Key takeaways
- Vertigo is a false sense of spinning or movement, often with nausea, unusual eye movements or ringing in the ears.
- BPPV, caused by tiny loose crystals in the inner ear, is the most common type and often responds to the Epley maneuver.
- Problems in the neck can cause dizziness and imbalance that is easily mistaken for vertigo.
- Sudden vertigo with trouble speaking, weakness or a severe headache needs emergency care.
Beep, beep, beep. The alarm goes off. It's a beautiful morning and time to get going. You get out of bed and it hits you like a freight train: the room starts spinning, your balance is off and you feel sick to your stomach. No, you're not on a boat, and no, you didn't have too much wine last night. What you're experiencing is vertigo.
What is vertigo?
People often confuse vertigo with dizziness, but they're not the same. Dizziness is a general feeling of being light-headed or unsteady. Vertigo is a specific sensation that you or the room is spinning or moving. Along with that, people with vertigo may have nausea, abnormal eye movements (nystagmus), headaches, ringing in the ears and even hearing changes.
Vertigo comes from a problem in the balance (vestibular) system. There are two main types: peripheral, from the inner ear, and central, from the brain or brainstem.
Peripheral vertigo
Benign paroxysmal positional vertigo (BPPV) is the most common type. Tiny calcium crystals (otoconia) normally sit in one part of the inner ear. If they come loose and drift into the ear's fluid-filled canals, they disturb the balance signals, and certain head movements, like rolling over or getting out of bed, set off a spin.
Other inner-ear causes include Meniere's disease, a buildup of fluid that changes the pressure in the inner ear, and vestibular neuritis, inflammation of the balance nerve, usually after a viral infection.
Central vertigo
Central vertigo comes from the central nervous system, for example a problem in the brainstem or cerebellum. It is less common but more serious, and needs medical evaluation.
How is vertigo treated?
BPPV can often be relieved with specific head movements that guide the loose crystals back where they belong. The best known is the Epley maneuver. It sometimes takes a few tries. Some medications can ease symptoms of other types of vertigo.
Can neck problems cause dizziness?
Yes. Problems in the neck (cervical spine) can cause dizziness, poor balance and nausea that is easily mistaken for vertigo. This is often called cervicogenic dizziness. It can happen when the neck's joints and muscles are irritated or not moving well, because they send balance information to the brain. It's often overlooked when brain scans and inner-ear tests come back normal.
We test for this by placing the head and neck in specific positions to see whether the symptoms are reproduced. When the neck is the cause, treating the neck is the answer. If the cause isn't in the neck, we'll make sure you're referred to the right doctor for the right tests.
When to get emergency care
Call 911 if vertigo or dizziness comes on suddenly with any of these: trouble speaking, facial drooping, weakness or numbness on one side, double vision, a severe headache, or inability to walk.