Vertigo: Causes, Symptoms and Treatment — What You Need to Know

Originally published 2025 · Updated April 2026 with new research including the StatPearls 2026 evidence-based diagnosis and treatment update

Vertigo is frequently confused with dizziness, fear of heights, or general unsteadiness. In clinical terms it means something more specific — and understanding that distinction is the first step toward getting the right diagnosis and treatment.

Vertigo describes the sensation of spinning or motion when no actual movement occurs, often grouped under the broader and ambiguous term "dizziness." Among its various causes, benign paroxysmal positional vertigo (BPPV) is the most common, accounting for more than half of peripheral vertigo cases (AAO-HNS Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo, 2017). Misdiagnosis or underdiagnosis is common.

This article covers what vertigo actually is, the main causes, how each is diagnosed, and what the evidence shows for treatment — including the repositioning manoeuvre that resolves most cases.

TL;DR

• Vertigo is a sensation of spinning or motion when you are not moving — it is a symptom, not a condition in itself.
• BPPV is the most common cause, accounting for more than half of peripheral vertigo cases. It is caused by displaced calcium crystals in the inner ear and is highly treatable.
• There are two main types: peripheral vertigo (inner ear origin, more common, better prognosis) and central vertigo (brain origin, less common, more serious).
• Causes originating from the periphery such as BPPV or vestibular neuritis typically have a good prognosis. Central causes such as cerebrovascular disease, tumours, or demyelinating conditions often have worse outcomes if not diagnosed promptly.
• The Epley manoeuvre resolves BPPV in the majority of cases — often in a single session (Cochrane Review, Hilton & Pinder, 2014).
• Red flag symptoms — sudden severe headache, difficulty walking, double vision, facial weakness — require emergency assessment.

Vertigo vs Dizziness: The Important Distinction

These terms are used interchangeably in everyday language but mean different things clinically — and the distinction determines the diagnostic pathway.

Vertigo is a sensation that you or the world around you is spinning. It is usually a symptom of a problem with the part of your inner ear or brain that keeps you balanced. Dizziness means that you are lightheaded, weak, or unsteady on your feet. The causes also differ — dizziness can result from a drop in blood pressure, medications, a vision problem, or a mental health condition (NICE CKS: Vertigo).

Vertigo has a specific quality — a rotational, spinning sensation, often described as the room moving or the floor tilting. It is frequently accompanied by nausea, and sometimes by nystagmus (involuntary rhythmic eye movement), hearing changes, or a feeling of fullness in the ear. These accompanying symptoms are important clues to the underlying cause.

The fear of heights, sometimes called acrophobia, is occasionally mislabelled as vertigo in colloquial use. They are unrelated conditions.

The Two Types of Vertigo

There are two main types of vertigo: peripheral and central. Peripheral vertigo is the most common type — it happens because of a problem with your inner ear or the vestibular nerve. Central vertigo stems from a problem in the brain such as a stroke or infection and causes more severe symptoms including difficulty walking (Bárány Society International Classification of Vestibular Disorders).

This distinction drives everything that follows — diagnosis, investigation, urgency, and treatment. Most vertigo is peripheral and manageable in a primary care setting. Central vertigo is less common but potentially serious and requires urgent assessment.

The Main Causes of Vertigo

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most common cause of vertigo and also the most treatable. It is caused by crystals in the balance centre of your inner ear moving out of place.

More specifically: the inner ear contains tiny calcium carbonate crystals called otoconia, which normally sit in a specific structure and help sense gravity and linear movement. When these crystals become dislodged — through head injury, prolonged bed rest, ageing, or sometimes spontaneously — they migrate into the semicircular canals, where they do not belong. There, they disrupt fluid movement within the canals when the head changes position, creating a false sensation of rotational movement.

BPPV is characterised by brief, intense episodes of vertigo triggered by specific head movements — turning over in bed, looking up, tilting the head back. Episodes typically last less than a minute, resolve quickly, and recur with repeated movement in the same direction. Between episodes, the person feels completely normal.

The Dix-Hallpike manoeuvre remains the gold standard for diagnosis, alongside the Epley and Semont manoeuvres for treatment (AAO-HNS Clinical Practice Guideline, 2017). The Dix-Hallpike test — performed by a clinician who moves the patient's head into specific positions while watching for nystagmus — confirms the diagnosis and identifies which ear and which canal is affected.

Vestibular Neuritis and Labyrinthitis

Vestibular neuritis is inflammation of the vestibular nerve, almost always caused by a viral infection — the same viruses responsible for common colds and upper respiratory infections can inflame the vestibular nerve and disrupt its signalling to the brain.

The presentation is distinct from BPPV: rather than brief positional episodes, vestibular neuritis produces sudden, severe, constant vertigo that comes on over hours, is often accompanied by nausea and vomiting, and persists for days to weeks. It is not triggered by head position changes — the vertigo is continuous rather than episodic.

Labyrinthitis is a closely related condition — inflammation that affects both the vestibular nerve and the cochlea (the hearing organ). It presents similarly but adds hearing loss and tinnitus to the vertigo picture.

Acute vestibular neuritis or labyrinthitis improves with initial stabilising measures and a vestibular suppressant medication, followed by vestibular rehabilitation exercises (Cochrane Review: Vestibular Rehabilitation, McDonnell & Hillier, 2015). Most people recover fully within weeks to months as the brain compensates for the disrupted vestibular input — a process called central compensation.

For more on how these conditions overlap, see our deep dive on labyrinthitis and the vertigo–hearing loss–tinnitus triad.

Ménière's Disease

Ménière's disease is less common than BPPV or vestibular neuritis but more complex — a chronic condition of the inner ear characterised by recurring episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness or pressure in the ear.

It may be caused by a buildup of fluid and changing pressure in the ear (Bárány Society Diagnostic Criteria for Ménière's Disease, 2015).

Episodes are unpredictable, typically lasting 20 minutes to several hours, and can be severely disabling. The underlying mechanism involves endolymphatic hydrops — an excess of fluid in the inner ear's endolymphatic space — though the exact trigger for this remains under investigation. Stress, dietary factors (particularly salt and caffeine intake), and sleep disruption are recognised contributors to episode frequency.

There is no cure for Ménière's disease. Management focuses on reducing episode frequency through dietary modification, stress management, and in some cases medication or procedural interventions. A low-sodium diet and reduced caffeine are the first-line lifestyle recommendations.

Migraine-Associated Vertigo

Epidemiological evidence shows a strong association between vertigo and migraine. Vestibular migraine is now recognised as one of the more common causes of recurrent vertigo — a diagnosis that was historically underappreciated (Bárány Society / IHS Diagnostic Criteria for Vestibular Migraine, 2012).

Vertigo may precede, accompany, or follow the headache, or occur independently of head pain in established migraineurs. The diagnosis is clinical and the treatment follows migraine management principles. Trials suggest that standard migraine prophylaxis is effective in the majority of patients with vestibular migraine.

Central Causes

Central vertigo originates in the brain rather than the inner ear — through stroke, transient ischaemic attack (TIA), tumour, multiple sclerosis, or other neurological conditions. It is less common than peripheral vertigo but considerably more serious.

The clinical features that distinguish central from peripheral vertigo are important to recognise. Central vertigo tends to be associated with other neurological symptoms — difficulty walking, double vision, facial weakness, slurred speech, sudden severe headache, or limb weakness. The vertigo itself may be less intense than peripheral causes, but the accompanying features are more alarming.

Any sudden onset of vertigo with neurological symptoms should be treated as a potential stroke until proven otherwise.

Treatment: What the Evidence Shows

The Epley Manoeuvre for BPPV

The Epley manoeuvre is the most effective and evidence-based treatment for posterior canal BPPV — the most common variant. It is a canalith repositioning procedure: a specific sequence of head and body movements, performed by a clinician, designed to guide the displaced otoconia back to their correct position using gravity.

Multiple randomised controlled trials and a Cochrane review confirm that the Epley manoeuvre resolves BPPV in the majority of patients — often in a single session (Cochrane Review, Hilton & Pinder, 2014). The procedure takes approximately five minutes, requires no medication, and has a high success rate.

A proportion of BPPV cases remain refractory to standard canalith repositioning manoeuvres, leading to persistent symptoms. Variations in the anatomical orientation of the semicircular canals may explain resistance to conventional manoeuvres. For these cases, personalised approaches using computational modelling of individual canal anatomy are an emerging area of research.

BPPV recurs in a proportion of patients — estimates vary but roughly 15 to 30% of people experience recurrence within a year. The Epley manoeuvre is equally effective for repeat episodes.

Medication

Vestibular suppressants — prochlorperazine, cinnarizine, betahistine, and some antihistamines — may help in the acute phase. These should only be used for a short amount of time, typically three to five days. Long-term use may slow the recovery process by interfering with central compensation (NICE CKS: Vertigo).

For BPPV specifically, vestibular suppressants are generally unnecessary given the effectiveness of repositioning manoeuvres. For vestibular neuritis or Ménière's disease, they provide symptomatic relief during acute episodes.

Betahistine is widely prescribed in the UK for Ménière's disease. The evidence for its effectiveness is mixed — some trials show meaningful reductions in episode frequency; others show no benefit over placebo. It remains a first-line recommendation in UK clinical guidelines partly due to its favourable side effect profile.

Vestibular Rehabilitation

Vestibular rehabilitation therapy (VRT) is a physiotherapy-based approach that uses specific exercises to accelerate the brain's compensation for vestibular dysfunction. It is most effective for vestibular neuritis and other conditions where the vestibular signal is permanently reduced rather than episodically disrupted.

VRT exercises involve deliberately exposing the visual and movement systems to the inputs that cause discomfort, gradually desensitising the brain's response and accelerating adaptation. This counter-intuitive approach — deliberately moving rather than staying still — produces faster and more complete recovery than avoiding the triggering movements.

If you are still experiencing vertigo or balance problems after six weeks, you may be referred to a vestibular physiotherapist or ENT consultant.

When to Seek Urgent Help

Most vertigo is benign and resolves with time or simple treatment. Some presentations require urgent or emergency assessment.

Seek emergency assessment if vertigo is accompanied by:

• Sudden severe headache — particularly described as the worst headache of your life
• Difficulty walking or loss of coordination
• Double vision or other visual disturbance
• Facial weakness, drooping, or asymmetry
• Slurred speech or difficulty swallowing
• Arm or leg weakness or numbness
• Fever and stiff neck

These symptoms suggest central causes — including stroke — that require immediate investigation.

Also seek prompt GP assessment for:

• First episode of severe vertigo with hearing loss — to rule out sudden sensorineural hearing loss, which is a medical emergency
• Vertigo following head injury
• Progressive or worsening symptoms over days or weeks

Self-Management During an Episode

There are things you can do to help your symptoms and reduce how often you have vertigo:

• Lie still in a quiet, dark room during an attack
• Get up slowly when getting out of bed and sit on the edge of the bed for a minute before standing
• Try to relax and avoid stress — anxiety can make vertigo worse
• Listen to your body, and if able, continue with some of your normal activities

Importantly: where possible, you should try not to avoid certain positions. Although it may feel easier in the short term, doing this will not help your vertigo. It can cause more harm if you avoid all movement and never get the correct diagnosis.

Avoiding movement is a natural instinct when movement triggers vertigo — but avoidance delays the central compensation process and can allow secondary anxiety and deconditioning to compound the original problem.

For BPPV specifically, the Brandt-Daroff exercises — a self-administered series of head movements that can be performed at home — have evidence for gradually habituating the vestibular system to the displaced crystals and may reduce episode frequency between professional repositioning treatments.

Driving and Work

If you drive, you must tell the DVLA about your vertigo (DVLA Assessing Fitness to Drive: Vestibular Disorders). The DVLA's guidance depends on the frequency and severity of attacks — episodic vertigo with warning signs is treated differently from sudden-onset vertigo without warning. Your GP can advise on specific implications for your driving licence.

Occupational considerations also apply if your work involves operating machinery, working at height, or other activities where a sudden episode could create safety risks.

Frequently Asked Questions

What is the most common cause of vertigo?

BPPV — benign paroxysmal positional vertigo — is the most common cause, accounting for more than half of all peripheral vertigo cases. It is caused by displaced calcium crystals in the inner ear that disrupt the vestibular signal when the head changes position. It is highly treatable with the Epley manoeuvre, which resolves symptoms in the majority of patients, often in a single session.

What is the difference between vertigo and dizziness?

Vertigo is a specific sensation of spinning or rotational movement when no movement is occurring — typically caused by a problem with the inner ear or brain's balance systems. Dizziness is a broader, less specific term covering lightheadedness, unsteadiness, or a feeling of being about to faint, which can have many unrelated causes including low blood pressure, medication side effects, or anxiety. The distinction matters for diagnosis.

How long does vertigo last?

This depends entirely on the cause. BPPV episodes typically last less than a minute and resolve when the head returns to a neutral position — though they recur with the same triggering movement. Vestibular neuritis produces continuous vertigo lasting days to weeks, gradually improving as the brain adapts. Ménière's disease produces episodic attacks typically lasting 20 minutes to several hours. Central vertigo duration depends on the underlying cause.

What is the Epley manoeuvre?

The Epley manoeuvre is a canalith repositioning procedure — a specific sequence of head and body movements performed by a clinician to guide displaced otoconia in the inner ear back to their correct position. It is the evidence-based first-line treatment for posterior canal BPPV and resolves symptoms in the majority of patients, often in a single session. It takes approximately five minutes, requires no medication, and can be repeated for recurrent episodes.

Can stress cause vertigo?

Stress does not directly cause vestibular dysfunction but can trigger and worsen vertigo through several mechanisms. Anxiety shares neural pathways with the balance and dizziness systems, and heightened anxiety commonly produces dizziness-type symptoms. Stress is also a recognised trigger for vestibular migraine and Ménière's disease episodes. Additionally, the experience of vertigo is itself a significant stressor that can create a self-reinforcing cycle of anxiety and symptom amplification.

When should I go to A&E with vertigo?

Seek emergency assessment for vertigo accompanied by any of: sudden severe headache, difficulty walking or coordination problems, double vision, facial weakness or asymmetry, slurred speech, arm or leg weakness or numbness, or fever with neck stiffness. These features suggest a central cause — potentially stroke — that requires immediate investigation. Isolated vertigo without these features, while distressing, is rarely an emergency.

The Bottom Line

Vertigo is common, frequently misunderstood, and — in the majority of cases — very treatable. BPPV, the most common cause, responds to the Epley manoeuvre with high success rates in a single session. Vestibular neuritis resolves with time and vestibular rehabilitation. Ménière's disease requires longer-term management.

The key for anyone experiencing vertigo is accurate diagnosis — which requires distinguishing peripheral from central causes, and identifying the specific peripheral condition driving symptoms. Most cases can be managed in primary care. Red flag symptoms demand urgent attention.

If your symptoms include tinnitus or hearing changes alongside vertigo, the Tinnitus Reset from the Reset Series™ covers the auditory and nervous system management that often accompanies vestibular conditions.

Related reading: Labyrinthitis: Why Vertigo, Hearing Loss and Tinnitus Often Appear Together · Tinnitus Isn't Just an Ear Problem: What's Changing · Why Tinnitus Gets Louder After Naps

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