Vertigo: Causes & Treatments
We can all feel a little bit dizzy from time to time. But when you feel that everything around you is moving or spinning – when you’re standing still – it’s a specific type of dizziness called vertigo.
Vertigo isn’t a fear of heights – though you may experience the type of dizziness associated with vertigo if you look down from a great height (the correct name for a fear of heights is acrophobia).
Vertigo also isn’t a medical condition either, but a symptom of another condition or cause (according to the Brain and Spine Foundation you could think of dizziness and vertigo like a cough, which can be a symptom of several different possible conditions or causes (i)). And other symptoms that are associated with it include nausea, vomiting and loss of balance.
Some people experience very mild vertigo, where the sensation of dizziness is hardly noticeable. Others may have much more severe vertigo that affects their ability to do everyday tasks. It can last for anything from a few seconds to several days, and can develop suddenly.
Vertigo and the balance system
According to the NHS, vertigo is commonly caused by a problem with the way balance works in the inner ear (though it can also be caused by problems in some parts of the brain) (ii).
Your sense of balance comes from the workings of your inner ears. Also called the labyrinth, the inner ear lies deep within bones in the skull and consists of the cochlea – which is responsible for hearing – and the vestibular organ, which is responsible for your balance (you have two vestibular organs – one in each ear – that work together and are often referred to as the vestibular system).
Each vestibular organ consists of three narrow tubes called the semicircular canals, which are attached to two small pouches called the utricle and saccule. These contain fluid and tiny hairs that detect head movement and send signals along the vestibular nerve to your brain, which calculates the direction and speed of the movement.
This explains why you may experience balance difficulties and dizziness if you have a problem with your vestibular system: your brain may lose its ability to calculate the direction, speed or angle of your head movements, and it may think that your head moving when it’s still.
While the workings of the inner ear play a significant role in vertigo, other things are important for your sense of balance too, including your vision and position detectors in your joints and muscles. According to the Brain and Spine Foundation, this explains why people who have lost the function of both inner ears may not entirely lose their sense of balance (i).
Causes of vertigo
There are two types of vertigo – peripheral vertigo and central vertigo. Peripheral vertigo – the most common type – is often caused by a problem with the balance system in the inner ear. Central vertigo, on the other hand, is caused by a problem in a certain part of the brain. Certain conditions that cause vertigo can also trigger other symptoms, including tinnitus (ringing in your ears), hearing loss and a raised temperature.
There are several different causes of peripheral vertigo, including the following:
Benign paroxysmal positional vertigo (BPPV)
One of the most common causes of vertigo, BPPV triggers short-lived but intense vertigo attacks where you experience a revolving or spinning sensation. You may also feel lightheaded and unable to balance for minutes or hours after the attack.
BPPV is often triggered when you move your head in a specific way (when looking up, for instance), or when you stand up, bend over or turn over in bed. Experts believe BPPV is caused by a build-up of fragments (or crystals) within the posterior semicircular canal, which is part of the balance system in the inner ear. Most cases are found in people over the age of 50.
An infection of the inner ear (or labyrinth) most often caused by a viral infection such as a cold or flu, labyrinthitis can cause sudden dizziness with a spinning sensation, and can also make you feel nauseated and unsteady on your feet. Vertigo caused by labyrinthitis can also cause hearing loss, tinnitus, ear pain and a raised temperature. Symptoms can last from a few days to a few weeks, though a small number of people will experience recurrent symptoms, either spontaneously or when they have another cold or bout of flu.
This is rare condition that affects the inner ear that can cause vertigo as well as other symptoms such as tinnitus, ear pressure and hearing loss. It can cause sudden and repeated attacks of vertigo, accompanied by nausea and vomiting, that can last from two to 24 hours. According to the Brain and Spine Foundation, people with Ménière’s disease who are having a vertigo attack can often look as if they’re drunk, as the symptoms are so similar (i). Specialists don’t know exactly what causes Ménière’s disease, but a build-up of pressure in the inner ear is believed to cause an attack.
Another inner ear condition, this causes the nerve that connects the inner ear to the brain to become inflamed, and – like labyrinthitis – is usually caused by a viral infection. As well as vertigo, it can cause unsteadiness, nausea and vomiting for a few hours or days, though according to the NHS it may take a few weeks to settle completely (iii).
Other things that may cause peripheral vertigo include head injuries and taking certain types of medication.
Caused by some types of neurological disorders, central vertigo is less common than peripheral vertigo, and may be caused by one of the following:
As well as the usual symptoms of migraine – including a throbbing headache, nausea, vomiting, visual disturbances and sensitivity to light – some sufferers also experience vertigo.
A condition that affects the brain and spinal cord (central nervous system), multiple sclerosis can cause vertigo too in some people.
If you have a tumour in your cerebellum – the area at the bottom of the brain – you may suffer from vertigo attacks. Another brain tumour that’s rare and non-cancerous, called an acoustic neuroma, can also cause vertigo as the tumour grows on the acoustic nerve (the nerve that helps to control not just your hearing but also your balance).
If you have a stroke or a transient ischaemic attack (TIA or mini stroke), the blood supply to part of your brain has been disrupted temporarily. This can cause dizziness and problems with balance and co-ordination.
Taking some types of medication may also cause central vertigo, as may having bony deformities at the back of the head and at the top of the spine.
Treatments for vertigo
If you have vertigo, the treatment you may receive will depend on what’s causing it. For instance, if you have vertigo caused by a migraine, taking migraine medication or remedies may help relieve the vertigo too.
Some people who have vertigo may be prescribed tranquilisers or a course of cognitive behavioural therapy (CBT) to help reduce stress and anxiety. Others may find that a medicine they’re taking is making them feel dizzy – some blood pressure medicines can cause dizziness in high doses, for instance. If you suspect a drug you’re taking is causing vertigo, discuss it with your GP to find out if there are any alternative medications you could take instead.
Meanwhile, the main causes of vertigo may be treated as follows:
Benign paroxysmal positional vertigo (BPPV)
This isn’t treated with medication as most cases tend to clear up without any treatment. However, there are certain movements and exercises that are used to treat BPPV, including the Epley manoeuvre – a series of four head movements where you hold each position for at least 30 seconds. If this isn’t effective, your GP may show you how to do other movements called Brandt-Daroff exercises that you can do at home, which may help relieve your symptoms for up to two weeks.
Meanwhile, those who have a severe case of BPPV, where they’ve had vertigo for months or years, may be advised to have surgery to block one of the canals in the ear.
As this infection is caused by a virus, antibiotics aren’t used to treat it (in rare cases, labyrinthitis is caused by a bacterial infection, in which case antibiotics can be effective). That’s why viral labyrinthitis is left to clear up on its own. It can, however, also be treated by a series of exercises called vestibular rehabilitation, where your brain is ‘retrained’ to adapt and rely on the signals from other parts of your body than your inner ear. This can help reduce dizziness and improve balance.
You can find more information about vestibular rehabilitation exercises on the Brain & Spine Foundation’s website.
Medication is available to treat and prevent attacks of Ménière’s disease – including antihistamines and other medicines used to treat travel sickness – which can help reduce the symptoms of this condition, including vertigo. However, diet may also help (people with Ménière’s disease are often recommended to try cutting down on salt (iv)).
As with labyrinthitis, vestibular neuronitis is usually left to clear up on its own, as antibiotics are ineffective against it in most cases. It can also be treated with medication such as antihistamines, and with vestibular rehabilitation.
Living with vertigo
If you have vertigo, avoiding stressful situations can help, as according to the NHS anxiety can make the symptoms of vertigo worse (ii). During an attack, it can help to lie still in a quiet, darkened room, as this may relieve the sensation of spinning.
There are other things you can do too, including the following:
Give up smoking
Having vertigo may be a good excuse to quit if you’re a smoker. That’s because the nicotine in tobacco smoke makes your blood vessels narrower, and that could affect the blood supply to your inner ear. Read our guide on how to stop smoking here.
Drink less alcohol
Cutting down on alcohol may also help, as some experts believe dizziness may be triggered by changes in the body’s fluid balance (alcohol is a diuretic, which means it increases urination and can lead to dehydration) (v). Alcohol misuse can cause many health problems, learn about them here.
Cut down on caffeine
Found mostly in coffee, tea, caffeinated fizzy drinks and chocolate, this is also thought by some to affect the body’s fluid balance. Caffeine is also a stimulant that can affect the nerves in the inner ear.
Eat less salt
People with Ménière’s disease are often advised to adopt a low-salt diet, as salt can also affect your fluid balance (iv). Try not to add salt to your food, and be aware of the level of salt in any processed foods you buy, including bread, pastries, breakfast cereals and ready meals (aim for less than 6g salt a day).
If you have vertigo, you may be tempted to avoid moving around whenever possible, especially if you have the kind of vertigo that’s triggered by head and body movements (as with benign paroxysmal positional vertigo or BPPV). According to the Brain and Spine Foundation, unless you’re having an attack, avoiding movement can make vertigo worse (i). Instead of being as inactive as possible, try to move more (the Brain and Spine Foundation recommends exercises such as tai chi that have been shown to improve your balance (i)).
Get plenty of sleep
Tiredness can make vertigo worse in some cases, so don’t try to burn the candle at both ends – aim for seven to eight hours of sleep a night.
Meanwhile, it’s important to consider your safety if you have vertigo. It could, for instance, affect your ability to drive (if affected, you must inform the DVLA about your condition). Also make sure your employer knows you have vertigo, especially if you operate machinery. You may also want to take steps to reduce your risk of having a fall at home, such as using non-slip rugs and mats, and removing clutter, wires or other objects that you could potentially trip over.
Natural support for vertigo
Research studies into complementary treatments for vertigo are few and far between. However, two natural supplements have shown some promise, namely ginkgo biloba and ginger.
Thought to be the oldest surviving species of tree, ginkgo biloba seeds are used for a number of health problems in traditional Chinese herbal medicine, with modern herbal remedies made from the tree’s leaves.
Arguably the most popular use for ginkgo is to help boost blood circulation to the extremities, including the brain. There’s also evidence that it may also help relieve the symptoms of vertigo.
One study suggests ginkgo extract performs better than placebo, with 47 per cent of people taking ginkgo recovering from vertigo symptoms after three months compared with just 18 per cent in the placebo group (vi). Researchers elsewhere claim ginkgo extract is as least as effective as a frequently prescribed anti-vertigo drug called betahistine (vii).
Ask your GP for advice before taking a ginkgo supplement if you’re taking any blood-thinning medication, such as aspirin or warfarin.
This herb is thought to boost digestive fluids and neutralise digestive acids. This may help relieve the nausea associated with vertigo because it has a calming effect on the gut. Studies also suggest ginger may be useful for relieving various forms of nausea (viii), including motion sickness (conventional treatments for vertigo include motion sickness medicines, with one study claiming ginger is as effective at treating sea sickness as an antiemetic travel sickness drug called dimenhydrinate (ix)).
One small-scale study also found that powdered ginger root reduced induced vertigo significantly better than placebo (x).
Meanwhile, hypnosis has been found to be effective at treating vertigo caused by head injury (xi).
Vertigo can be an unsettling experience, but following some of the steps above could help you manage its effects. To find out how to manage other common health conditions, visit our health library.
Brain & Spine Foundation. Dizziness and balance problems. Available online: https://www.brainandspine.org.uk/wp-content/uploads/2018/02/BSF_Dizziness-and-balance-A5-booklet.pdf
Available online: https://www.nhs.uk/conditions/vertigo/
Available online: https://www.nhs.uk/conditions/vestibular-neuronitis/
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Cedercreutz. C, Lahteenmaki. R, Tulikoura. J. Hypnotic treatment of headache and vertigo in skull injured patients. Int J Clin Exp Hypn. 1976;24:195–201. Available online: https://www.tandfonline.com/doi/abs/10.1080/00207147608416201
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.