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The newbie’s guide to vertigo

Man with good balance hiking on river rocks

Here’s what you need to know about what causes this unpleasant dizzy sensation — and how you can feel better.

Rosemary Black

By Rosemary Black

If you’ve ever felt as if the room were spinning around you and you had no control over it, you know what vertigo feels like. It’s a form of dizziness, which is a broader term for when you feel lightheaded, faint or woozy.

When you’re dizzy, you can feel a little off. But with vertigo, in addition to the spin, you may feel as if you’re floating, swaying or tilting. In short: It’s not fun.

In some cases, “a simple movement such as lying down to get into bed can feel like you’re spinning rapidly, tumbling or falling,” says Kenny Lin, MD. He’s a neurologist at Houston Methodist Hospital in Texas.

Vertigo affects both men and women, but it’s 2 or 3 times more common in women. You’re also more likely to experience it as you get older. There are many causes and treatments, and your doctor will help you find a solution. But for an overview of what might be behind your dizzy spells, keep reading.

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What causes vertigo?

Most causes of vertigo are related to the inner ear, Dr. Lin says. “The inner ear functions as the motion detector for your body,” he says. “It’s made of 3 semicircular canals — think hula hoops — arranged at 90-degree angles to each other.”

This arrangement lets your inner ear behave like a gyroscope, explains Dr. Lin. Any movement you make causes fluid to shift in the canals. This stimulates nerve endings that let you detect motion. But if things are even a little off, vertigo can result.

One of the most common causes of vertigo is a condition known as benign paroxysmal positional vertigo (BPPV). Normally, tiny crystals in your ear help you stay sensitive to gravity.

But if they become dislodged from their usual location, say, from a head injury or other damage to your inner ear, they can make you more sensitive to changes in your head’s position, according to the Mayo Clinic. This is especially true if they get stuck in one of the semicircular canals.

People experience BPPV in different ways. But it’s most often caused by a change in your head position. Just lying down or turning over in bed can result in vertigo. And the sensation can last 10 to 15 seconds, Dr. Lin says.

Other things can trigger vertigo episodes, too, though they’re less common. Neurological problems such as a migraine or even a stroke can mess with your inner ear’s motion-sensing ability. So can allergies, thanks to inflammation in the tube that connects your throat to your eardrum. Vertigo can also be linked to a condition called vestibular neuritis. It’s a viral inflammation of the balance nerve.

“Conditions like diabetes or anemia can also trigger vertigo,” says Ileana Showalter, MD. She’s an ENT-otolaryngologist affiliated with Mercy Medical Center in Baltimore. “It can also be caused by blocked carotid arteries.” Sudden fluctuations in blood glucose can lead to dizziness, explains Dr. Showalter. Anemia and carotid artery blockage can lead to less oxygen available for your brain, resulting in dizziness, too.

Learning what causes your vertigo

Your doctor will probably ask you to explain how you feel. “You will be asked to describe the sensation, duration, triggers and any symptoms linked to dizziness and vertigo,” Dr. Lin says. “The doctor wants to understand whether you’re likely experiencing vertigo or lightheadedness or something in between.”

If your doctor suspects BPPV, they can confirm it with the Dix-Hallpike test. It involves turning your head to one side and lying flat on your back.

“The doctor will be able to tell if you have vertigo by watching your eyes,” Dr. Lin explains. “The eyes make a certain twisting, jumping movement when you’re experiencing vertigo due to crystals moving around in your inner ear.”

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Treatments that can ease vertigo

The treatment for vertigo depends on what’s causing it, says Christy Zeiss, PT, DPT. She’s a physical therapist at Marianjoy Rehabilitation Hospital, a part of Northwestern Medicine in Wheaton, Illinois.

If you have BPPV, your doctor may do some maneuvers that move your head in a certain way. These movements encourage the crystals to go back to where they belong, Zeiss says. Keep in mind that it may take several treatments before they shift.

Some medications may also help vertigo. “Over-the-counter Dramamine® may help,” Dr. Showalter says. “But first it’s a good idea to have a full evaluation by your primary care provider and an ear, nose and throat specialist.”

For more chronic cases of vertigo, you may be given specific exercises to improve your balance. Some doctors recommend vestibular therapy. It’s a form of physical therapy that focuses on training your stability and overall mobility.

If you have vestibular neuritis, you may be given medication to reduce nausea. Some examples are ondansetron (Zofran®) or metoclopramide (Reglan®). You may also be prescribed something for dizziness such as meclizine (Antivert®), diazepam (Valium®) or lorazepam (Ativan®). These medications should not be used any longer than 3 days.

Can vertigo be prevented?

That really depends on what’s causing it, says Christopher Adams, a physician’s assistant and specialist in otolaryngology at Banner Health in Tucson, Arizona. “If it’s related to a long-term medical problem like migraines, then taking a daily medication will usually help prevent vertigo or decrease its frequency,” he says.

You may worry that once you’ve had an attack of vertigo, it might happen again. “Vertigo could come back,” Adams says. “But it really depends on the underlying cause.” The types of vertigo that are most likely to happen again are those triggered by migraines, Meniere’s disease and BPPV, says Adams. “If you’re having a lot of episodes, it’s best to get evaluated.”

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Additional sources
Common causes of dizziness:
Cleveland Clinic
Overview of benign paroxysmal positional vertigo: Mayo Clinic