Are all vertigo episodes short-lasting?

Not All Vertigo Episodes Are Short-Lasting

No, not all vertigo episodes are short-lasting, as different vestibular disorders have characteristic durations ranging from seconds to days depending on the underlying cause. 1, 2

Duration Patterns of Common Vertigo Causes

Short Duration (Seconds to Minutes)

• Benign Paroxysmal Positional Vertigo (BPPV)

  • Episodes typically last less than 1 minute (seconds)
  • Triggered by head position changes
  • Not associated with hearing loss, tinnitus, or aural fullness 1, 3

• Vestibular Paroxysmia

  • Brief episodes lasting seconds to minutes
  • Can occur up to 80 times per day
  • Often caused by neurovascular compression of the eighth cranial nerve 4, 5

Medium Duration (Minutes to Hours)

• Vestibular Migraine

  • Episodes lasting 5 minutes to 72 hours
  • About 30% of patients have episodes lasting minutes
  • Another 30% have attacks lasting hours 1, 6

• Ménière's Disease

  • Episodes lasting 20 minutes to 12 hours (definite MD) or up to 24 hours (probable MD)
  • Associated with fluctuating hearing loss, tinnitus, and aural fullness
  • Frequency decreases as disease progresses 1, 7

Long Duration (Hours to Days)

• Vestibular Neuritis/Labyrinthitis

  • Severe rotational vertigo lasting 12 to 36 hours initially
  • Followed by decreasing disequilibrium for 4-5 days
  • Prolonged vertigo (>24 hours) 1, 2

• Stroke/Ischemia

  • Continuous dizziness with neurological symptoms
  • May present with vertigo lasting minutes initially
  • Usually associated with other neurological symptoms 1, 2

Diagnostic Approach Based on Duration

1. For brief episodes (<1 minute):

   • Consider BPPV first, especially if positional
   • Evaluate with Dix-Hallpike maneuver
   • Consider vestibular paroxysmia if very frequent and brief

2. For medium-duration episodes (minutes to hours):

   • Consider vestibular migraine if history of migraine or migraine features
   • Consider Ménière's disease if associated with fluctuating hearing loss and aural fullness
   • Differentiate using associated symptoms and hearing tests

3. For prolonged episodes (>24 hours):

   • Consider vestibular neuritis/labyrinthitis
   • Rule out stroke with HINTS exam if acute onset
   • Evaluate for other neurological symptoms

Clinical Pitfalls to Avoid

• Misdiagnosis trap: Vestibular migraine can mimic both BPPV (when episodes are short) and Ménière's disease (when episodes are longer), leading to diagnostic confusion 6

• Overlooking stroke: Failure to consider stroke in older adults with acute vestibular symptoms, especially with neurological symptoms or vascular risk factors 2

• Focusing only on symptom description: The approach should be guided by categorizing episodes based on timing and triggers rather than simply the description of symptoms 2

• Premature diagnostic closure: Many vestibular disorders have overlapping symptoms, requiring careful evaluation of the complete clinical picture 6

Duration of vertigo is a critical diagnostic feature that helps narrow down the differential diagnosis and guide appropriate treatment for these often debilitating conditions.