Vertigo: A Common Symptom With Many Different Causes

Vertigo can be unsettling. One moment you're fine, and the next, the room feels like it's spinning. While it’s often described as dizziness, vertigo is a more specific sensation—typically a false sense of movement or spinning. Vertigo is not a diagnosis but a symptom that can point to a wide range of issues.

Key Takeaways: Vertigo

• Vertigo is a symptom, not a diagnosis, and it often signals inner ear or brain issues.
• Vertigo differs from general dizziness by creating a false sense of spinning or movement.
• The duration and severity of vertigo symptoms depend on the underlying cause, ranging from seconds to days.
• Effective treatments for vertigo include repositioning maneuvers, medications and lifestyle changes—many guided by a healthcare provider.

What Is Vertigo?

Vertigo is the sensation that you or your surroundings are moving or spinning when there is no actual movement. It’s not a diagnosis but a symptom of various disorders, most commonly those affecting the inner ear or brain. People with vertigo may also experience nausea, vomiting, balance issues, and abnormal eye movements (nystagmus).

According to the American Academy of Audiology, about one in four Americans has problems with dizziness and balance.

Is Vertigo Different From Dizziness?

Though often used interchangeably, vertigo and dizziness describe different sensations.

“Vertigo is very specific to a spinning sensation. Dizziness is more general, like feeling lightheaded, wobbly, weak,” said Christie St. Amour, physical therapist at Franciscan Health Mooresville. “They each can have many different causes, and they can be as harmless as causes as dehydration or as serious as a heart attack or stroke.”

Understanding this distinction helps healthcare providers diagnose and treat the underlying cause more effectively.

“The vestibular therapist has to figure out, are these symptoms that are consistent with an inner ear issue? Is this something a medical issue, like low blood pressure or low blood sugar, or is it something like a heart attack or a stroke?” St. Amour said. “So first we screen for red flags. Then it's a lot of relying on the patient to tell me what is going on, when they feel dizzy, when they're lightheaded, when they feel off balance.”

What Causes Vertigo?

The first step in treating vertigo is understanding its cause. Vertigo can stem from problems in the inner ear or the brain. Many conditions can trigger vertigo, including:

Benign paroxysmal positional vertigo (BPPV)

Triggered by changes in head position, BPPV occurs when tiny calcium crystals in the inner ear become dislodged and disrupt balance signals. A physician can confirm this diagnosis with a Dix-Hallpike test.

Inner ear infections or inflammation 

Conditions like labyrinthitis or vestibular neuritis (an inflammation of the nerve of the inner ear) can cause sudden vertigo, often accompanied by hearing changes.

Ménière’s disease 

Ménière’s disease is a chronic inner ear disorder that leads to episodes of vertigo, hearing loss and tinnitus.

Migraines 

Some people experience vertigo as part of a vestibular migraine episode.

“Migraines can attack the inner ear,” St. Amour said. “It can change from the crushing headache. This is more common in women, especially after age 50 or menuopause. Instead of causing the crushing headache, the migraine can attack the inner ear."

This results in episodes of vertigo along with other symptoms, such as headache, nausea and impaired balance. 

Neurological conditions 

Stroke, multiple sclerosis and brain tumors can affect balance centers in the brain, leading to central vertigo.

Medications 

Certain antibiotics, anti-inflammatory medications and cardiovascular drugs may cause vertigo as a side effect.

Head injuries 

Trauma to the head can disrupt the vestibular system, leading to vertigo symptoms.

Other medical causes

In some cases, vertigo may be linked to systemic issues like low blood pressure, diabetes, or even prolonged bed rest. Because vertigo has many potential causes, a thorough evaluation is key to identifying the source and guiding treatment.

How Long Does Vertigo Last?

The duration of vertigo varies depending on its cause:

• BPPV episodes are typically brief, lasting less than a minute. “That is when people can get a very violent spinning sensation when they roll over in bed, look up, bend over, sit up out of bed,” St. Amour said. “If that's what's going on, I can test for it, and we can treat it. And sometimes we can reposition those crystals within one treatment session, and then people are good.”
• Ménière’s disease can cause vertigo that lasts from 20 minutes to several hours.
• Labyrinthitis or vestibular neuritis may result in vertigo that persists for hours or even days, often accompanied by nausea and imbalance.
• Migrainous vertigo may last from minutes to hours and is usually linked to other migraine symptoms. “There can be really intense bouts of nausea, vertigo, vomiting, can't get out of bed,” St. Amour said. “Sometimes people just feel really off balance after that. So physical therapy, we can't stop the migraine per se. We can't always treat the trigger. However, if you've had a migraine attack and then you're extra off balance, there are different balance exercises that PT can do to help.”
• Central vertigo caused by neurological conditions may be more persistent and severe, sometimes lasting days or recurring over time.

How To Make Vertigo Go Away?

For many, vertigo resolves with treatment or over time. However, some individuals experience recurrent episodes, especially with conditions like BPPV or Ménière’s disease.

“Some conditions can be cured or fixed,” St. Amour said. “Others are where we manage and get people back up to where they want to be.”

Are There Treatments For Vertigo?

Treatments for vertigo depend on what's causing the symptoms. For example, BPPV can be treated effectively with repositioning maneuvers like the Epley maneuver. Other causes may require medication, physical therapy, or lifestyle changes. However, some people experience recurring episodes of vertigo, especially with chronic conditions like Ménière’s disease.

“I wish more people knew that many forms of vertigo are treatable," St. Armour said. In many cases, physical therapists can see people without needing a referral from a doctor. 

Work with your doctor or a physical therapist to determine which treatments can help manage your vertigo. Treatments include:

• Epley maneuver is a series of head movements to reposition inner ear crystals and may be effective for BPPV.
• Brandt-Daroff exercises may help reduce vertigo symptoms and improve balance. Some exercises may be done at home with instruction from your healthcare provider.
• Vestibular Rehabilitation Therapy (VRT), a physical therapy program tailored to improve balance and reduce dizziness.
• Taking medications
• Lifestyle changes, such as resolving common migraine triggers, staying hydrated, reducing salt intake (especially for Ménière’s disease), and avoiding sudden head movements

When To See A Doctor For Vertigo?

While feeling dizzy occasionally may not be cause for concern, a healthcare provider should evaluate vertigo that is persistent, recurrent or severe.

“If you're getting to the point where dizziness is really impacting your daily life, you find yourself avoiding certain things, if it's to the point where you're clutching walls or you're afraid you're going to fall, we absolutely need to get that taken care of,” St. Amour said. “When your daily life starts to be affected, when your safety starts to be affected, that's when we need to address it.”

You should seek medical attention if:

• Your vertigo keeps returning, lasts a long time or disrupts your daily life.
• It starts suddenly and has no apparent cause.
• You experience hearing loss, tinnitus, or abnormal eye movements alongside vertigo.
• You have balance issues that increase your risk of falling.

Seek Emergency Care For Dizziness If You Experience:

• Sudden, severe headache or chest pain
• Loss of feeling or movement in the face, arms or legs
• Trouble speaking, confusion or slurred speech
• Double vision or sudden hearing changes
• Fainting, seizures or ongoing vomiting

These symptoms could indicate a stroke, transient ischemic attack (TIA), or other serious neurological or cardiovascular conditions.