Vertigo: symptoms, causes and treatments

Vertigo and dizziness?

Learn more about vertigo, which is usually closely related to the inner ear.

What is vertigo and dizziness?

Vertigo is defined as the sensation of movement of the environment or of oneself turning, or of precipitation into the void which does not actually exist. It is a very uncomfortable feeling that is usually accompanied by nausea, loss of balance (dizziness) and a feeling of imminent fainting.

Dizziness and vertigo should not be confused. While in vertigo a fictitious movement is perceived, (it is not actually taking place), dizziness is a broader feeling of lightheadedness or disorientation.

Vertigo is almost always related to an alteration of the vestibular system, located inside the inner ear, which coordinates our balance, as well as our posture, and can be momentary or last hours or even days. This disorder can affect anyone, although in children it presents in the form of spontaneous and temporary crises and in the elderly it can evolve into chronic instability.

Types of vertigo

Peripheral vertigo

Peripheral vertigo is the most frequent type of vertigo and appears as a result of a change in the labyrinth (inner ear) and the vestibular nerve (in charge of transporting information about balance from the inner ear to the brain). It is associated with hearing loss and pressure in the ears.

Central vertigo

Central vertigo, on the other hand, occurs due to the alteration of the neurological mechanisms of the vestibular system itself and can be accompanied by double vision, instability and severe headaches. In addition, it can be objective or subjective, depending on whether the patient feels that they revolve around things or if they perceive that it is their environment that seems to revolve around them, respectively.

Cervical vertigo

Cervical vertigo, as its name suggests, arises as a result of a cervical problem, be it a bad position of the neck vertebrae or another type of cervical disorder.


Benign paroxysmal positional vertigo is a common disorder that causes brief episodes of vertigo in response to changes in the position of the head that stimulate the posterior semicircular canal of the inner ear.

Causes of vertigo and dizziness

One of the most common causes of vertigo is alterations in the nerve connection from the ear to the brain or in the brain itself, but there are many more, such as:

  • Infections: viral or bacterial ear infections that affect the inner ear such as labyrinthitis.
  • Menière's disease: a disorder whose cause is unknown which produces sudden bouts of vertigo is often accompanied by tinnitus (ringing in the ears), hearing loss, and nausea.
  • Abnormal blood pressure: this is especially the case in older people who take drugs to control hypertension or other heart diseases and may faint when they stand up abruptly, precisely because of a drop in blood pressure (orthostatic hypotension).
  • Neurological disorders: multiple sclerosis, skull fractures, tumors (especially those that develop at or near the base of the brain), or strokes.

Main symptoms of vertigo

The most frequent clinical sign that shows if you are suffering from vertigo is the sensation that the room you are in is spinning or that the body itself is in motion. However, there are also other  symptoms of vertigo:

  • Ringing in the ears (tinnitus).
  • Hearing loss in one ear.
  • Dizziness
  • Loss of balance
  • Double vision.
  • Facial paralysis.
  • Difficulty speaking
  • Difficulty focusing with the eyes.
  • Weak limbs.
  • Cold sweats.
  • General malaise.


Vertigo diagnosis

To perform a diagnosis for vertigo, the first step will always be to determine the nature of the problem and its cause. To do this, the ENT doctor will have the patient fill out a questionnaire to understand the symptoms that accompany the dizziness, its duration, possible triggers or what might produce relief.

The specialist will then proceed to vestibular testing, analyzing the ears, nose, oral cavity, nasopharynx and larynx. The vestibular tests are a series of diagnostic tests to learn more about the status and possible involvement of the inner ear, the vestibular labyrinth and the semicircular canals. Among these tests, the most common are electronistagmography or rotation tests , among others. It may be necessary to study nystagmus, a reflex disorder that manifests itself with rapid and uncontrolled movements of the eyes (either side to side, up and down or rotating) and is justified by the connection between the brain, vestibular system and nuclei of eye movements. The physician will attempt to stimulate nystagmus by jerking the patient's head or alternately introducing drops of hot and cold water into the ear canal.

Likewise, a computed tomography or an MRI of the head may be required, which would show, if present, bone alterations or tumors in the facial or acoustic nerve. In case your doctor suspects a meningeal infection, he will perform a lumbar puncture and, to confirm an insufficiency in the blood supply, he might order an angiography. These tests offer the specialist the information they need to determine how to deal with episodes of vertigo.


Treatment for vertigo and dizziness

The treatment of vertigo depends on what causes it, so it will not be the same in all cases. Several drugs exist to treat is, which are always suggested depending on each patient's case:

  • Diuretics, to reduce the amount of water in the inner ear and with it the feeling of vertigo
  • Betahistine, which reduces the activity of vestibular neurons
  • Calcium antagonists and cell protectors 

It is very common for all these drugs to cause drowsiness, especially in the elderly, so these prescriptions must be accompanied by a low-salt diet, a combination that is effective in 70% of cases.

If this first option is not effective,  treatment with intratympanic gentamicin, an antibiotic that is injected through the eardrum, passes into the middle ear and acts on the balance cells. If this does not solve the problem either, the only possible way is to go under the knife to undergo a vestibular neuroctomy, where the balance nerve is cut while maintaining the patient's hearing, or a  labyrinthectomy, which involves the removal of all sensory receptors for balance, with consequent hearing loss.

BPPV is triggered by sudden movements and it originates in the deposit of calcareous-type remains ("ear crystals") in one of the semicircular canals of the inner ear. In this case to treat it, the said material must be extracted from an area where it should not be.

Hearing aids and vertigo

A hearing aid can do much more than just improve hearing: since hearing loss is sometimes also associated with a worsening of balance, hearing aids have been shown to improve balance by reducing vertigo and protecting patients against the risk of falls.

Hearing aids allow us to improve orientation skills and detect the origin of sounds and to better understand the space around us which in turn can help in avoiding vertigo or other types of faintings.

Natural remedies for vertigo

  • Lie down: If you suddenly feel dizzy, lie down directly, put your legs up and place a cool cloth on your head or on your neck. 
  • Massage: A neck massage can help relieve tension and thus help against dizziness. 
  • Ginger: Ginger stimulates the blood flow towards the brain and thereby reduces dizziness.  
  • Chocolate or grape sugar: The sugar contained can quickly get the circulation going again. 
  • Water: Drinking a glass of water can usually help with mild dizziness and is important for people who are prone to dizziness. 
  • Homeopathy : Homeopathic remedies can help as long as the cause is not dangerous. However, when homeopathic remedies are taken, improvement should occur quickly. Low potencies like D6, D12 or D30 are used for dizziness. Extracts from the medicinal plant Ginkgo promote blood circulation in the inner ear and can help to improve the symptoms of dizziness. 
  • Bryonia, if you are dizzy after getting up or lying down
  • Belladonna, for severe and sudden dizziness 
  • Gelsemium when you feel like falling or when your vision is blurred 

Vertigo and dizziness in different situations

Dizziness can arise in various everyday situations. Let's see the most common ones:

Can stress cause vertigo and dizziness?

The reasons for stress-related dizziness can be found in one's living environment and can often be pointed out by the person in question. Anyone who feels uncomfortable in the workplace runs the risk of having these kinds of problems. Excessive demands can have negative effects as well as constant discussions with colleagues or superiors. The physical environment in which you work also plays an important role. Constantly staying in dark or excessively lit rooms can lead to stress and dizziness.

Benign positional vertigo

Benign paroxysmal positional vertigo is a common vestibular disorder that causes dizziness and other symptoms. This is caused by debris that has accumulated in part of the inner ear. These deposits, called otoliths, are made up of small crystals of calcium carbonate, also called "ear stones". When the head moves, the otoliths wander and send false signals to the brain.

Vertigo in elderly

Vertigo in elderly can arise due to a problem with the vestibular, central, and visual systems. Also, dizziness can be caused by neuropathy, psychological reasons, or unknown causes. However, vestibular syndrome is believed to be the most common cause of age-related dizziness and is responsible for 50% of dizziness in older people.

Vertigo and dizziness in children

Vertigo in children is found more often than imagined: it is a frequent disorder in children and about 15-20% of school-age children suffer from it. In most cases, it is a transient disorder and the most common causes can be:

  • head trauma;
  • middle ear infections;
  • inner ear infections such as labyrinthitis and vestibular neuritis;
  • migraine;
  • lowering of pressure.

However, in some cases, it is benign paroxysmal childhood vertigo, a form of balance disorder with no concrete cause that tends to diminish completely with growth. Regardless of the cause, the choice of therapy always depends on the form of vertigo the child suffers from. In most cases, it can be treated by: rest, lifestyle changes, use of antibiotics or antihistamines.

Cervical vertigo

In about 40% of cases, there is a functional disorder in the cervical spine that causes dizziness. For example, the cause can be pain in the head, neck and shoulders, as well as muscle tension due to poor posture, a slipped disc or even accidental trauma. In addition to acute sleepiness, tingling or numbness in the hands and arms, and difficulty concentrating, there are also dizziness. In the region of the neck, shoulders and arms, symptoms manifest themselves in the form of acute or chronic pain or movement disorders.

Vertigo in bed and when lying down

Dizziness before bedtime, like dizziness in general, can be the result of many different conditions. In addition to an organic change that can be used to explain dizziness, psychological problems and stress also often play a role in the development of dizziness in bed and when lying down.

Vertigo and anxiety

Positional phobic vertigo is a vertigo that usually occurs in stressful situations and is not accompanied by symptoms such as nausea and vomiting or brain stem symptoms.

Waking up with vertigo

Gravity causes blood to build up in the veins in your legs and trunk as soon as you get up. This lowers blood pressure and the amount of blood the heart pumps to the brain. Dizziness is caused by low blood flow to the brain.

Vertigo after sport and exercises

A common cause of dizziness after sports and exercise is hypoglycemia. Sugar is consumed faster during exercise. As soon as the body feels a lack of sugar, it reacts with nausea or other symptoms such as tremors, headaches and dizziness. That's why you shouldn't avoid eating before exercising.

Preventing vertigo

Do you want to know how to  reduce the risk of vertigo? Some recommendations to achieve this would be to avoid or rapid movements or extreme positions of the head, as well as to minimize the circumstances that can trigger this condition, such as anxiety, the use of substances that cause allergies or stress.

How long does vertigo last?

Attacks of vertigo can come on suddenly and last from a few seconds to a few hours; more severe dizziness can last for days or months.

Is vertigo hereditary?

Vertigo itself is not necessarily hereditary, but it is often the symptom of a disease, such as Meniere's syndrome, which can be hereditary.

Can you drive with vertigo?

You should avoid driving if you have had recent episodes of dizziness, as a matter of safety. If dizziness occurs while driving, it is best to stop and wait for it to pass if possible.

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