What Are the Causes of Vertigo I Need to Be Aware Of?

Vertigo is the feeling that the room or world is spinning around you. Most of us have experienced it at some point in our lives. It’s the same sensation you get after twirling or spinning around in an office swivel chair. In those scenarios, we know the sensation will pass quickly once we regain our balance. But some people experience vertigo out of the blue. And, what’s worse, it doesn’t go away so quickly. 

Vertigo can be caused by several different things. Most often, it is caused by a condition that is affecting a part of the ear that helps with balance, and does not come with any serious health risks. But sometimes vertigo can be caused by something going on in the brain, which can be more serious. 

Here, we will discuss the different causes of vertigo and how to know when you should see a provider. 

Are there different types of vertigo? 

There are two main types of vertigo: 

1. Peripheral: coming from the ear

2. Central: coming from the brain

Peripheral vertigo is more common. It happens when there is something off in the inner ear, which is made up of different parts that help you feel steady and balanced. 

The inner ear contains special fluid and crystals that help the brain understand when your body is moving. Changes in body position are then communicated to the brain through a special nerve, called the vestibular nerve. This nerve connection helps us maintain our balance.

Central vertigo is less common than peripheral vertigo. It happens when there is an problem with the brain. This could be an issue with the part of your brain at the back of your head, known as the cerebellum. The cerebellum has many important functions, and one of them is to maintain balance. Or it could be an issue with the brain stem, which also helps with balance. Central vertigo develops if either or both of these areas are affected.

What causes vertigo? 

Peripheral and central vertigo are caused by different underlying diagnoses. The most common causes of peripheral vertigo are:

• Benign paroxysmal positional vertigo (BPPV): This is when the crystals in your inner ear move into a position that disrupts the fluid that helps with balance. This sends a confusing message to the brain, making it harder for the brain to know your body’s position. BPPV is the most common cause of peripheral vertigo.

• Ménière’s disease: This is when a build up of fluid in your inner ear interferes with your brain’s ability to interpret if your body is moving. This condition also affects a person’s hearing.

• Labyrinthitis: Also called vestibular neuritis, this is an inflammation of the inner ear that is usually triggered by a virus, like the ones that can cause the common cold.

• Cholesteatoma: This is abnormal growth of skin behind the eardrum. Some people have a cholesteatoma when they are born, while others develop one after multiple ear infections.

• Acoustic neuroma: Also called vestibular schwannoma, this is a benign (harmless) tumor that tends to grow slowly on your vestibular nerve.

Central vertigo is much less common than peripheral vertigo. Some causes of central vertigo include: 

• Stroke: Vertigo is not a common symptom of a stroke. But if a stroke affects the blood vessels in the cerebellum or brain stem, vertigo can be one of the symptoms. 

• Head trauma: Just like a stroke, bleeding inside the brain can cause vertigo, depending on where the injury is. 

• Migraine headache: Most people are familiar with the way migraines cause a throbbing headache, sensitivity to light, and nausea. But some people get vertigo symptoms with their migraine, too.

• Multiple sclerosis: This is an autoimmune disease that involves the body attacking the nerves in the brain and spinal cord. More common symptoms of multiple sclerosis are weakness, difficulty walking, and vision changes. 

• Brain tumor: While possible, this is a very uncommon cause of vertigo.

Do symptoms differ depending on the type of vertigo? 

The symptoms of vertigo can vary from person to person. And peripheral and central vertigo can feel very similar. So you can’t always tell what’s causing the vertigo based on symptoms alone. But, sometimes, there are some clues that can help. 

Many times, the causes of peripheral vertigo can also lead to:

• Dizziness

• Increased sweating

• Severe nausea and vomiting

• Ringing in the ear

• Feeling of fullness in the ear

• Difficulty focusing your eyes or double vision

Note that dizziness is different from vertigo. It is a feeling of being off balance, whereas vertigo is the sensation that the room is moving around you.

The causes of central vertigo can also cause all of the above symptoms. But central vertigo tends to last longer than peripheral vertigo, which can go away after a few seconds or hours. 

Even though the causes of central vertigo are more serious, many times the vertigo feels less severe than with peripheral vertigo. Causes of central vertigo are also less likely to lead to a feeling of fullness or ringing in the ear.

In addition to the above symptoms, people with central vertigo may experience: 

• Headaches

• Weakness in one arm or one leg, similar to a stroke

• Trouble swallowing

• Slurred speech

• Facial paralysis

When to see a provider 

Many people with conditions that cause vertigo — like BPPV or Ménière’s — are familiar with vertigo attacks and how to recover from them. But if you are experiencing your first episodes of vertigo, symptoms can feel both severe and alarming. And it is natural to wonder if you should seek emergency medical care rather than wait for a scheduled appointment with your provider.

You should seek emergency evaluation if you are experiencing any of these symptoms along with the vertigo:

• Weakness in one arm or leg

• Numbness in an arm or leg

• Loss of vision or changes in your vision beyond the spinning sensation of vertigo

• Difficulty speaking

• Difficulty swallowing

• Confusion, disorientation, or lethargy

• Inability to stand or walk

• Severe headache

• Uncontrollable vomiting 

Beyond symptoms, there are other factors that determine if you should seek evaluation immediately. These include:

• Age: As you get older, your risk increases for conditions that can cause central vertigo, like stroke. So if you are 60 or older and you are experiencing vertigo for the first time, it is best to be evaluated to figure out what is causing it.

• Blood-thinning medications: These medications make the likelihood of bleeding in the brain higher.

• Recent head trauma: This also increases the possibility that there is bleeding in the brain.

• Higher risk of a stroke: Some conditions that increase your risk of stroke are high blood pressure, high cholesterol, diabetes, and atrial fibrillation. 

Why trust our experts?

Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in New York City. She has held local and national roles at the American Medical Women’s Association including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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