Vertigo is most commonly caused by a problem with the balance mechanisms of the inner ear. However, it can also be due to a problem within the brain or the nerves.
The different causes of vertigo are explained in more detail below.
Labyrinthitis
Labyrinthitis is an inner ear infection that causes a delicate structure deep inside your ear (the labyrinth) to become inflamed. The labyrinth is a maze of fluid-filled channels that control hearing and balance.
If the labyrinth becomes inflamed, the information it sends to your brain will be different from the information that's sent from your unaffected ear and your eyes. This difference can make you feel dizzy or that you're moving when you're still (vertigo).
Labyrinthitis is usually caused by a viral infection, such as the common cold or flu, which spreads to the labyrinth. Less commonly, it's caused by a bacterial inner ear infection.
Vertigo that's caused by an infection may be accompanied by other symptoms, such as a high temperature or severe earache.
Vestibular neuronitis
Vestibular neuronitis, also known as vestibular neuritis, is an inner ear condition that causes nerve pain and inflammation. It can also cause attacks of vertigo that can last for several hours or days.
A viral infection can sometimes lead to vestibular neuronitis if the infection spreads to your vestibular nerve. The vestibular nerve is one of the nerves in your ear that's used for balance.
If your vertigo attacks are caused by vestibular neuronitis, they will often come on suddenly and can cause:
- unsteadiness
- nausea (feeling sick)
- vomiting (being sick)
You won't usually have any hearing problems.
Benign paroxysmal positional vertigo (BPPV)
Short, intense, recurrent attacks of vertigo (usually lasting less than 30 seconds) are often the result of benign paroxysmal positional vertigo (BPPV).
BPPV can occur when you:
- turn your head suddenly
- roll over in bed
- look up
- stand up
- bend over
BPPV is often accompanied by nausea, although vomiting is rare. During the attack, you may also experience brief nystagmus. This is where your eyes move uncontrollably, usually from side to side.
Light-headedness and a loss of balance can last for several minutes or hours after the attack. You won't have tinnitus (ringing in your ears) or hearing loss.
BPPV is thought to be caused by small fragments of debris which, for unknown reasons, break off from the lining of the channels in your inner ear. The fragments don't usually cause a problem unless they get into one of the ear’s fluid-filled canals.
When your head is still, the fragments sit at the bottom of the canal. However, certain head movements cause them to be swept along the fluid-filled canal where they brush against the sensitive hairs that line the canal. This sends extra, confusing messages to your brain, which responds by causing vertigo.
BPPV usually affects older people, with most cases occurring at around 50 years of age. However, it can sometimes affect younger people. BPPV may occur for no apparent reason, or it may develop after:
- an ear infection
- ear surgery
- a head injury
- prolonged bed rest – for example, while recovering from an illness
Attacks of BPPV can clear up within a few days, but many cases require treatment because it can keep reoccurring.
Ménière's disease
Severe vertigo is sometimes caused by a rare condition called Ménière's disease. As well as vertigo, the symptoms of Ménière's disease include:
- hearing loss
- tinnitus
- aural fullness (a feeling of pressure in your ear)
If you have Ménière’s disease, you may experience sudden attacks of vertigo that last from 20 minutes to 24 hours. The attacks often cause nausea and vomiting.
The tinnitus that's associated with Ménière’s disease often gets worse over time. Initially, the hearing loss comes and goes, but it may eventually become permanent.
Head injury
Vertigo can sometimes develop after a head injury. If you have symptoms following a head injury, such as dizziness or vertigo, you should visit your GP as soon as possible. Alternatively, go to your nearest hospital’s accident and emergency (A&E) department.
Read more about severe head injury and minor head injury.
Migraines
A migraine is a severe headache that's usually felt as a throbbing pain at the front, or on one side, of your head. Some people also experience other symptoms, such as nausea and sensitivity to light (photophobia).
It's thought that migraines may be one of the most common causes of vertigo.
Other causes
As well as the conditions described above, vertigo may also occur as a side effect of some types of medication. Check the patient information leaflet that comes with your medicine to see if vertigo is listed as a possible side effect.
Less common causes of vertigo include:
- a stroke or transient ischaemic attack (TIA or 'mini-stroke’) – the blood supply to part of the brain is cut off or reduced
- multiple sclerosis – a condition that affects the central nervous system (the brain and spinal cord)
- acoustic neuroma – a rare, non-cancerous (benign) brain tumour that grows on the acoustic nerve, which is the nerve that helps control hearing and balance
- a brain tumour in the cerebellum (which is located at the bottom of the brain)
