Vertigo: Feel Like You Are Spinning Around?

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Healthy Matters

Vertigo is a sensation of feeling off balance, you might feel like you are spinning or that the world around you is spinning. Vertigo is a symptom of a range of conditions, it can be temporary or long term. People with problems in the inner ear, brain or sensory nerve pathway may experience vertigo.

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Causes of vertigo

Various medical conditions can lead to vertigo, most commonly involving either an imbalance in the inner ear or a problem with the central nervous system.

Common inner ear problems that cause vertigo:

  • Benign paroxysmal positional vertigo (BPPV). The inner ear contains structures called the otolith, which has fluid and crystals of calcium carbonate. BPPV is the most common cause of vertigo. In BPPV, these calcium crystals get dislodged from their normal location and collect in the inner ear. During movement, the fallen crystal touches the sensory part of the inner ear. As a result, the brain receives confusing information about a person’s position, and vertigo occurs.
  • Meniere’s disease. This is a disease of the inner ear thought to be caused by build up of fluid island changing pressure in the ear, which can lead to attacks of vertigo with ringing in the ears (tinnitus), feeling of a plugged ear and fluctuating hearing loss. 
  • Infection. An infection (usually viral) of the nerve supplying transmitting information from the inner ear to the brain (Vestibular neuritis); or infection of a fluid-filled structure in the inner ear (Labyrinthitis).
  • Cholesteatoma. A non-cancerous skin growth that develops in the middle ear behind the eardrum, as a result of repeated infection.

Other causes of vertigo

Vertigo can also occur with:

  • Migraine headaches
  • Head or neck injury
  • Shingles in or around the ear (Herpes Zoster Oticus)
  • Stroke or transient ischaemic attack
  • Brain tumour (e.g. acoustic neuroma)
  • Some medications (e.g. some chemotherapy medicine, antibiotics, non-steroidal anti-inflammatory drugs and aspirin)

Types of vertigo

The causes of Vertigo are categorised into two types:


Peripheral Vertigo

Around 80% of cases of vertigo are of this type. Peripheral vertigo usually occurs as a result of problems in the inner ear. Examples include:

  • Benign paroxysmal positional vertigo (BPPV)
  • Meniere’s disease
  • Labyrinthitis
  • Vestibular neuritis
  • Acoustic neuroma

Central Vertigo 

Central vertigo relates to a disease or injury to the brain, such as:

  • Head injuries 
  • Strokes or Transient ischaemic attacks (TIA)
  • Brain tumours 
  • Migraines
  • Multiple sclerosis 

Symptoms of vertigo

A person with vertigo might feel as though their head or the world around them is moving or spinning. People with vertigo typically describe it as feeling they are:

  • Spinning 
  • Swaying 
  • Unbalanced 
  • Tilting 

Vertigo is a symptom, but it can lead to other associated symptoms too. These may include:

Symptoms can last from a few minutes to a few hours or more depending on the underlying cause. Noting the triggers and length of time of each episode can be helpful for doctors to pinpoint the cause.

Diagnosing vertigo

Doctors use information from a person’s medical history and clinical examinations’ findings as a basis for ordering other diagnostic tests to assess the vestibular system and rule out other potential causes of vertigo.


Most people tolerate these tests well, but some of the tests can be fatiguing and result in temporary unsteadiness. Should you have any further tests, your doctor may explain them in detail.


Some physical or diagnostic tests may include:

  • General examination including a thorough examination of nerves supplying your head and nervous system
  • Otoscopy (examination of your ear)
  • Audiometry (hearing tests)
  • Electron/video-nystagmography
  • Vestibular-evoked myogenic potentials 
  • Magnetic resonance imaging (MRI)
  • Blood work and vision tests

Treatment of vertigo

You can treat vertigo by managing the underlying causes. Here are the treatment options for some common causes of vertigo:

  • Benign paroxysmal positional vertigo (BPPV). Can be managed with a vertigo exercise known as the Epley maneuver. It is a specific set of movements that physically guides the crystals out of the ear canals. It is a simple and effective treatment with 80%-90% of people getting better. Unfortunately, if someone has had BPPV, there is an increased likelihood of that happening again in the future. In cases of BPPV causing chronic vertigo, vestibular rehabilitation has been shown to be effective at treating these symptoms
  • Meniere’s disease. ENT specialists may prescribe medication to alleviate symptoms of attacks of Meniere’s disease. These may include prochlorperazine, cyclizine or betahistine to relieve nausea and vomiting. You might also be offered for vestibular rehabilitation or counseling if symptoms are difficult to cope with. Hearing aids or a Meniett device can be offered to regulate pressure in the ear and improve the ability to hear. Surgery to remove the labyrinth (labyrinthectomy) might be offered in some extreme cases. For details of ENT treatment, please consult HK ENT specialists.
  • Labyrinthitis/Vestibular neuritis is commonly caused by viral infections and will clear up on its own without treatment. Doctors may prescribe antihistamines or motion-sickness tablets to manage symptoms. In rare cases of labyrinthitis, where it is caused by a bacterial infection, antibiotics may be prescribed.
  • Cholesteatoma. To remove a cholesteatoma, you usually need to have surgery under general anaesthetic. The benefits of removing a cholesteatoma usually outweigh the risk, however, as with any type of surgery, there is a small risk associated with having anaesthetic and a small chance of damaging the facial nerve. Discuss the options and understand the risks of any procedures with your doctors before having the operation.

Complication of vertigo

If your vertigo attacks are frequent or severe, they can have a huge impact on your life. You may not be able to work, drive or perform other daily tasks. Vertigo can lead to unsteadiness and falls, which may cause serious injuries.

Prevention of vertigo

Most of the time, vertigo can’t be prevented. However, knowing the disease can prevent you from getting injured by vertigo. For instance, wearing a helmet when doing sports activities such as cycling can protect you from a head injury as well as BPPV. And typically, people with persistent vertigo are advised not to drive or operate machinery work as these can pose dangers to themselves and others. 


Is vertigo a serious condition?

Generally, vertigo is rarely a sign of a serious condition. However, if left undiagnosed, you may delay the treatment of the more serious underlying medical problems such as a tumour or injury to the brain or neck. You should see your doctor if you experience recurrent, sudden, severe or prolonged vertigo and get urgent help if you have an associated severe headache.

Can vertigo be cured by itself?
How long does it take for vertigo to go away?

*This article was medically reviewed by Dr. Gordon Chak Man Cheung from the London Medical Clinic, Central, Hong Kong. Dr. Cheung is a General Practitioner in HK who received his medical degree from King’s College London, University of London. Before completing his General Practice specialist training in UK, Dr. Cheung had worked in various hospitals in London and South East England in Cardiology, Endocrinology, Oncology, Paediatrics, Obstetrics and Gynaecology. He holds numerous postgraduate medical qualifications including Memberships to the Royal Colleges of Physicians in UK and to the Royal College of General Practitioners, Diploma of the Royal College of Obstetricians and Gynaecologists, Child Health as well as Clinical Dermatology.

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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Cheung Chak Man Gordon
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