Causes of Vertigo: 10 Common Reasons, Symptoms and Red Flags

What Is Vertigo?

Vertigo is a false sense of movement.

You may feel that:

• The room is spinning
• You are spinning
• The floor is moving
• You are tilting
• Your body is being pulled

Vertigo is different from general dizziness.

Dizziness can also mean:

• Feeling faint
• Feeling lightheaded
• Feeling weak
• Feeling unsteady

This difference matters because the causes may be different.

How Does the Inner Ear Control Balance?

Your inner ear has a balance system.

It is part of the vestibular system.

It includes three semicircular canals.

These canals contain fluid.

They help sense head movement.

Other small organs help sense gravity and straight movement.

Signals travel from the inner ear to the brain.

Your eyes, muscles, joints, inner ears, and brain work together to keep you balanced.

A problem in any part of this system can cause dizziness or vertigo.

Peripheral Vertigo Versus Central Vertigo

Peripheral Vertigo

Peripheral vertigo comes from the inner ear or vestibular nerve.

Common examples include:

• BPPV
• Vestibular neuritis
• Labyrinthitis
• Ménière’s disease

Central Vertigo

Central vertigo comes from the brain or central nervous system.

Possible causes include:

• Stroke
• Multiple sclerosis
• Some tumors
• Other neurological disorders

Symptoms alone cannot always tell the two groups apart.

A clinician may need to examine eye movements, balance, hearing, strength, sensation, speech, and coordination.

10 Important Causes of Vertigo

1. Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo is often shortened to BPPV.

It is a common cause of positional vertigo.

Tiny calcium particles normally sit in part of the inner ear.

These particles are called otoconia.

If some move into a semicircular canal, they can send false movement signals.

Typical BPPV Pattern

BPPV often causes a short spinning attack when you:

• Roll over in bed
• Lie down
• Sit up
• Look upward
• Bend down
• Turn your head in a certain direction

The spinning is often brief.

A typical attack may last less than one minute after the head stops moving.

Nausea can occur.

Does BPPV Cause Hearing Loss?

Typical BPPV does not usually cause hearing loss.

New hearing loss with vertigo points toward another possible cause and deserves assessment.

How Is BPPV Checked?

A clinician may use a positional test.

The Dix Hallpike test is one common example.

It looks for the typical dizziness and eye movement pattern.

Does BPPV Need a Brain Scan?

Typical BPPV usually does not need routine brain imaging.

Imaging becomes more important when the symptoms or examination are not typical.

2. Vestibular Neuritis

Vestibular neuritis affects the vestibular nerve.

That nerve carries balance information from the inner ear to the brain.

Symptoms often begin quickly.

They may include:

• Severe continuous vertigo
• Nausea
• Vomiting
• Trouble walking
• Loss of balance

The severe phase may last for hours or days.

Does Vestibular Neuritis Cause Hearing Loss?

Significant hearing loss is not typical of vestibular neuritis.

This is one clue that helps separate it from labyrinthitis.

Can Vestibular Neuritis Look Like a Stroke?

Yes.

A first episode of severe continuous vertigo can look very similar to a stroke.

Do not diagnose vestibular neuritis yourself when severe vertigo starts suddenly.

3. Labyrinthitis

Labyrinthitis affects structures of the inner ear involved in both balance and hearing.

It can cause:

• Strong vertigo
• Nausea
• Vomiting
• Balance problems
• Hearing loss
• Sometimes tinnitus

Vestibular Neuritis Versus Labyrinthitis

The simple difference is:

• Vestibular neuritis usually causes major balance symptoms without significant hearing loss.
• Labyrinthitis can cause vertigo with hearing loss.

Real cases can be more complex.

Sudden hearing loss should be medically assessed.

4. Ménière’s Disease

Ménière’s disease is an inner ear disorder.

It can affect both balance and hearing.

The classic group of symptoms includes:

• Repeated vertigo attacks
• Hearing loss
• Tinnitus
• Ear fullness

It usually starts in one ear.

How Long Does Ménière’s Vertigo Last?

NIDCD describes definite Ménière’s disease as including repeated spontaneous vertigo episodes that last from about twenty minutes to twelve hours.

Why Hearing Matters

A hearing test is important when Ménière’s disease is suspected.

Documented hearing changes help with diagnosis.

Does Every Person With Vertigo and Tinnitus Have Ménière’s Disease?

No.

Vertigo and tinnitus can occur with several conditions.

The full pattern matters.

Read more about tinnitus in:

What Is Tinnitus?

5. Vestibular Migraine

Vestibular migraine can cause vertigo, imbalance, motion sensitivity, nausea, and other migraine symptoms.

A headache does not have to occur during every episode.

Possible Clues

You may notice:

• Vertigo lasting minutes to hours
• Motion sensitivity
• Nausea
• Sensitivity to light
• Sensitivity to sound
• Visual aura
• A history of migraine

Can Vestibular Migraine Cause Ear Symptoms?

Some people report:

• Tinnitus
• Ear pressure
• Ear fullness

But significant hearing loss should raise concern for another inner ear condition such as Ménière’s disease.

Can Vestibular Migraine Occur Without Headache?

Yes.

This is one reason it can be difficult to recognize.

6. Medicines

Some medicines can cause dizziness or vertigo as a side effect.

Others may affect hearing or balance.

Examples vary widely.

The important clues are:

• Did symptoms begin after a new medicine?
• Did symptoms begin after a dose increase?
• Are you taking several medicines?
• Did another new symptom begin at the same time?

Do not stop prescribed medicine on your own.

Ask a doctor or pharmacist to review your medicine list.

7. Head or Inner Ear Injury

A head injury can affect the balance system.

It can also trigger BPPV.

Other injuries can affect:

• The inner ear
• The vestibular nerve
• The brain
• The neck
• Vision

Vertigo after a significant head injury deserves medical assessment.

Pressure Related Inner Ear Problems

Rarely, an abnormal opening or leak around the inner ear can cause dizziness.

Some people notice symptoms with:

• Loud sounds
• Pressure changes
• Straining
• Coughing

These patterns need specialist assessment.

8. Stroke or Transient Ischemic Attack

A stroke can cause vertigo.

A transient ischemic attack can also cause dizziness or vertigo.

This is one of the most important serious causes to recognize.

Possible Stroke Warning Signs

New vertigo is more concerning when it comes with:

• Face weakness
• Arm or leg weakness
• New numbness
• Slurred speech
• Trouble finding words
• Double vision
• Loss of vision
• New severe trouble walking
• Poor coordination
• New trouble swallowing

Call emergency services if stroke is possible.

Can a Stroke Cause Vertigo Without Obvious Weakness?

Yes.

Some strokes affecting the back part of the brain may present mainly with vertigo, imbalance, eye movement problems, nausea, or trouble walking.

This is why a first episode of severe continuous vertigo should not be self diagnosed.

9. Vestibular Schwannoma

A vestibular schwannoma is a noncancerous tumor on a nerve leading from the inner ear toward the brain.

It is sometimes called an acoustic neuroma.

It is not a common cause of vertigo.

Possible clues include:

• Hearing loss in one ear
• Tinnitus in one ear
• Balance problems
• Gradual hearing change

A vestibular schwannoma does not usually cause the classic short spinning attacks of BPPV.

Persistent one sided hearing or balance symptoms should be assessed.

10. Other Brain, Nerve, and Balance Disorders

Other less common conditions can also cause vertigo or imbalance.

Examples include:

• Multiple sclerosis
• Other brain disorders
• Some nerve disorders
• Problems with vision and balance integration
• Other inner ear conditions

These are less common than typical inner ear causes such as BPPV.

They become more important when neurological signs are present.

What Your Vertigo Pattern May Suggest

What Causes Vertigo When Turning in Bed?

Vertigo when turning in bed is a classic pattern seen with BPPV.

The spinning often begins after:

• Rolling to one side
• Lying back
• Getting out of bed

The attack is usually brief.

If vertigo continues even when the head is still, the pattern is less typical for BPPV.

What Causes Vertigo When Looking Up?

Looking upward can trigger BPPV in some people.

Other head movements may also trigger it.

Repeated brief spinning with the same head position should be assessed if it continues.

What Causes Sudden Vertigo?

Sudden vertigo can occur with:

• BPPV
• Vestibular neuritis
• Labyrinthitis
• Ménière’s disease
• Vestibular migraine
• Stroke

The time pattern is important.

A few seconds after a specific head movement is different from severe vertigo that continues for hours.

New severe vertigo that does not stop deserves medical assessment.

What Causes Vertigo With Hearing Loss?

Vertigo and hearing loss together can occur with:

• Labyrinthitis
• Ménière’s disease
• Some inner ear injuries
• Other ear conditions

Significant hearing loss is not typical of simple BPPV.

It is also not typical of classic vestibular neuritis.

New hearing loss with vertigo should be assessed.

Read:

Hearing Loss
.

What Causes Vertigo With Tinnitus?

Vertigo and tinnitus can occur together.

Possible causes include:

• Ménière’s disease
• Labyrinthitis
• Some inner ear injuries
• Vestibular migraine in selected people
• Other hearing and balance disorders

Tinnitus alone cannot identify the cause.

For tinnitus information, read:

Tinnitus Causes
.

What Causes Vertigo With Headache?

Vertigo with headache can occur with migraine.

But headache and vertigo together are not always migraine.

Seek urgent assessment when a new severe headache occurs with:

• Weakness
• Numbness
• Speech trouble
• Vision loss
• Severe balance loss
• Confusion

Can Stress Cause Vertigo?

Stress can make dizziness and balance symptoms feel worse.

It can also trigger migraine in some people.

But stress should not automatically be blamed for new true vertigo.

New or persistent spinning deserves proper assessment.

Can Dehydration Cause Vertigo?

Dehydration can make you dizzy or lightheaded.

That feeling is not always true vertigo.

You may feel:

• Faint
• Weak
• Lightheaded

This is why describing the exact sensation matters.

Can Low Blood Pressure Cause Vertigo?

Low blood pressure may cause lightheadedness, especially when standing up.

This is often different from a true spinning sensation.

A clinician can help separate:

• Vertigo
• Lightheadedness
• Faintness
• Imbalance

Can Neck Problems Cause Vertigo?

Some people report dizziness linked with neck pain or neck movement.

But neck related dizziness can be difficult to diagnose.

Do not assume a neck problem explains new spinning without first considering common ear and neurological causes.

Avoid forceful neck manipulation as a general vertigo treatment.

How Do Doctors Find the Cause of Vertigo?

There is no single vertigo test for every person.

The first step is the story.

A healthcare professional may ask:

• What does the feeling feel like?
• When did it start?
• Did it begin suddenly?
• How long does each attack last?
• Does moving your head trigger it?
• Does it happen when rolling in bed?
• Is hearing different?
• Do you have tinnitus?
• Do you have ear fullness?
• Do you have headache?
• Do you have double vision?
• Do you have weakness or numbness?
• Can you walk normally?
• Did you have a head injury?
• Which medicines do you take?

What Does the Physical Examination Include?

The examination may check:

• Eye movements
• Balance
• Walking
• Hearing
• Strength
• Sensation
• Speech
• Coordination
• Blood pressure

A positional test may be used when BPPV is suspected.

Do You Need a Hearing Test?

A hearing test can be useful when vertigo occurs with:

• Hearing loss
• Tinnitus
• Ear fullness
• Different hearing between the ears

Hearing results can help separate some inner ear conditions.

Does Everyone With Vertigo Need an MRI or CT Scan?

No.

The need for imaging depends on the pattern and examination.

Typical BPPV

Typical brief positional vertigo with the expected examination usually does not need routine imaging.

Possible Central Vertigo

Imaging becomes more important when:

• Neurological signs are present
• The examination suggests a central cause
• Symptoms do not fit a common inner ear pattern
• There is severe trouble walking
• There is new weakness or numbness
• There are important vision or speech changes

Vertigo With One Sided Hearing Loss or Tinnitus

Selected people with repeated vertigo and one sided hearing loss or tinnitus may need imaging of the brain and inner hearing pathways.

The clinician decides which scan is appropriate.

What Are the Main Vertigo Red Flags?

Important vertigo red flags include:

• New weakness
• New numbness
• Facial drooping
• Trouble speaking
• Trouble swallowing
• Double vision
• Loss of vision
• New severe trouble walking
• Loss of coordination
• Sudden significant hearing loss
• New severe headache
• Significant head injury
• Loss of consciousness

Do not wait for these symptoms to improve on their own.

When Should You See a Doctor for Vertigo?

Arrange medical advice when:

• Vertigo keeps returning
• Vertigo does not go away
• It affects walking
• It causes repeated vomiting
• You notice hearing loss
• You notice tinnitus with hearing change
• You have repeated headaches
• It began after an injury
• It began after a medicine change
• You are not sure whether the feeling is vertigo or faintness

How Are Different Causes of Vertigo Treated?

Treatment depends on the cause.

There is no single vertigo treatment for everyone.

BPPV

BPPV can often be treated with a repositioning maneuver performed by a trained professional or after proper instruction.

Vestibular Neuritis and Labyrinthitis

Care may include short term symptom control and later balance rehabilitation.

Treatment depends on the specific cause and symptoms.

Ménière’s Disease

A specialist may recommend a combination of diet changes, medicines, rehabilitation, injections, or other care based on the person and severity.

Vestibular Migraine

Care may use migraine treatment, regular sleep and meals, activity, stress control, and selected medicines.

Stroke

Stroke needs emergency medical treatment.

Do not try to treat possible stroke vertigo at home.

What Should You Do During a Vertigo Attack?

Safety comes first.

• Sit or lie down.
• Move slowly.
• Avoid driving.
• Avoid ladders.
• Avoid operating machinery.
• Use support if you are unsteady.
• Ask someone to stay nearby if symptoms are severe.

Seek urgent medical care if any red flag appears.

Common Myths About the Causes of Vertigo

Myth: All Dizziness Is Vertigo

False.

Vertigo is a false sense of movement.

Dizziness can also mean lightheadedness or faintness.

Myth: Vertigo Always Comes From the Ear

False.

The inner ear is a common source, but migraine, medicine effects, stroke, and neurological disorders can also cause vertigo.

Myth: BPPV Causes Constant Vertigo for Days

Usually false.

Typical BPPV causes brief attacks after certain head movements.

Myth: Migraine Vertigo Always Comes With a Headache

False.

Vestibular migraine can cause vertigo without headache during the same episode.

Myth: Hearing Loss Is Normal With Every Type of Vertigo

False.

Hearing loss is an important clue that can point toward certain inner ear conditions.

Myth: Every Person With Vertigo Needs an MRI

False.

Typical BPPV usually does not need routine imaging.

Scans are more useful when symptoms or examination findings suggest a central or structural cause.

Myth: Severe Vertigo Cannot Be a Stroke Without Weakness

False.

Some strokes can present mainly with severe dizziness, imbalance, eye movement problems, nausea, and trouble walking.

A Simple Vertigo Pattern Checklist

Before an appointment, write down:

• When vertigo started
• Whether it started suddenly
• How long each attack lasts
• Whether head movement triggers it
• Whether rolling in bed triggers it
• Whether hearing changed
• Whether tinnitus is present
• Whether your ear feels full
• Whether you have headache
• Whether you have nausea
• Whether you can walk normally
• Any weakness or numbness
• Any vision change
• Any recent injury
• Any new medicine

This information can help narrow down the causes of vertigo.