Most Common Cause of Vertigo
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, accounting for approximately 42% of all vertigo cases in primary care settings. 1, 2, 3
Epidemiology and Clinical Significance
BPPV is definitively the most common inner ear problem and leading cause of vertigo, as established by the American Academy of Otolaryngology-Head and Neck Surgery guidelines. 1, 2
The prevalence increases significantly with age, and many individuals will experience BPPV at some point in their lives. 1, 2
In subspecialty settings, the distribution shifts somewhat, with Meniere's disease accounting for 43% of cases, followed by BPPV at 23% and vestibular neuritis at 26%. 1, 2
Other Common Causes to Consider
While BPPV predominates, the differential diagnosis varies by clinical setting:
In Primary Care Settings:
- BPPV: 42% of vertigo cases 1, 3
- Vestibular neuritis: 41% - presents with acute prolonged vertigo lasting 12-36 hours with severe nausea but no hearing loss 1, 3
- Meniere's disease: 10% - characterized by episodic vertigo lasting 20 minutes to 12 hours with fluctuating hearing loss, tinnitus, and aural fullness 1, 3
- Vascular causes: 3% - including vertebrobasilar insufficiency and stroke 1
Critical Central Causes (Less Common but Dangerous):
- Vestibular migraine accounts for approximately 14% of all vertigo cases with a lifetime prevalence of 3.2%. 1, 4
- Posterior circulation stroke can present as isolated vertigo in up to 25% of acute vestibular syndrome cases, and critically, 75-80% of stroke-related vertigo patients have no focal neurologic deficits initially. 3
Key Clinical Pitfall
Never dismiss isolated vertigo without focal neurologic findings as automatically benign - 11% of patients presenting with acute persistent vertigo and no obvious neurologic signs have acute infarct on imaging. 3 This is particularly important in elderly patients with vascular risk factors, where posterior circulation stroke prevalence can reach 75% in high-risk cohorts. 3
Age-Specific Considerations
In adults over 65 years, vertigo/dizziness is the primary cause of falls in 13% of cases, with fall-related costs exceeding $20 billion annually in the United States. 3
Elderly patients may describe "vague dizziness" rather than classic spinning vertigo, even with significant inner ear pathology like BPPV, making diagnosis more challenging. 3
Undiagnosed BPPV affects 9% of geriatric clinic patients, with three-fourths having fallen within the preceding 3 months. 3