Common Causes of Vertigo in Elderly Adults, and When It Shouldn’t Be Ignored

Vertigo is a specific type of dizziness that makes you feel like you’re spinning in a circle, even though your body isn’t moving. It’s a symptom, not a disease itself. And it can have many different causes. Sometimes, it’s a minor problem with the part of the inner ear that controls balance. But it can also be caused by more serious problems in the parts of the brain that also help with balance. 

And if you’re an older adult experiencing vertigo for the first time, your risk of one of the more serious causes is a little higher. So we go through how the sensation of vertigo in older adults may require emergency medical care.

What causes vertigo in older adults?

Vertigo comes from a problem with the body’s balance mechanisms. This mainly involves two parts of the body: the ear and the brain. 

The inside of the ear has a special fluid-filled area that measures your body’s position. Think of it like a level you would use to hang a picture. Information from that part of the ear is carried to the brain by nerves. The brain processes that information to keep you upright and balanced. And so problems at any of these steps can lead to vertigo.

The medical conditions that cause vertigo can range from minor to serious. But no matter what’s causing it, vertigo often feels intense, unpleasant, and debilitating. So the severity of your symptoms doesn’t always correlate to the severity of the cause.

Ear conditions that can lead to vertigo include:

• Benign paroxysmal positional vertigo (BPPV): This is a condition in which little stones form inside the liquid of the inner ear. This is the part that helps with balance. The stones interfere with the inner ear’s function.

• Meniere’s disease: This is a condition in which the fluid levels in the inner ear get too low. It’s not clear why this happens. It often causes a ringing in the ear as well as vertigo.

• Inflammation: If the inner ear or the nerves near it get inflamed, this is called labyrinthitis. The inflammation interferes with the signals going to the brain. It could be caused by viruses like the common cold.

• Schwannomas: These are harmless growths of the nerves in the ear. These are also called acoustic neuromas. They can interfere with the inner ear’s signals to the brain.

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Some of the brain conditions that can lead to vertigo are more common in older adults include: 

• Strokes: Strokes happen when a blood vessel is blocked or bleeds into the brain. If this happens near the part of the brain that helps keep you balanced, vertigo is often a symptom. And it may be the first or only symptom.

• Arterial dissections: Sometimes the walls of blood vessels — especially older blood vessels — develop tears. This can block blood flow or cause strokes, especially when it happens in one of the blood vessels of the neck that supply the brain. 

• Brain tumors: This is a less common cause. But any tumor in the brain could grow in the part of the brain that controls your balance. 

Other brain conditions that can cause vertigo include migraine headache and multiple sclerosis. But these are more common in younger people.

What medications can cause vertigo?

Some medications can cause vertigo, too. These medications can cause damage to the inner ear or its associated nerves. Many times they often cause a ringing sensation in the ear, too. These include:

• Aspirin

• Loop diuretics (examples include furosemide, bumetanide, and torsemide)

• Aminoglycoside (examples include gentamicin, tobramycin, and neomycin)

• Platinum-containing chemotherapy drugs (like cisplatin and carboplatin)

What should you do if you’re experiencing vertigo?

If you’re experiencing vertigo for the first time, you should get medical care right away. This is especially true for older adults since they’re at a higher risk of many serious conditions. 

If you already have a known condition that causes vertigo, and you are familiar with the feeling, a call or visit with your primary care provider may be enough. But only if the vertigo feels similar to what you’re used to. If not, be cautious and get medical care. This usually means going to the ER (emergency room).

An ER is better than urgent care for vertigo in older adults. An ER will have all the necessary testing and treatments to help you quickly. And in most cases, it’s better to call 911 rather than trying to get yourself there. This is not only because you should never get behind the wheel of a car if you’re experiencing vertigo. But also because ambulance crews are best equipped to assess for a possible stroke, and get you quick care if you need one.

And you should definitely call 911 if you’re experiencing new vertigo and you have:

• A new headache

• Trouble seeing or vision changes

• Trouble talking

• Confusion

• Any numbness or weakness in your face, arms, or legs

• New neck pain or chest pain

• Recent head trauma

You should also call 911 if you’re having new vertigo and are taking a blood thinner.

How can you reduce the symptoms of vertigo?

The first and most important step is to rule out any serious causes of vertigo. Once a healthcare professional is able to pinpoint exactly what’s causing your vertigo, your treatment options will partly depend on the cause. 

But no matter the cause, there are also treatments that can help reduce your symptoms until the vertigo passes. Vertigo as a symptom can range from mild to severe and debilitating. The treatments include:

• Avoiding quick movements or position changes

• Returning to activity gradually

• Using a walking device to help avoid any falls

• Medications, such as meclizine (Antivert) or dimenhydrinate (Dramamine)

• Physical therapy, which can really help people for ongoing or recurrent symptoms

Why trust our experts?

Written by:

Michael Dreis, MD

Dr. Dreis is an emergency medicine physician currently practicing in Milwaukee, Wisconsin. He went to medical school at the University of Wisconsin – Madison and completed his residency at Henry Ford Hospital in Detroit, Michigan.

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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