Vertigo is a specific sensation of false movement, characterized by the feeling that you or your surroundings are spinning, tilting, or swaying when no actual movement is occurring. This sensation is distinct from general dizziness, lightheadedness, or feeling faint, which are often related to cardiovascular issues or low blood pressure. True vertigo originates from a disturbance within the vestibular system, the body’s balance network composed of the inner ear structures and their connections to the brain. When accurate information about head position and motion is disrupted, the brain perceives a rotational illusion. Finding the underlying cause is the first step toward relief from this disorienting experience.
The Mechanical Cause: Benign Paroxysmal Positional Vertigo (BPPV)
The most common cause of vertigo is a mechanical issue known as Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when tiny calcium carbonate crystals, called otoconia, become dislodged from their normal position in the utricle of the inner ear. Normally, these crystals help the inner ear sense linear acceleration and gravity.
Once displaced, the otoconia drift into the fluid-filled semicircular canals, which sense rotational head movements. When the head changes position—such as rolling over in bed or looking up—gravity pulls the loose crystals. This movement causes the fluid in the canal to shift, inappropriately stimulating the hair cells lining the canal.
The stimulated hair cells send a false signal to the brain, resulting in a brief but intense spinning sensation. These vertigo episodes are short-lived, usually lasting less than a minute, and are directly provoked by specific changes in head posture. BPPV is treated with specific maneuvers designed to guide the displaced otoconia back into the utricle.
Inflammation and Fluid Issues in the Inner Ear
Vertigo can also arise from inflammation or fluid imbalance affecting the inner ear’s sensory organs and nerves.
Inflammatory Conditions
Labyrinthitis involves inflammation of the entire labyrinth structure, including both balance and hearing organs. It typically follows a viral infection, causing prolonged, severe vertigo that can last for days or weeks, often accompanied by hearing loss and tinnitus.
Vestibular neuritis is a related condition involving inflammation specifically targeting the vestibular nerve connecting the inner ear to the brain. It causes a sudden onset of intense, continuous vertigo and severe imbalance, but usually without hearing loss or tinnitus. In both cases, swelling interferes with the accurate transmission of balance signals to the brain, creating a sustained sense of spinning.
Meniere’s Disease
Meniere’s disease involves excessive fluid pressure, known as endolymphatic hydrops, within the inner ear. This pressure buildup causes a classic triad of symptoms: episodic vertigo attacks lasting several hours, fluctuating hearing loss, and a persistent feeling of fullness in the affected ear. Unlike BPPV, Meniere’s attacks are spontaneous and not linked to positional changes. The abnormal fluid dynamics disrupt nerve signals for both hearing and balance, leading to recurrent episodes.
Central Nervous System Sources of Vertigo
When vertigo originates from a problem within the brain or brainstem, it is classified as central vertigo. These areas comprise the central vestibular system, which processes and interprets balance information sent from the inner ears. Central vertigo often results in a pronounced sense of unsteadiness or imbalance, sometimes described as a rocking or swaying sensation, rather than intense spinning.
A common central cause is vestibular migraine, a neurological disorder causing vertigo episodes even without a severe headache. These episodes can last from minutes to several days and may include sensitivity to light and sound or visual disturbances known as auras. The vertigo is caused by abnormal activity in the parts of the brain that control balance.
Less frequent central causes include conditions such as a stroke affecting the brainstem or cerebellum, multiple sclerosis, or brain tumors. These conditions compromise the neural pathways responsible for coordinating balance and spatial orientation. Central vertigo is distinguished from peripheral (inner ear) causes by the presence of other neurological signs, which indicate broader brain dysfunction.
Recognizing Warning Signs and Next Steps
While most cases of vertigo are caused by inner ear problems that are not life-threatening, certain accompanying symptoms signal a potentially serious central nervous system issue. These “red flag” symptoms require immediate medical evaluation, as they may indicate a stroke or other critical condition. Signs such as a sudden, severe headache, double vision, slurred speech, or weakness and numbness in the limbs should prompt an emergency room visit.
A sudden inability to walk or severe unsteadiness that makes standing impossible, known as ataxia, is also a concerning symptom that warrants urgent attention. For less severe, recurrent, or persistent vertigo that is not accompanied by these neurological warning signs, consultation with a healthcare provider is still necessary.
Diagnosis involves a physical examination, including positional testing like the Dix-Hallpike maneuver to check for BPPV, and possibly imaging studies to rule out central causes. Addressing the underlying cause is the definitive path to managing the spinning sensation and regaining stability.