Vertigo can be diagnosed by your GP who will listen to your symptoms. They will probably want to give you a physical examination – checking your ears, eyes and nervous system reflexes.

If the vertigo is very bad, or doesn’t clear up, then you may be referred for more tests, including a ‘provocation test’ which is designed to bring on the symptoms of vertigo.
 
A caloric test (where warm and cold water is squirted into the ear canals) can check to see if the inner ear is working properly. A Vestibular test using a rotating computer controlled chair may also be needed.

You may be referred for other tests such as an x-ray to rule out arthritis, or an , MRI scan to rule out a brain tumour.

The treatment of vertigo depends on the reason for it. In many cases, given time the brain is able to adapt and overcome the imbalance that is causing vertigo. A programme called Vestibular Rehabilitation is often used to treat vertigo with a high success rate. This helps restore your sensation of balance by doing daily eye, body and movement exercises to help the brain’s adaption process.
If it is to do with ear problems such as bacterial infections, then you will probably be given antibiotics.

A condition called BPPV (benign paroxysmal positional vertigo) is caused by loose calcium crystals in the ear canals. It can be solved easily by moving your head to reposition the crystals away from the sensitive balance sensors.

If the vertigo is caused by Ménière's disease you may be given antiemetic drugs to stop you feeling sick, along with antihistamines to lower the number of attacks. A reduction in salt intake is recommended and often helps relieve the symptoms. In rare cases a nerve in the inner ear can be cut to reduce symptoms.

When to ask for medical help

If your vertigo starts after a head injury, you need to see your GP straight away.
Also go if you have any concerns about spells of dizziness or vertigo.

What’s going to help?

Travelling (by car, plane or boat) can often make vertigo worse, in which case antiemetic (anti-sickness) medication may be helpful. In general vertigo attacks can be helped by lying down and trying to avoid stressful situations. A low-salt diet can sometimes help reduce symptoms.

Can vertigo be prevented?

Sleeping with your head raised on two or more pillows is thought to help relieve or prevent vertigo. When you get up in the morning, sit up slowly first then wait for a minute or so before standing. Avoid bending down quickly.

Looking forward

Because there are so many different causes of vertigo, it’s difficult to know what the outcome will be. Normally, if an accurate diagnosis is made, the vertigo, or the problem causing the vertigo, can be treated successfully.

For more help and information

Read more about balance testing and treatment here.

Last reviewed by Great Ormond Street Hospital: 19 December 2007

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