What should you know about vertical vertigo?

Vertigo is an illusion of movement rather than ordinary light-headedness. A vertical sensation can occur when signals from the inner ear, eyes, and brain do not match. It may be triggered by turning in bed, looking up, standing, walking, or moving the head, or it may continue while still. Nausea, vomiting, sweating, unsteadiness, or difficulty focusing can accompany an episode.

Several conditions can present with vertigo. Brief attacks linked to head position may occur with [Benign Paroxysmal Positional Vertigo](/conditions/benign-paroxysmal-positional-vertigo/). Ear pressure or hearing changes can occur with [Meniere's Disease](/conditions/menieres-disease/), while infection-related symptoms may occur with [Middle Ear Infection](/conditions/middle-ear-infection/). [Migraine](/conditions/migraine/) can also present with dizziness or vertigo, sometimes without a headache. These patterns guide assessment but do not establish a diagnosis by themselves.

Sit or lie down in a safe place and keep your head as still as is comfortable. Avoid driving, climbing, bathing alone, or operating machinery until the sensation has settled. Sip fluids if you can keep them down, and ask someone to stay nearby if walking is unsafe. Note when the episode began, how long it lasted, what movement brought it on, and whether hearing symptoms, headache, weakness, or visual changes occurred.

A clinician may examine eye movements, balance, hearing, and positional responses. If the pattern fits positional vertigo, an [Epley Manoeuvre](/treatments/minor-procedures/epley-manoeuvre/) may be considered. Do not perform a repositioning manoeuvre without guidance if you have significant neck or back problems, or if the symptoms are unexplained.

Call emergency services or go to an emergency department for sudden vertigo with trouble speaking, facial drooping, new weakness or numbness, severe difficulty walking, fainting, a new severe headache, double vision, chest pain, or loss of consciousness. Seek prompt medical assessment for new hearing loss, persistent vomiting, fever with severe dizziness, a recent head injury, or vertigo that is continuous or worsening. Urgency depends on these warning signs and the overall pattern, not simply on how often vertigo occurs.

Ask: Does the sensation fit an inner-ear problem, migraine, medication effect, or another cause? Should my hearing and balance be tested? Is a positional examination or Epley manoeuvre suitable for me? Which symptoms should make me return urgently, and what activities should I avoid while I am unsteady?