Vertigo: Causes, Assessment and Treatment

Vertigo is a false sensation of spinning or movement, often linked to the balance system in the inner ear.

You may feel that the room is turning, that you are moving when still, or that walking is unsteady. Nausea, vomiting, sweating, ringing in the ear, hearing change, or headache can occur alongside it. Light-headedness from dehydration or standing up quickly is different from the spinning sensation of vertigo.

Get urgent help for sudden vertigo with trouble speaking, a new facial droop, weakness or numbness on one side, double vision, a severe new headache, fainting, chest pain, or inability to walk safely. These symptoms need prompt assessment because they can involve the brain, circulation, or another serious illness.

Seek same-day medical advice if vertigo follows a head injury, comes with a sudden hearing loss, or causes ongoing vomiting that prevents you from keeping fluids down.

Vertigo can result from signals coming from the inner ear, the nerves that carry balance information, or migraine pathways. The conditions here appear alphabetically and are not a likelihood ranking.

Benign paroxysmal positional vertigo is often triggered by a change in head position. Labyrinthitis may follow an inner-ear inflammation and can produce sustained dizziness. Meniere’s disease can combine episodes with ear fullness or hearing symptoms. Middle-ear infection may bring ear pain or discharge, while migraine can cause vertigo with or without head pain.

The assessment begins with the exact sensation, when it started, how long episodes last, and whether head movement, illness, travel, sound, or visual stimuli trigger it. A clinician may ask about hearing, headaches, medicines, prior migraines, and recent infections.

Examination can include watching eye movements, checking hearing and the ear, testing balance and walking, and carefully moving the head into specific positions. Blood tests, hearing tests, or scans are reserved for situations where the history or examination suggests they may clarify the cause.

For positional vertigo, a trained clinician may use a sequence of head movements to guide inner-ear particles away from a sensitive area. This is called an Epley manoeuvre. Inner-ear inflammation, ear infection, and migraine are managed differently, so a diagnosis matters before choosing treatment.

Short-term medicines may sometimes ease severe nausea, but they do not replace assessment of the underlying cause. Vestibular rehabilitation uses guided balance and gaze exercises when recovery or persistent imbalance needs support.

Sit or lie down as soon as spinning begins, and avoid driving, climbing, swimming alone, or using machinery until you feel steady. Keep a clear path to the bathroom and use support when walking if needed. Rise slowly from bed and turn your head deliberately rather than abruptly.

If migraine is part of the pattern, a clinician may help you identify personal triggers and plan preventive care. Follow the technique and timing advised if you have been taught a positional manoeuvre; repeated unsupervised movements can be unhelpful when the diagnosis is uncertain.

Tell a clinician about hearing loss, tinnitus, ear pressure, ear pain, vomiting, headache, sensitivity to light, changes in vision, weakness, numbness, or difficulty speaking. The combination and timing of these symptoms often provides more useful clues than the word dizziness alone.

Vertigo can increase the risk of falls and may make work, travel, and daily movement difficult. Follow-up is particularly helpful when episodes recur, balance does not return between episodes, or hearing symptoms change, because the treatment plan may need to be adjusted.