Vertigo
Also known as BPPV, Benign paroxysmal positional vertigo
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is vertigo?
Vertigo is the illusion that you or your surroundings are moving, usually spinning. It is a symptom rather than a diagnosis. The commonest cause is benign paroxysmal positional vertigo, in which displaced inner ear crystals cause brief spinning on head movement and which can be cured in minutes by a repositioning manoeuvre.
Causes
- Displaced otoconia in benign paroxysmal positional vertigo
- Vestibular neuritis following viral infection
- Meniere disease
- Vestibular migraine
- Stroke affecting the brainstem or cerebellum
- Medication side effects
Symptoms
- Spinning sensation triggered by head movement
- Brief episodes lasting under a minute in BPPV
- Nausea and vomiting
- Loss of balance and unsteadiness
- Nystagmus with involuntary eye movement
- Hearing loss or tinnitus in inner ear causes
- Prolonged severe vertigo in vestibular neuritis
Risk factors
- Age over 50
- Female sex
- Previous head injury
- History of migraine
- Vascular risk factors for central causes
- Prolonged bed rest
Diagnosis
- Dix Hallpike manoeuvre to confirm posterior canal BPPV
- HINTS examination to distinguish peripheral from central causes
- Audiometry when hearing is affected
- MRI if central cause is suspected
- Blood pressure measurement lying and standing
Treatment
- Epley repositioning manoeuvre for BPPV
- Vestibular rehabilitation exercises
- Short term vestibular sedatives only, to avoid delaying compensation
- Treating underlying migraine or Meniere disease
- Urgent stroke pathway if central features are present
- Falls prevention advice
Self care
- Move slowly when changing position, especially getting out of bed
- Sit down immediately when an episode starts
- Learn the Epley manoeuvre for BPPV if taught by a clinician
- Do vestibular rehabilitation exercises consistently
- Avoid long term use of vertigo medication
- Remove trip hazards and use night lighting
- Do not drive during active episodes
When to see a doctor
Book an appointment if:
- Recurrent episodes triggered by head movement
- Vertigo with hearing loss or tinnitus
- Episodes lasting hours rather than seconds
- Persistent unsteadiness between episodes
- Falls or near falls
- Vertigo not settling after a few days
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Treat BPPV promptly with repositioning to prevent recurrence
- Manage migraine if vestibular migraine is the cause
- Reduce salt and caffeine in Meniere disease
- Address cardiovascular risk factors
- Stay active to maintain balance function
- Review medicines that cause dizziness
Outlook
BPPV responds extremely well to repositioning manoeuvres, with most people resolving after one or two treatments, though recurrence over years is common. Vestibular neuritis improves over weeks as the brain compensates, helped by rehabilitation rather than by prolonged medication. Central causes require different treatment, which is why distinguishing them matters.
Common questions
How can I tell dangerous vertigo from benign vertigo?
Warning features include new severe headache, double vision, slurred speech, limb weakness, numbness, difficulty walking out of proportion to the spinning, or vertigo that is constant rather than triggered by position. These need emergency assessment for stroke.
How effective is the Epley manoeuvre?
Very. It resolves symptoms in around 80 to 90 percent of people with posterior canal BPPV, often after one or two treatments, and can be repeated if symptoms return.
Should I take vertigo medication long term?
Generally no. Vestibular sedatives such as prochlorperazine help acute severe symptoms for a few days but delay the brain natural compensation if continued, and they do not treat BPPV.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.