Vertigo is a specific form of dizziness in which a person perceives either their own body or the surrounding environment to be moving or rotating when no such motion exists. Patients commonly describe the experience as spinning, tilting, swaying or feeling pulled to one side. Vertigo results from a mismatch of signals about head position and motion that arise from the inner ear, eyes and sensory nerves and how the brain integrates that information. It is important to distinguish vertigo from other types of dizziness such as presyncope (feeling faint), disequilibrium (imbalance when standing or walking) and vague lightheadedness.

Causes and mechanisms

Vertigo arises from problems in the peripheral vestibular system (inner ear and vestibular nerve) or from central causes in the brainstem or cerebellum. Common peripheral causes include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis and Ménière's disease. Central causes include migraine-associated vertigo, stroke involving the posterior circulation, multiple sclerosis and other lesions affecting central vestibular pathways. Additional contributors can be head injury, certain medications that affect the ear or nerves, and age-related degeneration.

Typical features and associated symptoms

Vertigo episodes vary in onset, duration and intensity depending on cause. BPPV produces brief, intense spells triggered by head position changes. Vestibular neuritis often causes a prolonged single attack of severe vertigo with nausea and vomiting. Ménière's disease may cause recurrent vertigo with hearing loss and tinnitus. Central vertigo is more likely to be accompanied by neurological symptoms such as double vision, difficulty speaking, weakness or numbness. Common accompanying signs include nausea, vomiting, imbalance, and involuntary eye movements called nystagmus.

Evaluation and diagnosis

Diagnosis begins with a careful history and physical examination. Clinicians look for timing, triggers, accompanying auditory or neurological symptoms and risk factors for stroke. Bedside maneuvers and tests often help localize the problem:

  • Dix–Hallpike test to provoke and identify positional nystagmus typical of BPPV.
  • Head impulse test to assess vestibulo-ocular reflex function.
  • Observation for direction and type of nystagmus, gait assessment and hearing testing.

When clinical features suggest a central cause or there are red flags (sudden onset, neurological deficits, vascular risk factors), neuroimaging such as MRI may be indicated. Audiological assessment can help when hearing loss or tinnitus are present.

Treatment and management

Treatment depends on the underlying diagnosis. For BPPV, particle-repositioning maneuvers (for example, the Epley maneuver) are effective and often performed in clinic. Acute peripheral vertigo may be managed with short-term vestibular suppressants and antiemetics to relieve severe symptoms, while vestibular neuritis sometimes benefits from corticosteroids early on. Long-term rehabilitation relies on vestibular rehabilitation therapy — a program of exercises that promotes compensation and improves balance. Ménière's disease management can include dietary adjustments, diuretics or procedures for refractory cases. Migraine-associated vertigo is treated with migraine prevention strategies and vestibular therapy when appropriate.

Prognosis and impact

Prognosis varies: many people with BPPV recover completely after treatment, whereas chronic conditions such as Ménière's disease or recurrent vestibular migraine may cause intermittent disability. Vertigo increases the risk of falls and can substantially affect daily activities, work and quality of life. Early evaluation helps identify treatable causes and reduces complications.

Distinguishing vertigo from other dizziness and further reading

Clear differentiation among vertigo, presyncope, disequilibrium and non-specific lightheadedness guides appropriate investigation and management. If vertigo is sudden, severe or accompanied by focal neurological signs, urgent medical assessment is required to exclude stroke. For nonmedical context or the homonymous title in film and culture, see the cinematic work Vertigo (film) which is a different subject and not related to the medical condition.

If you or someone else experiences new, severe, or progressive vertigo, seek medical attention. For reliable general information and guidance on vestibular disorders and rehabilitation, consult a qualified healthcare provider or specialist in otolaryngology or neurology.