What should you know about benign vestibular vertigo?

Vertigo is different from feeling generally light-headed: the surroundings may seem to spin, tilt, or move. The vestibular system in the inner ear works with the eyes and brain to keep you steady. A mismatch between these signals can produce vertigo, nausea, unsteadiness, or difficulty walking.

Benign paroxysmal positional vertigo commonly presents with short attacks brought on by turning in bed, looking up, bending, or sitting up. Other causes of vestibular symptoms include Meniere's Disease, migraine, or a middle-ear infection. The pattern of symptoms, hearing changes, headache, recent illness, medicines, and examination findings help a clinician narrow the cause.

Sit or lie down as soon as spinning starts, move your head slowly, and use support when standing. Avoid driving, climbing, or operating machinery while balance is affected. Drink normally unless a clinician has advised fluid restriction, and keep a note of triggers, episode length, nausea, hearing symptoms, headache, and recent infections.

A clinician may recommend balance exercises or a repositioning treatment such as the Epley Manoeuvre when the examination supports positional vertigo. Do not perform a manoeuvre without suitable instructions if you have neck or back problems, significant vascular disease, or uncertainty about the diagnosis.

Seek urgent medical help for vertigo with new weakness or numbness, facial drooping, trouble speaking, fainting, severe difficulty walking, a sudden severe headache, chest pain, or new double vision. These symptoms can signal a problem that needs prompt assessment.

Arrange medical assessment for a first episode, repeated attacks, symptoms that do not settle, new hearing loss or ringing, severe vomiting, fever, ear pain, or symptoms after a head injury. Until you are assessed, reduce fall risks by keeping walkways clear and asking for help on stairs.

Ask: Could my symptoms be coming from the inner ear, migraine, an infection, or another cause? What movements or tests will you use to assess my balance? Is a repositioning manoeuvre or exercise appropriate for me? Which symptoms should send me to urgent care, and when is it safe to drive again?