What are the causes of vertigo (dizziness)?

From the Guidelines

Vertigo, or the sensation of spinning or dizziness, can be caused by various conditions, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, migraines, and neurological conditions, as outlined in a 2020 clinical practice guideline on Meniere's disease 1.

Causes of Vertigo

The causes of vertigo can be diverse, ranging from inner ear disorders to neurological conditions. Some of the common causes include:

• Benign paroxysmal positional vertigo (BPPV), characterized by positional vertigo lasting less than a minute
• Vestibular neuritis, a viral infection of the vestibular system leading to acute prolonged vertigo
• Meniere's disease, an inner ear disorder that affects balance and hearing
• Migraines, which can present with vertigo lasting from minutes to hours
• Neurological conditions such as stroke or multiple sclerosis

Diagnosis and Management

To diagnose vertigo, it is essential to evaluate the patient's symptoms, including the nature of the onset, duration, and concurrent otologic symptoms. A thorough otologic history and medical/surgical history should also be addressed. For accurate diagnosis and management, a healthcare provider should first ensure that the patient is describing actual vertigo, as defined by the Barany Society, and then rule out other causes of dizziness, such as lightheadedness or presyncopal episodes 1.

Treatment Options

Treatment options for vertigo depend on the underlying cause. For immediate relief, medications like meclizine, diazepam, or promethazine can help manage symptoms. Vestibular rehabilitation therapy, including specific exercises to retrain the balance system, may be recommended for persistent vertigo. The Epley maneuver is effective for BPPV, involving a series of head movements to reposition inner ear crystals. It is crucial to seek immediate medical attention if vertigo persists beyond a few days, is accompanied by hearing loss, severe headache, or difficulty walking, as these may indicate a more serious condition 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Causes of Vertigo

The causes of vertigo can be classified into several categories, including:

• Peripheral causes:
  • Benign paroxysmal positional vertigo (BPPV) 2, 3, 4, 5, 6
  • Meniere's disease 2, 5
  • Vestibular neuronitis 2, 5
  • Labyrinthitis 5
  • Perilymph fistula 2, 5
• Central causes:
  • Cerebrovascular disease 2
  • Migraine 2
  • Psychological disease 2
  • Multiple sclerosis 2
  • Intracranial neoplasms 2

Diagnosis of Vertigo

Diagnosing the cause of vertigo involves a systematic approach, including:

• Categorizing dizziness into one of four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo 5
• Differentiating between central and peripheral vertigo 2, 5, 6
• Using clinical evaluation and tests such as the Dix-Hallpike maneuver 2, 3, skew test, and head impulse test (HINTS) 6
• Performing tonal threshold audiometry to evaluate the integrity of the vestibular-cerebellar pathway 6

Treatment of Vertigo

Treatment for vertigo depends on the underlying cause, but may include:

• The Epley maneuver for BPPV 3, 4
• Rehabilitative exercises and physical maneuvers for peripheral vertigo 3, 4
• Medical or surgical treatment for central vertigo 2