From the Guidelines
Sudden vertigo, or a false sense of spinning, is most commonly caused by Benign Paroxysmal Positional Vertigo (BPPV), a disorder of the inner ear characterized by repeated episodes of positional vertigo, as stated in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
Causes of Sudden Vertigo
The causes of sudden vertigo can be varied, but some common causes include:
- Inner ear problems, such as BPPV, labyrinthitis, or vestibular neuritis
- Sudden drop in blood pressure
- Dehydration
- Medication side effects
- Anxiety or panic attacks
- Low blood sugar
- Migraine headaches
- Anemia
- Heart rhythm disturbances
- Stroke or TIA (mini-stroke)
BPPV as a Common Cause
BPPV is the most common inner ear problem and cause of vertigo, with symptoms that can be very intense and upsetting, but it is not life-threatening 1. The condition is characterized by sudden, short spells of vertigo triggered by certain head positions or movements.
Diagnosis and Treatment
Diagnosis of BPPV is typically made through simple bedside testing, such as the Dix-Hallpike test or supine roll test, and treatment usually involves bedside repositioning exercises that can be performed by a healthcare provider or self-repositioning maneuvers taught to the patient 1.
Importance of Medical Attention
If you experience sudden, severe, or persistent dizziness, it is essential to seek medical attention immediately to rule out more serious causes, such as stroke or TIA (mini-stroke) 1. For mild cases, staying hydrated, sitting or lying down, and avoiding sudden movements can help alleviate symptoms. Keeping a symptom diary can also help identify triggers and patterns, which can aid in proper diagnosis and treatment.
From the Research
Causes of Sudden Vertigo
The causes of sudden vertigo can be diverse and may include:
- Benign paroxysmal positional vertigo (BPPV), which is triggered by head motion 2
- Meniere disease, characterized by vertigo with unilateral hearing loss 2
- Vestibular neuritis, which may cause episodic vertigo not associated with any trigger 2
- Vestibular migraine, which can cause vertigo and is often associated with other symptoms such as headache and sensitivity to light and sound 3
- Central etiologies, such as stroke or posterior fossa mass lesions, which can cause vertigo and require urgent treatment 2, 4
Diagnostic Approaches
To determine the cause of sudden vertigo, a physical examination can be helpful, including:
- Orthostatic blood pressure measurement 2
- A full cardiac and neurologic examination 2
- Assessment for nystagmus 2, 4
- The Dix-Hallpike maneuver 2
- The HINTS (head-impulse, nystagmus, test of skew) examination, which can help distinguish peripheral from central etiologies 2
Co-Occurring Vestibular Disorders
Some patients may experience co-occurring vestibular disorders, which can make diagnosis and treatment more complex 3. The probability of co-occurring disorders can be estimated using tools such as the dizziness symptom profile, which includes symptom clusters specific to six disorders that cause vestibular symptoms 3.
Treatment Options
Treatment for sudden vertigo depends on the underlying cause and may include:
- Canalith repositioning procedures, such as the Epley maneuver, for BPPV 2
- Vestibular suppressant medications and vestibular rehabilitation for vestibular neuritis 2
- Salt restriction and diuretics for Meniere disease 2
- Antivertigo agents and other medications for acute and chronic vestibular syndromes 5