Vertigo: What Is It, Its Symptoms, Causes, and How Does It Go Away?

Vertigo (dizziness) is a frequently encountered condition in which a person feels that they or their surroundings are spinning. This sensation is one of the primary reasons for seeking primary healthcare services and for visiting the emergency department. A large majority of patients who present with dizziness in the emergency department experience vertigo originating from the inner ear. These episodes of dizziness are severe and very intense. The person feels as if their surroundings are spinning forcefully. Consequently, severe nausea and vomiting may accompany the dizziness. Such episodes indicate a pathology within the vestibular system. Vestibular evaluations conducted during the acute phase are very beneficial for diagnosis. Therefore, with an accurate diagnosis, treatment and rehabilitation can commence without delay.

Doctor Audiologist Emel Uğur

Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. During her 15-year tenure at Istanbul Training and Research Hospital, she primarily worked on Pediatric Audiology (Hearing Loss in Infants and Children), Otological Diseases (Ear Diseases and Hearing Health), and Vestibular System Disorders (Vertigo and Imbalance). In 2015, she joined the Acıbadem Healthcare Group.

About Me

Is Vertigo a Common Health Problem?

Vertigo, or dizziness, is an active condition. Acute cases characterized by dizziness and imbalance are 80% vestibular (originating from the inner ear) and 20% central (originating from the central nervous system). Therefore, accurately identifying vertigo symptoms is extremely important.

Vertigo can affect people of all age groups. Moreover, it can occur for different age-related reasons:

In the younger population, conditions such as BPPV, Meniere’s disease, vestibular neuritis, and vestibular migraine are more frequently encountered. With advancing age and the presence of systemic diseases, central etiologies should be excluded first. Age-related changes also occur in the inner ear, referred to as presbyvestibulopathy. Individuals who develop presbyvestibulopathy may experience chronic imbalance and acute episodes of vertigo. These individuals are more prone to BPPV. In elderly patients, a comprehensive evaluation is essential, taking into account the risk of falls and any other potential complications.

For both age groups, the condition requires an individualized evaluation and a treatment/rehabilitation approach. Once diagnosed, vertigo is a manageable health problem with appropriate interventions, and it can significantly affect patients’ quality of life.

What Are the Factors That Cause Vertigo?

Vertigo is examined in two main types: peripheral and central. Peripheral vertigo originates from problems in the inner ear and is generally more common. Central vertigo, on the other hand, occurs in association with issues in the central nervous system.

• Among the types of peripheral vertigo, benign paroxysmal positional vertigo (BPPV) is the most common. BPPV is triggered by changes in head position and typically causes short episodes of vertigo. This condition is related to the displacement of calcium carbonate crystals in the inner ear.

Another form of vestibular vertigo is Meniere’s disease. Meniere’s disease is characterized by an abnormal increase in fluid pressure in the inner ear. Patients usually present with vertigo along with complaints of hearing loss, a sensation of fullness in the ear, and tinnitus. It is important that this is regularly documented. In Meniere’s disease, vertigo can last from 20 minutes to 24 hours. Hearing loss and a feeling of fullness in the ear may resolve spontaneously after an attack, although some hearing loss may become permanent. In fact, hypofunction in the vestibular system on the affected side may also develop. Therefore, proper documentation is crucial for the treatment plan. In Meniere’s disease, medical treatment is arranged by an ENT specialist, and vestibular rehabilitation should be initiated immediately when Meniere’s disease is suspected.

Labyrinthitis and vestibular neuritis generally occur as a result of viral infections. These conditions initiate an inflammatory process in the inner ear, leading to imbalance and a sensation of vertigo. While labyrinthitis affects larger areas of the inner ear, vestibular neuritis targets only the vestibular nerve.

Vertigo and balance disorders should be addressed through a multidisciplinary approach, taking into account the patient’s detailed history and physical examination. The diagnosis is shaped by the duration of symptoms and other accompanying signs. The tests to be performed may vary depending on the situation. Whether or not there are auditory complaints, a hearing examination should be conducted for differential diagnosis.

• Central vertigo is due to issues in the central nervous system. The most common central vertigo is vestibular migraine (migraine-associated vertigo). Vertigo during a migraine attack or as a condition accompanying migraine can be observed along with headache, nausea, and light sensitivity. Although motion sickness or visually induced motion sickness (VIMS) may not primarily cause vertigo, they can lead to significant imbalance. The treatment of these conditions is planned by neurological specialists, and vestibular rehabilitation aims to help patients cope with attacks and improve their quality of life.

Some tumors, especially those affecting the brain and nervous system, such as schwannoma or meningioma, are among the triggers of vertigo.

Conditions such as stroke, brain tumors, and multiple sclerosis are also evaluated under this category. Damage occurring in the brainstem and cerebellum can lead to vertigo along with various neurological symptoms.

What Other Conditions Might be Associated with Vertigo?

Vertigo is a common health problem in the community. Epidemiological studies have shown that the prevalence of vertigo in women is approximately two to three times higher than in men. As age advances, the prevalence of vertigo also increases, which has a significant impact on the general population.

Vertigo (dizziness) can be associated with various health conditions, and these conditions generally require a complex differential diagnosis process. The sensation of vertigo can originate from central or peripheral lesions of the vestibular system. Moreover, this condition is often confused with imbalance and presyncope symptoms. Therefore, it is important that patients exhibiting vertigo symptoms are carefully evaluated.

Other conditions characterized by vertigo play a critical role in understanding the prevalence of vertigo. In addition to peripheral and central causes, some conditions that can cause dizziness and imbalance include: some conditions are as follows:

• Vitamin D deficiency
• Anemia
• Systemic diseases
• Cardiovascular diseases
• Neck problems
• Depression

According to general population studies, the annual prevalence of vertigo is approximately 5%, while the annual incidence is 1.4%. In adults, dizziness and balance problems affect approximately 15 to 20% annually. Specifically, the annual prevalence rates for benign paroxysmal positional vertigo and vestibular migraine are 1.6% and less than 1%, respectively.

Research shows that a large portion of individuals experiencing vertigo have interruptions in their daily activities, leading to consequences such as loss of workforce and the need for additional medical assistance. The prevalence of Meniere’s disease has recently been reported as 0.51%, which is a significant increase compared to previous periods.

In recent years, the number of epidemiological studies on imbalance has increased. A population-based study in Sweden found that the one-year prevalence of imbalance reported without a sensation of spinning was 9.2%. A national health interview survey in the United States reported that 15% of adult Americans experienced dizziness or balance problems in the past 12 months. The prevalence and effects of vertigo have a significant impact on individuals’ quality of life. Balance tests conducted among older adults and the associated health problems of vertigo provide important data for health policies and clinical practices.

What Happens in the Body During Vertigo?

Vertigo can manifest as a symptom of many different health problems. Asymmetry in the vestibular system is one of the main causes of this condition. This asymmetry usually presents itself as a sensation of spinning, creating the illusion that objects in the environment are moving. Dizziness triggers feelings of nausea and vomiting. Consequently, sweating, blood pressure fluctuations, fatigue, difficulty concentrating, and even emotional symptoms may also occur.

According to general population studies, the annual prevalence of vertigo is approximately 5%, while the annual incidence is 1.4%. In adults, dizziness and balance problems affect approximately 15 to 20% annually. Specifically, the annual prevalence rates for benign paroxysmal positional vertigo and vestibular migraine are 1.6% and less than 1%, respectively. Damage to structures such as the vestibular labyrinth or nerve can cause severe vertigo and trigger other symptoms. The prevalence of Meniere’s disease has recently been reported as 0.51%, which is a significant increase compared to previous periods. During attack phases, patients may experience loss of workforce and other socio-economic difficulties.

In cases of dizziness and chronic imbalance, compensation eventually develops. This adaptation process usually takes a few days to several weeks, resulting in a reduction of symptoms. However, underlying symptoms that negatively affect an individual’s quality of life may persist. If adequate adaptation does not occur, significant limitations in daily activities may develop. These individuals may be reluctant to go out alone, which can lead to loss of workforce, withdrawal from social life, and even social isolation. Consequently, additional medical assistance may become necessary, making this an important health problem from an economic standpoint.

In recent years, the number of epidemiological studies on chronic imbalance has increased. A population-based study in Sweden found that the one-year prevalence of imbalance reported without a sensation of spinning was 9.2%. A national health interview survey in the United States reported that 15% of adult Americans experienced dizziness or balance problems in the past 12 months. The prevalence and effects of vertigo have a significant impact on individuals’ quality of life. Balance tests conducted among older adults and the health issues accompanying vertigo provide important data for health policies and clinical practices.

What Are the Vertigo Symptoms and Which Examination Techniques Are Used?

Vestibular function tests can reveal abnormalities in the function of specific vestibular organs or the vestibular nerve. However, before beginning the evaluation, a detailed patient history should be obtained. Some medications can affect the vestibular system and cause vertigo symptoms, and similarly, the use of alcohol and other substances should also be taken into account.

Among these are bedside tests, which include simple cerebellar tests and postural tests.

The tests performed for the accurate diagnosis of dizziness and imbalance include:

• VNG tests
• Caloric test
• VEMP (Cervical, Masseter, and Ocular Vestibular Evoked Myogenic Potentials)
• v-HIT (Video Head Impulse Test)
• Posturographic tests, etc.

Even in cases of BPPV, evaluation cannot be performed with a single test because each vestibular test method targets a different anatomical structure or physiological aspect. Therefore, detailed examinations are essential to achieve an accurate diagnosis, to identify the patient’s problem, and to enable appropriate treatment/rehabilitation. However, it should not be assumed that every test must be performed for all cases of dizziness.

Additionally, among the other factors that should be considered in all cases of dizziness and balance disorders are the patient’s hearing status and past medical history. The presence, type, degree, configuration of hearing loss, or normal hearing are important in the differential diagnosis of the cause of dizziness.

How Is Vertigo Treated and Managed?

Peripheral vertigo is a condition arising from a vestibular system disorder, and its treatment is determined by the underlying cause. Once the etiology is established, the management of symptoms becomes more effective. Various medications are used during acute attacks to alleviate vestibular symptoms. The medications prescribed should be planned by your physician based on the characteristics of your symptoms.

In addition to medication, some patients may require more comprehensive methods. For individuals with persistent vestibular dysfunction, vestibular rehabilitation is absolutely necessary. Rehabilitation consists of systematic exercises that enhance the brain’s ability to use various sensory inputs to maintain balance. Patients with chronic vestibular hypofunction may struggle even with balance skills that previously seemed easy, which can undermine their motivation. Vestibular rehabilitation programs focus on improving the skills that the individual is unable to perform. Although the initial phase of the rehabilitation process is usually challenging, the patient’s stability and motivation are key. In a well-designed vestibular program, the individual’s balance control will definitely improve, and this requires cooperation between the patient and the audiologist.

The benefits of rehabilitation include:

• Management of vertigo attacks
• Reduction in accompanying vertigo symptoms
• Improvement in balance control and achievement of postural stability
• Improvement in daily activities

Such effects are observed.

Another important factor in managing vertigo is diet and lifestyle changes. Particularly, patients with Meniere’s disease can control their symptoms by reducing the intake of salt, caffeine, and alcohol. In some cases, a medical treatment plan may be formulated based on the severity of the symptoms, and the treatment plan will be arranged by an ENT specialist.

For patients with benign paroxysmal positional vertigo (BPPV), the primary and most effective treatment method recommended is canalith repositioning maneuvers. The most well-known maneuver is the Epley maneuver. However, the Epley maneuver is not suitable for every case of BPPV and should definitely not be performed alone at home.

What Other Health Problems Might Be Associated with Vertigo?

Vertigo can be associated with various health conditions, and these conditions generally require a complex differential diagnosis process. The sensation of vertigo can originate from central or peripheral lesions of the vestibular system. Moreover, this condition is often confused with imbalance and presyncope symptoms, so careful evaluation of patients exhibiting vertigo symptoms is essential.

What Are the Potential Complications Associated with Vertigo and Imbalance?

Vertigo and chronic balance disorders are manageable conditions, but there are various potential complications as well. Falls during acute dizzy spells can lead to dangerous injuries, particularly in elderly individuals, where falls can result in head trauma or fractures. Additionally, severe and recurrent vertigo attacks can significantly affect a person’s daily activities.

• Social isolation: When vertigo is experienced continuously, individuals may avoid interacting with the outside world.
• Anxiety and depression: Fear of imbalance and falls can lead to psychological issues.

Chronic imbalance and vertigo can negatively impact work life, leading to decreased performance and even loss of workforce or unemployment. These issues must be evaluated in a multidisciplinary and patient-centered manner.

What Are the Vertigo Patient Management and Prevention Strategies?

Firstly, during acute vertigo attacks, it is essential to focus the eyes on a fixed point. Especially in peripheral vestibular disorders, the vestibular system may be functioning inadequately or erroneously. Therefore, to correct the resulting erroneous perception of movement (the sensation that everything is spinning), it is necessary to ensure the stability of vision and proprioception (sensory input from the musculoskeletal system). For this reason, individuals experiencing dizziness should not close their eyes during an attack; instead, they should focus on a fixed point. In this way, even if the vestibular system mistakenly perceives motion when there is none, the input from other sensory systems continuously provides data to the central nervous system to correct the error. Focusing on a fixed point for 1-2 minutes during an episode will help subside the dizziness. After this phase, resting without movement for a while is soothing. It should be remembered that head movement can trigger dizziness again. After controlling the dizziness and resting for a while, you should seek medical attention.

Patients with chronic imbalance or active dizziness may try to remain motionless for a period after treatment due to anxiety caused by the dizziness. In fact, it is beneficial for these patients to continue with their daily activities and remain active, as this supports vestibular compensation and contributes to the recovery process. Of course, triggers should be avoided during this period.

Prolonged medical treatment (medication use) for dizziness and chronic imbalance may delay vestibular recovery. Therefore, these medications should be used carefully and always under a physician’s supervision.