What is vertigo?

What is the difference between dizziness and vertigo?

Patients often use the terms dizziness and vertigo interchangeably, but they describe different sensations and it is important to distinguish between them because the underlying causes and treatments can be quite different. Dizziness is a general term used to describe feelings of light-headedness, faintness, unsteadiness, or being off-balance. Some people describe it as feeling “woozy” or as though they might pass out. Dizziness can result from a wide range of conditions, including dehydration, low blood pressure, anxiety, infections, medication side effects, heart rhythm disturbances, or other circulatory problems.

Vertigo, by contrast, is a specific type of dizziness in which there is a false sensation of movement. People often describe this as feeling that they or their surroundings are spinning, tilting, or moving when there is no actual movement.

Vertigo is most commonly caused by problems affecting the balance organs of the inner ear, although occasionally it may be related to conditions affecting the brain. Episodes can last from a few seconds to several days depending on the cause. In other words vertigo is a form of dizziness, but not all dizziness is vertigo.

What are the common causes of vertigo?

The most common cause of vertigo is Benign Paroxysmal Positional Vertigo (BPPV), which occurs when tiny calcium crystals become displaced within the inner ear. This typically causes brief episodes of spinning dizziness triggered by certain head movements, such as turning over in bed, looking up, or bending down.

Another common cause is vestibular neuritis, which is inflammation of the balance nerve usually following a viral infection and often causes sudden, severe vertigo lasting several days. Labyrinthitis affects both the balance and hearing parts of the inner ear and can cause vertigo alongside hearing loss or ringing in the ears.

Ménière’s disease is caused by excess fluid within the inner ear and typically leads to recurrent episodes of vertigo accompanied by hearing loss, tinnitus, and a feeling of fullness in the ear.

Some people experience vertigo as part of migraine, known as vestibular migraine, which may occur with or without a headache.

Less commonly, vertigo can be caused by neurological conditions affecting the brain, such as stroke or multiple sclerosis. Although these causes are uncommon, they may be suspected if vertigo is accompanied by symptoms such as weakness, numbness, difficulty speaking, double vision, or severe headache.

What symptoms associated with vertigo can help identify the cause and how long will it last?

The symptoms that occur alongside vertigo often provide valuable clues about its underlying cause. Hearing loss, ringing in the ears, or a feeling of fullness or pressure in the ear often suggest a problem affecting the inner ear, such as Ménière’s disease or labyrinthitis. Nausea and vomiting are common because the balance system is closely connected to the areas of the brain that control these symptoms.

Vertigo that is triggered by turning over in bed, looking up, or bending down is characteristic of BPPV. If symptoms develop following a recent cold or viral illness, vestibular neuritis or labyrinthitis may be responsible. A history of migraine, headache, or sensitivity to light may point towards vestibular migraine.

The duration of the vertigo also gives a clue about causation. If it is just seconds, its likely to be BPPV, minutes is more likely migraine and days more likely a neuritis or a neurological cause.

Some people continue to feel unsteady even after the spinning sensation has settled, particularly following vestibular neuritis, and recovery can take several weeks.

Symptoms such as double vision, slurred speech, weakness, numbness, severe difficulty walking, or a sudden severe headache are not typical of common inner ear causes of vertigo and require urgent medical assessment, as they may indicate a problem affecting the brain.

Similarly, palpitations, blackouts, or feeling faint are more suggestive of other causes of dizziness, such as low blood pressure, dehydration, or heart rhythm disturbances, rather than true vertigo and they also need careful diagnostic consideration.

When should I make an appointment?

Vertigo can be extremely unpleasant and we are always happy to see patients to discuss this. Often if it is due to BPPV, a simple head positioning manoeuvre we can do called the Epley manoeuvre can alleviate symptoms.

If it is your first attack, we would always encourage you to come in to discuss diagnosis and treatment, and if there are any associated symptoms that suggest a possible stroke, we would want you to consider it an emergency and seek immediate attention. We will sometimes decide to refer you on to a neurologist, Audio-vestibular physician or vestibular physio if that is appropriate, and please remember that  we will  help with swift appointments if you are suffering.