Vertigo: Why the Room Spins and What a Visit Can Sort Out

What it involves

MedlinePlus describes vertigo as a sensation of motion or spinning that is often described as dizziness. People with vertigo feel as though they are actually spinning or moving, or that the world is spinning around them, which separates it from being lightheaded.

Who this is for

• Adults who feel the room spin when they roll over in bed or tilt the head back
• Patients with spinning, nausea and unsteadiness that comes in episodes
• People who had a head injury or an ear infection before the spinning began
• Anyone who is unsure whether they have vertigo or ordinary lightheadedness

What to expect

• Questions about what triggers the spinning, how long each episode lasts and whether hearing or ringing changed
• A review of your medicines and a check of blood pressure, balance and how you walk
• Blood work when the history calls for it, such as a blood count or metabolic panel
• A plan based on the likely cause, or a referral for repositioning treatment, balance therapy or brain imaging when needed

Vertigo versus lightheadedness

MedlinePlus says dizziness and vertigo are not the same thing but are often mixed up. Dizziness can feel lightheaded, woozy or unsteady, while vertigo is the feeling that you or the room is spinning even when nothing is moving. Lightheadedness that comes on when you stand up points toward blood pressure or fluids, and the dizziness guide covers that wider group. This page is about the spinning kind, which has its own list of causes and a different set of warning signs.

The most common cause: BPPV

The MedlinePlus encyclopedia calls benign positional vertigo the most common type. It happens when small calcium pieces called canaliths break free and float in the fluid-filled tubes of the inner ear, sending confusing messages to the brain. The spinning usually starts suddenly, is triggered by moving the head, and lasts a few seconds to minutes. Rolling over in bed and tilting the head up to look at something are classic triggers. Family history, a past head injury and a past inner ear infection raise the chance.

Other inner ear and brain causes

MedlinePlus separates peripheral vertigo, from the inner ear or its nerve, from central vertigo, from the brain. Peripheral causes it lists include Meniere disease, labyrinthitis, inflammation of the vestibular nerve, head injury and certain medicines that are toxic to the inner ear. Central causes include blood vessel disease, stroke, multiple sclerosis, tumors, seizures and vestibular migraine. Most spinning is peripheral, but a provider sorts out which kind you have by asking about other symptoms, since the central kind comes with additional signs.

How a provider checks

MedlinePlus says the provider will do a physical exam and ask about your history, and may use a head-position test called the Dix-Hallpike maneuver to look for abnormal eye movements while you feel the spin. Further tests that may follow include hearing tests, balance testing, a head CT or MRI and imaging of the blood vessels of the head. At Serenity By A Dr. Sareen the visit covers the history, exam and blood work, and hearing, balance and imaging tests are ordered as referrals when needed. The balance problems guide covers unsteadiness without spinning.

Treatment, and what to do meanwhile

For BPPV, MedlinePlus says a provider may perform the Epley maneuver, a series of head movements that repositions the canaliths, and that it may need to be repeated if symptoms return. Referral to vestibular rehabilitation or home repositioning exercises may also help, and some medicines relieve the spinning, though they often do not work well for vertigo itself. Until you are seen, avoid the head positions that trigger it, and be careful on stairs and in the shower. Severe vomiting can lead to dehydration, which the stomach flu and dehydration guide explains.

When it is an emergency

MedlinePlus says to get medical help right away if vertigo comes with weakness, slurred speech or vision problems, because these may be signs of a more serious condition such as a stroke. Double vision, trouble swallowing, facial drooping, severe headache or a fall with a head injury belong on the same list. Call 911 instead of driving yourself. A spinning episode that is mild, brief and tied to turning your head is a reason to book a visit, not to go to the emergency room.

Sources

• MedlinePlus: Benign positional vertigo (medical encyclopedia)
• MedlinePlus: Vertigo-associated disorders (medical encyclopedia)
• MedlinePlus: Dizziness and Vertigo (health topic)