What are the causes of vertigo (dizziness)?

From the Guidelines

Vertigo is most commonly caused by inner ear problems such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease, as well as other conditions like stroke, migraine, and labyrinthitis, as outlined in the clinical practice guideline on Meniere's disease 1. The causes of vertigo can be diverse and include:

• Benign paroxysmal positional vertigo (BPPV), which is characterized by brief, intense episodes of vertigo triggered by specific head movements, as described in the clinical practice guideline on BPPV 1
• Vestibular neuritis, an inner ear infection that causes inflammation of the vestibular nerve, leading to severe vertigo, as mentioned in the guideline on Meniere's disease 1
• Meniere's disease, a disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, and hearing loss, as discussed in the guideline on Meniere's disease 1
• Stroke or ischemia, which can cause vertigo, nausea, vomiting, and severe imbalance, as outlined in the guideline on Meniere's disease 1
• Migraine, which can present with vertigo, photophobia, and other symptoms, as mentioned in the guideline on Meniere's disease 1
• Labyrinthitis, an inner ear infection that causes vertigo, hearing loss, and tinnitus, as discussed in the guideline on Meniere's disease 1
• Other conditions, such as autoimmune disorders, infectious diseases, and tumors, can also cause vertigo, as outlined in the guideline on Meniere's disease 1. It is essential to note that the diagnosis and management of vertigo should be guided by a thorough medical history, physical examination, and diagnostic testing, as recommended in the clinical practice guidelines on Meniere's disease and BPPV 1.

From the Research

Causes of Vertigo

The causes of vertigo can be divided into two main categories: peripheral and central causes.

• Peripheral causes include:
  • Benign paroxysmal positional vertigo (BPPV) 2, 3, 4, 5, 6
  • Acute vestibular neuronitis 2
  • Meniere's disease 2, 3
  • Perilymphatic fistulas 2
• Central causes include:
  • Cerebrovascular disease 2
  • Migraine 2
  • Psychological disease 2
  • Multiple sclerosis 2
  • Intracranial neoplasms 2

Diagnosis of Vertigo

The diagnosis of vertigo involves a thorough history and physical examination, including:

• Timing and duration of symptoms 2
• Provoking factors 2
• Associated signs and symptoms 2
• Special tests such as the Dix-Hallpike maneuver 2, 4, 5
• Laboratory and radiologic studies such as magnetic resonance imaging (MRI) 2

Treatment of Vertigo

The treatment of vertigo depends on the underlying cause.

• For BPPV, the Epley maneuver is a effective treatment 4, 5, 6
• For acute vertigo, pharmacotherapy such as Levo-sulpiride, methoclopramide, and triethilperazine may be used 3
• For central causes of vertigo, further work-up with laboratory and radiologic studies may be necessary 2