Vertigo: Symptoms, Causes, Treatments, and Natural Approaches

Vertigo is a form of dizziness in which a person feels like they are moving even though everything is still. People often feel like they, their surroundings, or both are spinning. Dizziness is a broader term that, in addition to vertigo, includes lightheadedness (feeling woozy), disequilibrium (a sense of imbalance or instability), and presyncope (a feeling of impending faintness).

1. Peripheral 2. Central Ménière’s Disease: Symptoms, Causes, Treatments, and Natural Approaches The Essential Guide to Tinnitus: Symptoms, Causes, Treatments, and Natural Approaches The utricle and saccule help us sense movements like going up and down or side to side.



They contain tiny calcium carbonate earstones, or crystals, called otoliths and hair cells that sense linear movements and gravity. Otoliths shift when we move our heads and push against tiny hairs, sending messages to our brains about our position. Various conditions can cause vertigo, some of which are harmless, while others may be serious or even life-threatening.

Benign paroxysmal positional vertigo (BPPV): Also known as benign positional vertigo, BPPV is commonly described as a sudden feeling of spinning that happens with a quick head movement, such as turning over in bed or sitting up quickly. It doesn’t cause ear pain, ringing, or hearing loss. This sensation is usually due to otoliths in the inner ear getting out of place or moving into one or more semicircular canals.

When this happens, and a person turns their head, the otoliths can spin around, making the person feel like they are moving. BPPV is the most common cause of vertigo globally. Ménière’s disease: Ménière’s disease is a condition marked by repeated episodes of severe vertigo, nausea, fluctuating hearing loss (especially in lower frequencies), and tinnitus.

For more information, please refer to our Ménière’s disease guide . Vestibular neuritis or labyrinthitis: Vestibular neuritis is often caused by a viral infection and leads to sudden, severe nausea, vomiting, vertigo, and difficulty walking. Although patients may struggle with balance, they can still move around.

When vestibular neuritis occurs in combination with one-sided hearing loss, the condition is called labyrinthitis. Cogan syndrome: Cogan syndrome is an autoimmune disorder that causes symptoms similar to Ménière’s disease, and caloric testing typically shows a lack of vestibular function. Ramsay Hunt syndrome: Herpes zoster, or shingles , is a viral condition caused by the reactivation of the varicella-zoster virus, which remains dormant in the nervous system after a person has chickenpox.

In Ramsay Hunt syndrome, reactivation of the virus causes shingles to attack the facial nerve near the ear, causing vertigo. Acoustic neuroma: Acoustic neuromas, also called vestibular schwannomas, are benign tumors that develop in the ear and can affect hearing and balance. Otitis media: Otitis media is the inflammation or infection of the middle ear, often resulting from a cold, sore throat, or respiratory infection.

Perilymphatic fistula: A perilymph fistula is an abnormal connection in the delicate membranes that separate the air-filled middle ear from the fluid-filled inner ear. Medications: Aminoglycosides are antibiotics that can lead to toxicity in the vestibular or cochlear systems in up to 10 percent of patients who receive these medications intravenously. Cisplatin, diuretics, and salicylates can also harm the structures of the inner ear.

Injury: For instance, a concussion or other head injuries can cause vertigo. Cholesteatoma: A cholesteatoma is a type of skin cyst found in the middle ear and the mastoid bone of the skull. Otosclerosis: Otosclerosis is caused by abnormal bone remodeling (old bone tissue replaced by new tissue) in the middle ear, which interferes with sound transmission to the inner ear.

Heart arrhythmia: An abnormal heart rate or rhythm can be associated with vertigo, either as a cause or a result of vertigo. Hyperventilation: Hyperventilation involves breathing more rapidly and deeply than normal, thus reducing carbon dioxide levels in the blood, which can cause vertigo and dizziness. Orthostatic hypotension: Postural low blood pressure, or orthostatic hypotension, is a drop in blood pressure that occurs when standing up from a seated or lying down position.

Tissue damage or deficient blood supply to the central vestibular structure: Central vertigo most often occurs due to ischemia, or deficient blood supply, in the central vestibular structures located in the cerebellum, brainstem, or vestibular nuclei, particularly in older adults with vascular risk factors. Vertebrobasilar insufficiency: Vertebrobasilar insufficiency refers to insufficient blood flow in the back of the brain. Space-occupying lesions: Any lesion affecting the “balance headquarters” of the brain can lead to symptoms of vertigo and associated signs of nystagmus (uncontrolled, rapid eye movement).

Lesions could include tumors such as brainstem gliomas, medulloblastomas, and vestibular schwannomas. Demyelination: In younger patients, acute damage to the protective myelin encasing nerve fibers, such as that seen in multiple sclerosis, is a more frequent cause of central vertigo. Vestibular migraine: Migrainous vertigo, or vestibular migraine, affects 1 percent to 3 percent of the population.

Type 1 diabetes: Type 1 diabetes can cause vertigo because the inner ear is especially sensitive to changes in blood glucose and insulin levels, which can disrupt normal vestibular function. Anticonvulsants: Examples include phenytoin, phenobarbital, and carbamazepine. Chiari malformations: Chiari malformations are complex brain abnormalities that affect the region at the lower posterior skull where the brain connects to the spinal cord.

Psychological disorders: Mood, anxiety, and somatization (the manifestation of physical symptoms related to psychological factors) disorders can all cause vertigo. Sex: Vertigo occurs in women two to three times more often than in men. Age: Older adults have a higher prevalence of vertigo, as it increases with age.

Age-related changes in the inner ear also increase the likelihood of conditions such as vestibular disorders. Certain occupations: Aircraft pilots and underwater divers often experience vertigo due to the lack of reference points in their environments, leading to disorientation. Frequent travel: People who travel often, especially by air, may experience vertigo related to changes in pressure or motion sickness .

Alcohol: People may feel vertigo when they are drunk or during a hangover. Underlying medical conditions affecting the ear, brain, or nervous system. Medication.

HINTS test: The head impulse test, nystagmus, and skew deviation (HINTS) test is the most effective bedside method to distinguish between peripheral and central vertigo. However, this test is only valid if the patient is still experiencing ongoing, continuous vertigo during the assessment. Videonystagmography testing: Videonystagmography assesses inner ear function through a series of visual and sensory exercises.

Since the inner ear sends signals to the eye muscles to help maintain balance, this test records eye movements to help audiologists determine if inner ear issues are causing vertigo. The Dix-Hallpike test: The Dix-Hallpike maneuver is considered the “ gold standard” test for diagnosing BPPV. During the test, the patient is seated on an exam table and asked to look at a fixed point (like the examiner’s nose).

The patient’s head is turned to one side and lowered toward the table. If the patient experiences vertigo (“dizziness”) and has nystagmus, it indicates likely BPPV in the ear facing the floor. The process is then repeated on the other side to examine the opposite ear.

Rotational chair testing: The rotational chair test helps identify whether vertigo originates from peripheral or central causes. In this test, the patient sits in a rotating chair and wears special goggles that record eye movements, allowing the audiologist to assess how the balance system responds. Other inner ear tests: Additional inner ear tests may include vestibular evoked myogenic potentials testing, which measures the response of the vestibular system and neck muscles to sounds, and electrocochleography, which checks for fluid buildup and pressure in the inner ear.

Audiologists use these tests to assess how the inner ear responds to sound stimuli. Magnetic resonance imaging (MRI) scan: For some people with vertigo, especially those with hearing loss, doctors may recommend an MRI scan to closely examine the inner ear and nearby structures to detect fluid buildup, inflammation, or growths on the nerve that may be causing symptoms. Neurological testing: If hearing or sensory tests suggest that vertigo is centrally caused, doctors may refer the patient to a specialist for neurological evaluation and treatment.

Computerized dynamic posturography (CDP): CDP is a specialized test used to assess an individual’s balance and postural control. It measures how well a person can maintain their balance under various conditions. Other tests: Other tests recommended by the doctor may include blood tests, hearing tests, caloric stimulation (uses temperature differences to diagnose damage to the acoustic nerve while also checking for potential damage to the brainstem), lumbar puncture, and gait testing.

Falls and injuries: Since vertigo can lead to loss of balance and disorientation, it can cause falls, which may result in hip fractures, head injuries, or other trauma. Impaired daily activities: Persistent vertigo can interfere with daily tasks such as driving, working, or performing household chores. Chronic symptoms: In some cases, vertigo can become chronic, which may require long-term management.

Anxiety and depression: The unpredictable nature of vertigo can cause significant anxiety and stress, which may lead to depression. 1. Medications Antihistamines: For instance, meclizine and promethazine can treat nausea and vomiting.

Benzodiazepines. Antiemetics. Corticosteroids: In cases of vestibular neuritis, corticosteroids are recommended for use in the acute phase, alongside vestibular rehabilitation.

An intravenous corticosteroid treatment is indicated if the cause is an acute demyelinating event related to multiple sclerosis. Diuretics: Diuretics may be prescribed when dietary changes alone do not effectively control Ménière’s disease symptoms, such as swelling. Betahistine: Betahistine may help reduce fluid buildup in the inner ear in Ménière’s disease and prevent symptoms from occurring.

While taking betahistine daily may not wholly eliminate vertigo, it can lessen its severity and frequency. However, it is not effective for everyone. Motion sickness medication.

Seizure and antidepressant medications: These can treat migraine-induced vertigo. 2. Physical Therapy Vestibular rehabilitation: Vestibular rehabilitation exercises help the brain use alternative visual and sensory cues to maintain balance.

Canalith repositioning treatment (CRT): Canalith repositioning treatment , also known as the Epley maneuver, is a type of physical therapy specifically designed to treat BPPV and involves specific sequential head movements to reposition misplaced canaliths (i.e., otoliths) in the inner ear.

In one randomized clinical trial , over 70 percent of BPPV patients who completed a web-based video for self-administration of CRT found symptom relief. Balance retraining: Balance retraining is an exercise program designed to enhance the coordination of muscles, joints, and vision to help individuals feel more stable. Gaze stabilization exercises: Gaze stabilization exercises involve specific eye movements that help the eye muscles adjust to changes in the vestibular system.

Brandt-Daroff exercises: To perform these, sit on the edge of a bed or sofa and quickly lie down on the side that triggers the most severe vertigo, staying in that position for at least 30 seconds or until the symptoms subside. Then, sit up and wait for any vertigo to stop before repeating the process on the other side. This should be done 10 times, twice a day, until the vertigo resolves.

Semont maneuver: The Semont maneuver is about as effective as the Epley maneuver in treating BPPV, as demonstrated by a 2021 study . Half-somersault maneuver: Also known as the Foster maneuver, the half-somersault maneuver can be used as an alternative to the Epley maneuver in treating BPPV, and it is easier to self-apply than the former. 4.

Surgery 5. Self-Care To prevent worsening symptoms during a vertigo episode, individuals should stay still by sitting or lying down, gradually resume activity, avoid sudden position changes, refrain from reading, and steer clear of bright lights. Ensure you get adequate sleep.

Sleep with your head elevated on two or more pillows. Follow a balanced and nutritious diet without overeating. Engage in regular exercise.

Rise slowly when getting out of bed, and sit on the edge for a minute or so before standing up. Avoid bending down to pick up items. Avoid extending your neck, such as when reaching for something on a high shelf.

Move your head carefully and slowly during daily activities. Perform exercises that trigger your vertigo to help your brain adapt and reduce symptoms. Explore and practice relaxation techniques such as guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.

Maintain a diary to track instances of dizziness and the activities you were doing at the time, which may help identify triggers to avoid. To enhance safety, remove loose throw rugs, install night lights, and place nonskid mats and grab bars near the bathtub and toilet. Inform your employer about your symptoms, particularly if your job requires operating machinery or climbing ladders.

A negative mindset can also increase the perception of vertigo, making even mild episodes feel more intense. Conversely, a positive, proactive mindset fosters a sense of control, motivating individuals to adopt helpful behaviors that can improve symptoms. 1.

Herbal Medicinals Ginkgo (Ginkgo biloba): Out of the nine studies examined by a 2021 review on the effectiveness of ginkgo extracts for vertigo, eight reported improvements. Some of these studies reported that the extracts were as effective as betahistine in treating vertigo. Ginger (Zingiber officinale): In a 1986 study , powdered ginger root significantly reduced induced vertigo in eight healthy participants compared to a placebo.

2. Supplements Vitamin D: A 2021 study found a link between low serum vitamin D levels and BPPV recurrence, and the researchers suggested that insufficient vitamin D might worsen symptoms in individuals with BPPV. Therefore, vitamin D supplementation may improve BPPV symptoms in these patients.

Another 2022 systematic review found that vitamin D supplementation helped reduce BPPV recurrence. Iron: A 2005 study involving nearly 340 upper secondary students discovered that participants with iron deficiency experienced significantly higher rates of vertigo and that three months of iron supplementation effectively reduced vertigo, along with irritability, depressive symptoms, and general malaise. 3.

Acupuncture 4. Moxibustion and Manual Repositioning 5. Yoga and Tai Chi Managing high blood pressure and cholesterol levels Avoiding smoking and minimizing alcohol consumption Lowering salt intake if you have Ménière’s disease Taking steps to avoid head injuries whenever possible Avoiding triggers to vertigo episodes Treating the conditions that may induce vertigo Ensuring adequate intake of vitamin D and iron.