Vertigo can make it seem as if the world around you is spinning.

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What is vertigo? It’s caused by vestibular (balance) system disorders that originate in the inner ear, where balance is regulated. Vertigo symptoms can lead you to three types of the condition:

1. Benign paroxysmal positional vertigo (BPPV): This occurs when tiny calcium crystals in the utricle (one of the structures of the inner ear) break loose and stimulate sensory hair cells in the inner ear. The result can involve brief spells of intense spinning that are triggered by turning over in bed, bending down, or looking up.
2. Vestibular neuritis (acute labyrinthitis): This is caused by a viral infection of the inner ear and cochlea, and often develops after a cold or the flu. It manifests as a sudden, unexpected attack of vertigo that can last from a few days to a few weeks.
3. Meniere’s disease: A problem related to sodium and fluid balance in the ear. The onset may be sudden, and may last for several hours, causing nausea and vomiting.

What Causes Vertigo?

Besides the characteristics of the three types listed above, vertigo may also be triggered by certain medications, by mixing medication with alcohol, or by taking more of a drug than is prescribed.

Other causes of vertigo may include a head injury, a neck injury, or migraine headaches. A stroke or a similar brain-related issue also may cause vertigo.

Vertigo Symptoms

Symptoms experienced by those with vertigo can last a few minutes to a few hours or more. They also may come and go. People with vertigo often describe the condition as feeling like they’re: spinning, tilting, swaying, unbalanced, or pulled in one direction.

Other symptoms that may accompany vertigo include:

• Lightheadedness or dizziness
• Nausea
• Abnormal or jerking eye movements
• Headache
• Sweating

Screening to Diagnosis

Vertigo screening begins with a physical exam where you describe your first episode, the character of the vertigo, what you were doing when it began, and the frequency and severity of other episodes. The exam also helps identify nystagmus (a repetitive, abnormal eye movement) and any abnormalities in gait and balance that may contribute to your vertigo.

Several diagnostics tests can help identify possible causes. For instance, an audiogram (hearing test) and electronystagmography (ENG) record the function of your hearing and balance systems. An MRI can rule out tumor, stroke, or multiple sclerosis.

Vertigo Treatment and Prevention

Sometimes vertigo goes away on its own as the brain is able to adapt to some inner ear changes in order to maintain balance. If treatment is needed, the following options are often used:

• Vestibular rehabilitation, or physical therapy that corrects any deficits in your vestibular system, such as problems with your balance, your gait, neck motion, and visual stability. Types of exercise include vision stability training, posture training, stretching and strengthening exercises, balance retraining, walking, neck motion exercises, and general fitness routines. (Click here to read our post on balance exercises.)
• Epley maneuver, used to treat BVVP by helping to dislodge calcium crystal debris. A doctor or physical therapist performs the 10 to 15-minute session. It works like this:
  • In a seated position, your head is turned 45 degrees horizontally toward the affected ear.
  • The doctor or therapist then tilts you backward to a horizontal position with your head kept in place at a hanging, 45-degree angle. An attack of vertigo will likely occur as the calcium crystal debris moves toward the apex of the canal. You stay in this position for 30 seconds or until the vertigo stops.
  • The doctor or therapist then turns your head 90 degrees toward the unaffected ear. He or she then rolls you onto the side of the unaffected ear, so you look at the floor. The debris should move in the canal again, and trigger another vertigo episode. Again, you are held here for 30 seconds, or until the vertigo stops.

Besides seeking necessary care and treatment, review your medications with your doctor to determine whether any of them contribute to attacks. Also, avoid or restrict alcohol intake as it can cause or worsen dizziness.

Originally published in May 2016 and updated.