Vertigo is not a condition itself but a symptom of various underlying disorders. It creates a false sensation of movement or spinning, often accompanied by dizziness, nausea, and balance problems. Whether it’s triggered by sudden head movement or an inner ear disturbance, understanding the causes of vertigo is the first step toward accurate diagnosis and treatment.

What Exactly Is Vertigo?

Before diving into causes, it’s important to define vertigo clearly. Vertigo is typically classified into two main types based on the origin of the issue:

Peripheral Vertigo :- Caused by problems in the inner ear or vestibular nerve.
Central Vertigo :- Originates from issues in the brain, especially the cerebellum or brainstem.

Symptoms can range from mild to debilitating and can be intermittent or constant depending on the cause. Understanding whether vertigo is peripheral or central can help healthcare professionals determine the best course of treatment.

Most Common Causes of Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) :- BPPV is one of the most common and easily treatable causes of peripheral vertigo. It occurs when tiny calcium carbonate crystals (otoconia) become dislodged from their normal position in the inner ear and move into one of the semicircular canals. This disrupts the flow of fluid in the inner ear and confuses the brain, leading to a sensation of spinning.
- Typical triggers :- Changing head position suddenly, turning over in bed, looking up or down.
- Duration :- Episodes usually last less than a minute but can recur frequently.
Vestibular Neuritis :-Vestibular neuritis is an inflammation of the vestibular nerve, which connects the inner ear to the brain. This condition often results from a viral infection, like the common cold or flu. It causes sudden, intense vertigo that may last for several days, sometimes accompanied by nausea, imbalance, and difficulty focusing. Unlike BPPV, vestibular neuritis does not typically involve hearing loss, which helps differentiate it from labyrinthitis another similar condition.
Labyrinthitis :- This condition involves inflammation of both the vestibular and cochlear nerves within the inner ear. In addition to vertigo, patients often experience hearing loss, ringing in the ears (tinnitus), and a feeling of fullness in the ear. Labyrinthitis is usually triggered by a viral infection, though bacterial infections and autoimmune diseases can also cause it. It can take days to weeks for symptoms to subside, with hearing sometimes remaining affected.
Meniere’s Disease :- Meniere’s disease is a chronic condition of the inner ear that causes episodes of vertigo along with hearing loss, tinnitus, and a feeling of fullness in the ear. The exact cause is unknown, but it is believed to involve abnormal fluid buildup (endolymph) in the inner ear. Meniere’s can significantly impact quality of life due to its unpredictable and recurring nature. Episodes can last anywhere from 20 minutes to several hours and may increase in frequency over time.

Neurological and Central Causes of Vertigo

While inner ear issues account for most vertigo cases, central vertigo stems from brain-related disorders.

Migrainous Vertigo (Vestibular Migraine) :- People who suffer from migraines may also experience vertigo either during or between migraine episodes. Vestibular migraines can present with or without a headache and often include sensitivity to light, sound, and motion.
- Symptoms :- Vertigo that lasts from minutes to hours, motion sickness, nausea.
- Triggers :- Stress, hormonal changes, certain foods, lack of sleep.
Vestibular migraines are often misdiagnosed due to their complex symptom profile, and a proper diagnosis requires a thorough neurological evaluation.
Stroke or Transient Ischemic Attack (TIA) :- In rare but serious cases, vertigo can be a symptom of a stroke or mini-stroke (TIA), especially when it is sudden, severe, and accompanied by other neurological signs such as double vision, speech difficulties, facial droop, or weakness in the limbs.
- Urgency :- Immediate medical attention is crucial to prevent permanent damage.
Vertigo associated with stroke is typically central in origin and may be due to reduced blood flow to the cerebellum or brainstem.
Multiple Sclerosis (MS) :- MS is a chronic autoimmune condition that affects the central nervous system, including the brain and spinal cord. Vertigo can be one of the early symptoms, caused by demyelination (damage to the protective covering of nerves) in areas responsible for balance and coordination.

Patients with MS may experience recurring episodes of vertigo, especially during relapses. This form of vertigo is often accompanied by other symptoms like visual disturbances, numbness, and weakness.

Less Common But Notable Causes

Acoustic Neuroma :- This is a benign tumor on the vestibulocochlear nerve, which connects the ear to the brain. As the tumor grows, it can press on surrounding nerves and structures, causing vertigo, hearing loss, and tinnitus. Although rare, acoustic neuroma should be considered, particularly in cases of one-sided hearing loss combined with persistent dizziness or imbalance.
Head or Neck Injury :- Whiplash, concussion, or other trauma to the head and neck area can damage structures in the inner ear or interfere with blood flow to the brain, leading to vertigo.
- Delayed Onset :- Symptoms may appear immediately or develop days later.
- Duration :- Recovery may be gradual and depend on the severity of the injury.
Ototoxic Medications :- Certain medications can damage the inner ear, resulting in vertigo. These include some antibiotics (like gentamicin), chemotherapy agents, diuretics, and high-dose aspirin.
Monitoring and adjusting medication under a doctor’s supervision can help prevent long-term vestibular damage

When to Seek Medical Help

While occasional light-headedness or dizziness may not be a cause for concern, repeated or prolonged episodes of vertigo should not be ignored. Sudden vertigo with symptoms like slurred speech, double vision, weakness, or chest pain could indicate a serious neurological or cardiovascular event and should be treated as a medical emergency.

Conclusion

Vertigo is a multifactorial symptom that can arise from problems in the inner ear, brain, or even systemic conditions. Accurate diagnosis is crucial to address the root cause and implement effective treatment. Whether the vertigo is caused by BPPV, an infection, or a neurological disorder, recognizing the warning signs early can prevent complications and improve long-term outcomes.

If you or someone you know experiences recurring dizziness or spinning sensations, consult an ENT specialist or neurologist for a thorough evaluation. Understanding the causes of vertigo empowers patients to seek timely care and regain control over their balance and daily life.