This is what vertigo really feels like

Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP
·10-min read
Photo credit: gawrav - Getty Images
Photo credit: gawrav - Getty Images

Contrary to popular opinion, vertigo is not a fear of heights, nor is it the wobbly-legged sensation of looking down from a high place. Vertigo is in fact the feeling that you are spinning or that everything in the environment is spinning or moving around you, but without any accompanying movement.

Dr Louise Wiseman looks at vertigo symptoms, causes and treatment options:

What is vertigo?

Vertigo differs from dizziness or light headedness as it is a symptom of a condition and not a condition in itself. Vertigo is best described as a spinning sensation which feels like either you or the world around you is moving, but it is an illusion as you experience it when you are not actually moving at all.

Vertigo tends to occur in episodes or attacks that can come on suddenly and last anywhere from seconds to hours. There is often a trigger for this attack, such as moving your head in a certain direction or changing swiftly from lying to standing. Some attacks are mild while others are more severe and can make daily life difficult, particularly if they are prolonged.

Vertigo can range from a momentary feeling that does not interrupt what you are doing, to a debilitating condition that affects your balance and ability to do everyday tasks like walking or even standing. The sensation can occur out of the blue and only last a short while or it can last for many days, severely affecting your quality of life.

Photo credit: Cecilie_Arcurs - Getty Images
Photo credit: Cecilie_Arcurs - Getty Images

Vertigo causes

Vertigo can be a symptom of many different medical conditions but sometimes the cause is unknown. The condition can be split into Peripheral and Central vertigo:

• Peripheral vertigo

Peripheral vertigo originates in the ear and means there is a problem with the inner ear. With inner ear problems the brain receives balance messages from the ear that don’t match with what the eyes are seeing or the body is feeling. The vertigo is what a person feels while the brain tries to work it all out.

Our ears are used for hearing but they also play a vital role in our balance, relaying information about the position of our body to our brain. Within the inner ear there are three fluid filled structures called the semi-circular canals. When we move, the fluid within the canals moves too. Tiny hairs lining the canals are wafted by the moving fluid and they send messages to the brain to inform it of the position of the head. Any disruption to this process, such as by infection or inflammation, can result in incorrect messages to the brain and lead to vertigo. Vertigo from the ear tends to start suddenly and come in bouts.

• Central vertigo

Central vertigo originates in the brain andmeans there is a problem with a part of the brain to do with balance (cerebellum) or the part of the brain where it connects to the spinal cord (brainstem). The brain receives and sends information via the nerves in our body. The cerebellum is the part of our brain which mainly controls co-ordination, posture and balance; it is located at the back of the head. Vertigo from the brain tends to start more slowly than that from the ear and is often more constant in nature.

Vertigo symptoms

If you have vertigo, alongside the spinning sensation you might also experience a number of symptoms including:

  • Loss of balance

  • Nausea or being sick

  • Dizziness

  • Problems with focussing eyesight

  • Ringing in the ears (tinnitus)

  • Feeling sweaty and anxious

  • Hearing loss which may be progressive

A number of conditions also include vertigo as a symptom, including the following:

1. Labyrinthitis

This can occur after a virus such as a cold or the flu (viral labyrinthitis) or more rarely from a bacterial infection. The labyrinth becomes inflamed. Vertigo seems to arise out of the blue often with nausea and vomiting. Hearing can sometimes be affected, and tinnitus may temporarily occur with possible earache and temperature. It is likely to make the sufferer bedridden and may last for 2 to 3 weeks. If hearing is affected, patients are referred to an ENT doctor to prevent long term hearing loss.

2. Benign paroxysmal positional vertigo

Mainly seen in the over 50s, this is one of the most common causes of vertigo. It can occur during or after specific movements of the head. Turning in bed, bending over or looking to cross the road can all be triggers. Episodes are short and intense; usually a few seconds or minutes, often accompanied by nausea. It's common to feel light-headed for a while after the attack. The cause is thought to be that the tiny calcium carbonate crystals have detached from the lining of the inner ear channels. These then float in the fluid of the canals and distort the sense position of where the head is.

3. Head injury

Vertigo can develop after a head injury. If you feel dizzy or nauseous following a head injury seek urgent medical attention.

4. Vestibular neuronitis or neuritis

The vestibular system includes a nerve used in the ear for balance. Vertigo can develop when the vestibular nerve becomes inflamed, usually by a viral infection. Symptoms come on intensely and don’t seem to go away. They can gradually resolve on their own but sometimes specialist physiotherapy and medication are needed.

5. Meniere’s disease

Meniere’s disease is a rare condition caused by fluid build-up in the inner ear – known as a triad of:

  • Vertigo and nausea

  • Tinnitus and fullness in the ear

  • Progressive deafness

Sufferers can often tell an attack is imminent with the feeling of fullness in the ear. Vertigo can last from a few hours to a few days in a bout. Diet and medication can help reduce symptoms.

6. Medications

Certain medications can cause vertigo or simple dizziness that may be confused with vertigo. Examples include anticonvulsants, antidepressants, analgesics, anti-inflammatories and blood pressure medicines. It is important to speak to your doctor before stopping taking any medication.

7. Migraines

Migraine sufferers often experience vertigo and dizziness in addition to a severe headache, light and noise sensitivity.

8. Vertebrobasilar insufficiency

Common in the elderly, vertebrobasilar insufficiency can occur when stretching the head and neck back when looking around. This constricts blood vessels and can trigger vertigo. This is more common in those with osteoarthritis in the joints of the neck. Some people benefit from wearing a cervical collar.

More rarely vertigo can be part of the presentation of:

When to see your doctor

An occasional, brief episode of vertigo is usually nothing to be concerned about. You should see your doctor if your vertigo is recurrent or if the attacks are severe and affect your ability to carry out your normal daily life. If this is a first episode you may need reassurance, as it can be frightening and disabling.

Make an urgent appointment with your doctor if you experience any of the following symptoms alongside vertigo:

  • Weakness or numbness in a leg or arm

  • Severe headache

  • Visual loss or double vision

  • Hearing loss

  • Recurrent vomiting or severe nausea

  • High temperature

Vertigo diagnosis

How you report your vertigo symptoms to your doctor is crucial in helping them to make the correct diagnosis, so go prepared to explain exactly what you feel, how often the attacks last and how frequently they occur. Also whether you have any other symptoms, any triggers that cause attacks and anything that makes your symptoms better.

Your doctor will examine your heart, blood pressure, ears and eyes and may test your balance too. You may be referred to a specialist ENT doctor or Neurologist for further tests including hearing and eye tests, balance tests and scans such as a CT or MRI scan. You doctor may refer you to a specialist either before or after initial tests.

Self-help tips for vertigo treatment

There are a number of treatments for vertigo depending on the underlying cause, and there are a few things you can do at home to ease symptoms:

  • During an attack it’s best to be as still as you can and lie down in a dark, quiet room until your symptoms ease.

  • You can try to avoid an attack coming on by being aware that sudden movements may trigger an attack.

  • Always move your head slowly and carefully.

  • Avoid bending over to pick things up; squat and bend from the knees instead.

  • Similarly, it’s best not to crane your neck, especially when you’re reaching up for things.

  • It can also help if you use two or three pillows at night to raise your head slightly.

  • Take care when you move from lying to standing and spend a few minutes sitting before you get up.

  • Anxiety is also known to make vertigo worse in some people, so relaxation techniques such as steady, deep breathing may help.

Vertigo treatment exercises

There are a number of specialist exercises that can help with vertigo:

✔️ Vestibular Rehabilitation Training

Sometimes specific exercises can be used to treat vertigo and a specialised may perform vestibular rehabilitation (VRT). Guided by a hearing specialist or physiotherapist, VRT aims to retrain the brain and help it to ignore the confusing messages coming from the ear.

✔️ Epley manoeuvre

If you have BPPV then there is a specific series of head movements call the Epley manoeuvre that helps to clear out the debris that may be floating in your inner ear canals. Many GPs and specialists will carry out the exercise with you. In some patients this can temporarily trigger the vertigo. This often needs repeating and may take a couple of weeks to show benefit.

Practising general balance exercises when you do not have vertigo may help to strengthen your muscles and reduce your risk of falling during subsequent attacks.

Vertigo medication

Most cases of vertigo will resolve without treatment but there are some situations in which medication may be used:

  • If a bacterial infection is present, your doctor may prescribe an antibiotic. Most infections causing vertigo are viral and don’t require antibiotics.

  • If nausea and vomiting are prominent, antihistamines that have an anti-emetic (anti-vomiting) effect can be prescribed, eg cinnarizine, cyclizine or promethazine.

  • Prochlorperazine is often used to relieve nausea and dizziness; tablets which dissolve between the lip and the gum pass directly into the blood stream without the need for swallowing and are therefore useful if vomiting is recurrent. Prochlorperazine can also be given as an injection.

  • Betahistine may be used for treatment of Ménière’s disease. It improves blood flow to the ear and helps to reduce the frequency and severity of attacks.

Treatment may only be required for a few days but may need to be used repeatedly if attacks are recurrent. Other treatments depend on the underlying cause of the vertigo.

Can you drive with vertigo?

You are legally obliged to inform the Driver and Vehicle Licensing Agency (DVLA) if you have any condition that affects your ability to drive and vertigo fits this criterion. Sudden movements of the head and neck are often required while driving and this could provoke a vertigo attack. Do not drive if you have recently had vertigo and there is a risk you may have another episode while driving.

It’s important to keep yourself safe if you have vertigo due to the risk of falling. Don’t climb ladders alone and tell your employer if you need to use a ladder at work. If you have recurrent attacks that upset your balance, then you may want to consider a walking cane to give you some support in mobilising and reduce your risk of falls.

Further help and support

If you experience vertigo symptoms your first port of call should be your GP. For additional help try the following resources:

  • Menieres: UK charity for people with vestibular (inner ear) disorders causing dizziness and imbalance.

  • Tinnitus: tinnitus treatment and relief to help improve your quality of life.

  • RNI:D: charity working on behalf of the UK's 9 million people who are deaf or have hearing loss.

Last updated: 22-03-2021

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