Vertigo

What Is It?

Vertigo is the sensation that either your body or your environment is moving (usually spinning). Vertigo can be a symptom of many different illnesses and disorders. The most common causes of vertigo are illnesses that affect the inner ear, including:

Benign positional vertigo – In this condition, a change in head position causes a sudden sensation of spinning. The most likely cause is small crystals that break loose in the canals of the inner ear and touch the sensitive nerve endings inside.

Acute labyrinthitis, also called vestibular neuritis – This is an inflammation of the balance apparatus of the inner ear, probably caused by a viral infection.

Ménière’s disease – This causes repeat episodes of dizziness, usually with ringing in the ear and progressive low-frequency hearing loss. Ménière’s disease is caused by a change in the volume of fluid inside the inner ear. Although the reason for this change is unknown, scientists suspect that it may be linked to loud noise, to a viral infection or to biologic factors inside the ear itself.

Symptoms

Vertigo can feel like the room is spinning or like you are spinning in the room, or it can be just a sense of imbalance. It may be associated with nausea, vomiting and ringing in one or both ears (tinnitus).

Diagnosis

Your doctor will diagnose vertigo based on your description of what you are feeling. Vertigo can be divided into two major categories, peripheral vertigo and central vertigo.

Peripheral vertigo, which is much more common, includes benign positional vertigo, labyrinthitis and Ménière’s disease. Positional vertigo is diagnosed when moving the head causes the vertigo and returning the head to a neutral position relieves symptoms. Labyrinthitis and Ménière’s attacks usually come on abruptly and last from a few hours to a couple of days. There may be intense nausea and vomiting and variable hearing loss.

Central vertigo is a more serious problem in the cerebellum (back part of the brain) or brain stem.

Your doctor will evaluate your eye to look for abnormal jerking movements (nystagmus). The pattern of your eye movements may help to determine if the problem is peripheral or central. Usually, no further testing is needed unless your doctor suspects you have central vertigo. If central vertigo is suspected, your doctor will order a computed tomography (CT) scan or magnetic resonance imaging (MRI) of your brain.

Expected Duration

Depending on its cause, vertigo may last only a few seconds or last for weeks or months.

Treatment

Your doctor may begin treatment by recommending bed rest or prescribing medications that suppress the activity of the inner ear, such as meclizine (Antivert, Bonine and other brand names), dimenhydrinate (Dramamine) or promethazine (Phenergan); anticholinergic medications such as scopolamine (Transderm-Sco); or a tranquilizer, such as diazepam (Valium). Depending on the cause and duration of the vertigo, additional advice may be offered. For example, for persistent benign positional vertigo, you may be given specific exercises to help reduce your symptoms.