What causes vertigo?

From the Guidelines

Vertigo is primarily caused by problems in the inner ear or brain that affect your balance system, with the most common causes including benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis or labyrinthitis, and migraines. The inner ear contains structures called the vestibular system that help maintain balance by sending signals to your brain about your head's position and movement. When these signals are disrupted or misinterpreted, vertigo occurs. According to 1, vertigo makes you feel like you are spinning or moving when you are still, and it is caused when your vestibular system isn’t working properly.

Some key points to consider when evaluating vertigo include:

• The definition of vertigo as an illusory sensation of motion of either the self or the surroundings in the absence of true motion, as stated in 1 and 1
• The distinction between peripheral causes of vertigo, such as BPPV, and central causes, such as stroke or multiple sclerosis, as discussed in 1
• The importance of a thorough diagnostic evaluation, including a physical examination and potentially imaging studies or vestibular function tests, to determine the underlying cause of vertigo, as outlined in 1 and 1
• The various treatment options available, depending on the underlying cause, including specific head movements, medications, vestibular rehabilitation exercises, and in some cases, surgery, as described in 1, 1, and 1

It's also important to note that vertigo can have a significant impact on a person's quality of life, and effective treatment can help to improve symptoms and reduce the risk of complications, as highlighted in 1. Treatment should be tailored to the individual's specific needs and underlying cause of vertigo, and may involve a combination of these approaches. By understanding the causes and treatment options for vertigo, healthcare providers can help patients to manage their symptoms and improve their overall quality of life.

From the Research

Causes of Vertigo

• Vertigo can be caused by various factors, including otological, central, psychogenic, and undetermined or ill-defined causes 2
• Otological vertigo includes disorders of the inner ear, such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and bilateral vestibular paresis 2
• Central vertigo includes entities such as vertigo associated with migraine and certain strokes 2
• Psychogenic vertigo occurs in association with disorders such as panic disorder, anxiety disorder, and agoraphobia 2
• Other causes of vertigo include cerebrovascular disease, multiple sclerosis, and intracranial neoplasms 3

Specific Causes of Vertigo

• Benign paroxysmal positional vertigo (BPPV) is the most common cause of brief symptoms of vertigo secondary to head and body movements 4
• BPPV is caused by wayward crystals in the semicircular canals of the inner ear 4
• Ménière's disease and vestibular neuritis are also common causes of vertigo 2
• Migraine-associated vertigo is a type of central vertigo that can be treated with prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers 2

Diagnosis and Treatment of Vertigo

• The diagnosis of vertigo involves a thorough history and physical examination, including special tests such as the Dix-Hallpike maneuver 3
• The Epley maneuver is a effective treatment for BPPV, with a success rate of 90.7% after the initial maneuver and 96% after the second maneuver 5
• Vestibular suppressants such as anticholinergics and benzodiazepines can be used to treat vertigo, but are not recommended for BPPV and bilateral vestibular paresis 2
• Physical therapy treatment can be very useful in treating BPPV and bilateral vestibular paresis 2