What Is Vertigo? Causes, Symptoms and Types

Have you ever felt like the room was spinning, tilting or moving even though you were standing still? That sensation is called vertigo.

As a physical therapist who works with patients experiencing dizziness, vertigo and balance problems, I often help people understand what's behind their symptoms. One of the most important things to know is that vertigo is a symptom, not a diagnosis. The underlying cause determines the appropriate treatment.

What is vertigo?

Vertigo is a specific type of dizziness characterized by the sensation of movement when no actual movement is occurring. People may describe it as spinning, rotating, tilting or feeling as though the room is moving.

Dizziness is a broader term. Someone who feels dizzy may feel lightheaded, unsteady, disoriented, as though they are floating, or simply “off.”

The distinction matters because different types of dizziness and vertigo can have very different causes.

What causes vertigo?

Vertigo can have several causes. Many involve the vestibular system, which includes structures in the inner ear and the brain pathways that help us maintain balance and understand where our bodies are in space.

Vestibular conditions can be classified as:

• Peripheral vestibular disorders: Problems involving the inner ear and vestibular organs.
• Central vestibular disorders: Problems involving the brain and the pathways connecting the inner ear to the central nervous system.

Dizziness and vertigo-like sensations can also occur with systemic or metabolic conditions, including dehydration, vitamin deficiencies, thyroid or adrenal disorders and changes in blood sugar.

Autonomic dysfunction, including conditions such as POTS, can also cause dizziness, particularly when changing positions.

What are the most common types of vertigo?

In my practice, I see patients with a variety of vestibular and balance-related conditions. Some of the most common include:

• BPPV, or benign paroxysmal positional vertigo
• Vestibular migraine
• Vestibular neuritis
• Labyrinthitis
• Ménière’s disease
• PPPD, or persistent postural-perceptual dizziness
• Concussion-related vestibular symptoms
• Dysautonomia, including POTS

BPPV

BPPV is a common cause of positional vertigo.

Inside the inner ear are tiny calcium-carbonate crystals called otoconia. Normally, these crystals are located in a specific part of the inner ear. With BPPV, they become displaced and enter one of the semicircular canals.

This can cause brief episodes of vertigo when the head moves.

Common triggers include:

• Rolling over in bed
• Lying down
• Sitting up
• Looking up
• Bending over

BPPV can also occur following a concussion or other head injury because the mechanical forces involved can dislodge the otoconia.

Vestibular migraine

Vestibular migraine is another important cause of dizziness and vertigo.

It can cause vertigo, dizziness, motion sensitivity, visual sensitivity and imbalance. Importantly, these symptoms can occur with or without a typical headache.

Vestibular migraine tends to be recurrent and may require longer-term management.

Vestibular neuritis and labyrinthitis

Vestibular neuritis and labyrinthitis involve inflammation affecting the vestibular system. They can cause significant dizziness and balance problems, and recovery may take weeks to months.

Ménière’s disease

Ménière’s disease is an inner-ear disorder that can cause episodes of vertigo along with other symptoms, including hearing changes and ringing in the ear.

PPPD

PPPD, or persistent postural-perceptual dizziness, is characterized by persistent dizziness, unsteadiness or non-spinning vertigo.

Symptoms may become worse when standing upright, moving or being exposed to visually complex environments.

Can a concussion cause vertigo?

Yes. Concussions and other head injuries can cause dizziness and vertigo.

A concussion can affect multiple systems involved in balance, including the vestibular and visual systems. It can also trigger BPPV by dislodging the crystals in the inner ear.

However, dizziness after a concussion is not necessarily caused by BPPV alone.

Depending on the injury, someone may experience vestibular dysfunction, visual-motion sensitivity, impaired eye movements, balance problems, neck dysfunction, migraine, autonomic dysfunction or reduced tolerance for physical exertion.

When several systems are affected, recovery may take longer and require a more comprehensive rehabilitation approach.

Can migraines cause vertigo?

Yes. Vestibular migraine can cause vertigo even when a person does not have a headache.

Symptoms may include:

• Spinning or other sensations of movement
• Dizziness
• Motion sensitivity
• Visual sensitivity
• Imbalance

If these symptoms are recurrent, a medical evaluation can help determine whether vestibular migraine or another condition may be contributing.

Can anxiety cause vertigo?

Anxiety can worsen existing dizziness and may contribute to persistent dizziness in some people.

For example, people with PPPD may experience symptoms that become worse with movement, standing or visually stimulating environments. Anxiety, increased attention to physical sensations and avoidance of certain activities can interact with the vestibular system and influence how the brain processes balance and spatial information.

This does not mean the symptoms are “just in your head.” Dizziness is real, and understanding the factors contributing to it is an important part of treatment.

Who is most likely to experience vertigo?

It depends on the cause.

Older adults may be more prone to BPPV because age-related changes can make the inner-ear crystals more likely to become displaced.

Women are more commonly affected by vestibular migraine, similar to migraine in general.

Adolescents and young adults may experience concussion-related dizziness and vestibular symptoms, particularly after sports-related injuries.

Anyone can experience vertigo, however, and symptoms should not be dismissed based solely on age or other characteristics.

When should I see a doctor for vertigo?

New, severe, unexplained or persistent vertigo should be medically evaluated.

Some symptoms that occur along with dizziness or vertigo can indicate a neurological or other serious medical condition. Vestibular rehabilitation clinicians are trained to screen for warning signs before assuming symptoms are coming from the inner ear.

If vertigo occurs with sudden neurological symptoms such as new weakness, numbness, difficulty speaking, difficulty swallowing or double vision, seek immediate medical attention.

If your symptoms are recurrent or are affecting your ability to walk, exercise, work or participate in everyday activities, a vestibular physical therapy evaluation may also be appropriate.

Frequently Asked Questions About Vertigo

What does vertigo feel like?

Vertigo commonly feels like spinning, rotating, tilting or as though the room or your body is moving when it is not.

What is the difference between vertigo and dizziness?

Vertigo is a specific sensation of movement. Dizziness is a broader term that can include lightheadedness, imbalance, disorientation, floating or feeling “off.”

What is the most common cause of positional vertigo?

BPPV is a common cause of positional vertigo. It occurs when tiny calcium-carbonate crystals in the inner ear become displaced.

Can vertigo go away on its own?

Sometimes. The timeline depends on the underlying cause. Some conditions, including BPPV, can respond quickly to treatment, while others may require weeks or months of rehabilitation or medical management.

Can physical therapy help vertigo?

Yes. Vestibular physical therapy can help people with several causes of dizziness and vertigo. Treatment depends on the underlying condition and may include repositioning maneuvers, balance exercises, habituation exercises and other individualized interventions.

Can vertigo be a sign of something serious?

Sometimes. New or severe vertigo accompanied by sudden neurological symptoms requires prompt medical evaluation.

Want to speak to an expert about treatment for vertigo? Contact us at (203) 284-2888 or fill out an appointment request form on our outpatient neurological rehabilitation page.

This content is for educational purposes only and is meant to provide general information. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider with any questions or concerns about your health. In case of a medical emergency, contact your doctor or call 911 right away.