Vertigo is the sensation that you or your surroundings are spinning while you are actually standing still. How it goes away depends on its cause. In the most common cause, dislodged ear crystals, a repositioning maneuver applied to the correct ear resolves the complaint in one or two sessions for most patients. When the balance nerve is inflamed, the severe spinning eases within a few days, while balance returns over several weeks. During an attack, sitting down immediately, fixing your eyes on a stationary point and avoiding sudden head movements are the first steps that help most. Dizziness that comes with slurred speech, facial drooping or weakness in an arm or leg is an emergency.
How do you get rid of vertigo?
The first thing I do during an examination is work out whether the dizziness being described is really vertigo. Some patients who say "I feel dizzy" are describing their vision going dark, others a light-headed or unsteady feeling. In true vertigo, the surroundings spin or the person feels as if they are spinning. Most vertigo originates in the inner ear, and treatment changes according to the cause.
Dislodged ear crystals (BPPV)
Benign paroxysmal positional vertigo is the most common cause of vertigo. Tiny crystals in the inner ear come loose and drift into the balance canals. A severe spinning sensation that starts when turning over in bed, getting out of bed, looking up or bending down, and that usually lasts less than a minute, is typical. Medication does not cure it; the crystals have to be moved back into place. Once the examination has shown which ear and which canal are affected, a maneuver such as the Epley maneuver is performed. Home exercises such as the Brandt-Daroff exercise can help afterwards, but they should be started once the diagnosis is clear.
Vestibular neuritis and labyrinthitis
This is inflammation of the balance nerve, most often following a viral infection. It causes severe dizziness that begins suddenly, is accompanied by nausea and vomiting, and continues for days even when you are lying still. If hearing is also affected, it is called labyrinthitis. The dizziness is at its worst in the first 2-3 days and then gradually eases. In most patients, balance fully recovers within a few weeks.
Meniere's disease
Meniere's disease develops when the fluid pressure in the inner ear rises. Vertigo attacks lasting from 20 minutes to a few hours are accompanied by reduced hearing, ringing and a feeling of fullness in the same ear. It is not a disease that disappears completely, but salt restriction and medication can noticeably reduce how often attacks occur.
Vestibular migraine
People with migraine can have vertigo attacks with or without a headache. Sensitivity to light and sound often accompanies them. The first step in treatment is avoiding migraine triggers such as lack of sleep, skipped meals and stress.
What does the duration of dizziness tell you about its cause?
The most valuable piece of information a patient can give is how long a single episode lasts. Noting this down before your appointment makes the diagnosis much easier.
- If it lasts seconds or at most a minute and is triggered by head movement, it is most often dislodged ear crystals (BPPV).
- If it lasts from 20 minutes to a few hours and there is also ringing in the ear and reduced hearing, Meniere's disease is considered.
- If it lasts from minutes to hours and is accompanied by headache or light sensitivity, it may be vestibular migraine.
- If it continues without a break for days, even at rest, vestibular neuritis or labyrinthitis comes to mind.
- If it begins suddenly together with slurred speech, double vision or weakness, it may originate in the brain and is an emergency.
This distinction does not replace a definite diagnosis, but it shows which direction to look in.
What helps vertigo?
Whatever the cause, what to do during an attack is the same:
- Sit or lie down straight away. The most dangerous consequence of vertigo is falling.
- Fix your eyes on a stationary point. Closing the eyes makes the spinning worse for some people and better for others; do whichever feels more comfortable.
- Stay in the same position without moving your head suddenly until the spinning passes.
- When the attack is over, get up slowly and have someone stay with you for a while.
Between attacks, drinking enough water, sleeping regularly and cutting down on caffeine and alcohol help with vertigo. In Meniere's disease, reducing salt directly affects the attacks. Ginger tea may ease nausea, but it does not treat the vertigo itself.
Medication given for nausea and dizziness provides relief in the first few days. Taking these drugs for a long time delays the brain's adaptation to the balance problem and prolongs recovery. For this reason they should not be used for longer than your doctor recommends.
What is the fastest way to get rid of vertigo?
The treatment that resolves vertigo fastest is the repositioning maneuver used when the cause is dislodged ear crystals. After an Epley maneuver performed on the correct ear and the correct canal, a significant proportion of patients feel better the same day, while some need two or three sessions.
A common mistake is performing a maneuver watched online without knowing which ear is affected. A maneuver done on the wrong side does not work and sometimes makes the complaint worse. Which ear the crystals are in can be determined in a few minutes during the examination with the Dix-Hallpike test.
For other causes such as vestibular neuritis, there is no single-step cure. After the first few days, gradually starting to move around instead of staying in bed speeds up the recovery of the balance system.
How long does vertigo last?
BPPV can go away on its own within weeks even without a maneuver, but during that time the attacks that recur with every head movement are exhausting. With a maneuver it usually improves within a few days. In vestibular neuritis the severe spinning eases in 2-3 days, while the mild unsteadiness brought on by movement can last 3-6 weeks. This period may be longer in older patients.
What causes vertigo?
Vertigo is not the name of a disease; it is a symptom. Most of its causes are related to the inner ear:
- Dislodged ear crystals; head trauma, prolonged bed rest and older age increase the risk,
- Viral inflammation of the balance nerve (vestibular neuritis, labyrinthitis),
- Meniere's disease,
- Middle ear inflammation and ear infections,
- Some blood pressure medications and sedatives,
- Vestibular migraine,
- More rarely, causes originating in the brain such as stroke, MS or a brain tumor.
Stress and lack of sleep trigger an existing tendency rather than causing vertigo on their own.
Is vertigo dangerous? When should you go to the emergency room?
Vertigo that originates in the inner ear is very unpleasant but not dangerous; the real risk is falling during an attack. However, dizziness can sometimes be the first sign of a problem in the brain, particularly a stroke. If any of the following accompanies the dizziness, go to an emergency department without waiting:
- Slurred or unintelligible speech,
- Drooping on one side of the face,
- Weakness or numbness in an arm or leg,
- Double vision,
- A very severe headache unlike any you have had before,
- Being unable to stand or walk even with support,
- Sudden hearing loss in one ear.
Sudden hearing loss in one ear may not look like an emergency at first glance, but starting treatment in the first few days increases the chance of hearing returning.
Which doctor treats vertigo?
Because most vertigo originates in the inner ear, the first specialty to see is Ear, Nose and Throat (ENT). In an ENT examination the ear, eye movements and positional tests are assessed, and a hearing test is performed if needed. If a cause in the brain is suspected, the evaluation is carried out together with neurology.
For recurrent dizziness attacks, you can contact Op. Dr. Ümit Küçüktepe in Antalya, Turkey. This article has been prepared for information purposes and does not replace an examination.
Frequently Asked Questions
All vertigo is dizziness, but not all dizziness is vertigo. In vertigo there is a sensation that the surroundings or the person themselves are spinning. Vision going dark, feeling faint or light-headed can come from different causes such as low blood pressure, anemia or low blood sugar, and these are investigated differently.
Rather than being a cause of vertigo on its own, stress triggers an existing tendency. In people with Meniere's disease or vestibular migraine, attacks can become more frequent during periods of intense stress. Dizziness that starts along with stress should still be checked for an inner ear cause.
After dislodged ear crystals are corrected, the problem can recur months or years later; this is common. When it recurs, the same maneuver works again. Meniere's disease and vestibular migraine are conditions that come in attacks by nature.
Yes. Because of the connection between the inner ear and the nausea center in the brain, vertigo is often accompanied by nausea and vomiting. Vomiting is particularly marked in vestibular neuritis. Anti-nausea medication can be used in the first few days, but should not be taken for a long time.
You should not drive while attacks are continuing. With dislodged ear crystals, turning the head while reversing or changing lanes can suddenly set off an attack. It is also safer not to drive on the day a repositioning maneuver is performed.
Dizziness originating in the neck is not as common as people think. In many people with neck pain, the real cause of the dizziness is dislodged ear crystals or another inner ear problem. For this reason, in a patient with neck pain and dizziness the inner ear should be assessed first.
Dizziness is common in pregnancy, but most of it is light-headedness related to changes in blood pressure and blood sugar rather than true vertigo. Spinning-type dizziness can also be caused by dislodged ear crystals, and the repositioning maneuver can be performed during pregnancy. Always consult your doctor before taking any medication.
Most vertigo goes away completely. Dislodged ear crystals and vestibular neuritis usually heal without leaving any lasting effect. In Meniere's disease the attacks can be brought under control, but hearing may be permanently affected over time. Vestibular rehabilitation exercises are helpful for unsteadiness that lasts for months.
