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Vertigo has many potential causes, broadly divided into peripheral (inner ear) and central (brain) origins. Common peripheral causes include BPPV (displaced crystals in the inner ear), vestibular neuritis (inflammation of the balance nerve), and Meniere's disease (inner ear fluid disorder). Central causes include vestibular migraine, stroke, and multiple sclerosis. Cardiovascular conditions, medications, and anxiety can also cause dizziness. Accurate diagnosis through systematic examination is essential because treatment differs significantly depending on the underlying cause.

Many causes of vertigo are highly treatable with excellent outcomes. BPPV can often be completely resolved with repositioning maneuvers in a single clinic visit, with success rates exceeding 90 percent. Vestibular neuritis typically resolves over weeks with medication and vestibular rehabilitation exercises. Meniere's disease can be well controlled with dietary modification and medication in most patients. Vestibular migraine responds to migraine preventive treatment. Even when a condition cannot be fully cured, effective management strategies can significantly reduce symptoms and improve quality of life.

Benign Paroxysmal Positional Vertigo is the most common cause of vertigo, accounting for approximately 20 to 30 percent of all dizziness cases. It occurs when tiny calcium carbonate crystals (otoconia) become dislodged from their normal location in the inner ear and migrate into the semicircular canals, where they disrupt normal fluid movement and send false motion signals to the brain. This causes brief but intense spinning episodes triggered by specific head movements such as rolling over in bed, looking up, or bending forward. Treatment with the Epley or other repositioning maneuvers is remarkably effective.

Seek immediate emergency care if vertigo is accompanied by severe headache (especially sudden onset), double vision, slurred speech, facial weakness or numbness, limb weakness or difficulty walking, or difficulty swallowing. These symptoms may indicate a stroke or other serious central nervous system condition requiring emergency treatment. Vertigo accompanied by sudden hearing loss also requires urgent evaluation. While most vertigo is caused by benign inner ear conditions, rapid assessment is essential to distinguish these from potentially dangerous central causes.

Brain imaging is not required for all vertigo cases but is recommended when clinical features suggest a central nervous system cause, when peripheral causes have been ruled out through examination and testing, when vertigo is accompanied by neurological symptoms such as weakness, numbness, or speech changes, or when symptoms are atypical or not responding to expected treatment. MRI with specific sequences can detect stroke, tumors, multiple sclerosis, and other structural causes. Your specialist will determine if imaging is needed based on your clinical presentation.

Treatment duration varies significantly by cause. BPPV can often be treated successfully in a single visit with repositioning maneuvers, though some patients require two or three sessions. Vestibular neuritis typically improves over two to six weeks with medication and vestibular exercises. Meniere's disease requires ongoing management but symptoms can be well controlled. Vestibular migraine responds to migraine preventive treatment over four to eight weeks. Vestibular rehabilitation exercises, when prescribed, are typically practiced daily for several weeks to retrain the balance system.

Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy designed to retrain the brain to compensate for inner ear dysfunction and improve balance. It involves specific exercises tailored to your condition, including gaze stabilization exercises to improve visual focus during head movement, habituation exercises to reduce dizziness provoked by movement, and balance training to improve stability. VRT is highly effective for many vestibular conditions and is particularly valuable for patients with persistent dizziness following vestibular neuritis or incomplete BPPV resolution.

Meniere's disease is a chronic inner ear disorder characterized by episodes of vertigo lasting 20 minutes to several hours, fluctuating hearing loss typically in one ear, tinnitus (ringing or roaring), and a sensation of ear fullness or pressure. It is caused by abnormal fluid accumulation in the inner ear. Management includes dietary sodium restriction, diuretic medications, and acute episode treatment. Most patients achieve good symptom control with conservative measures. Our specialists coordinate between neurology and ENT for comprehensive Meniere's management.