Dizziness / Vertigo
Symptoms, Causes & Treatment
Dizziness and vertigo are among the most common reasons people visit a GP. Most causes are benign and treatable — BPPV alone accounts for over 30% of cases. However, some forms of dizziness indicate serious neurological or cardiovascular conditions requiring emergency care.
What is Dizziness & Vertigo?
Dizziness encompasses vertigo (a false sensation of movement), presyncope (feeling faint), disequilibrium (balance problems), and non-specific dizziness. The distinction between peripheral vestibular causes (BPPV, vestibular neuritis, Ménière’s) and central causes (stroke, tumour) is clinically critical.
Symptoms of Dizziness & Vertigo
The type of dizziness — vertigo, presyncope, or disequilibrium — the trigger (positional vs spontaneous), and associated features all help identify the underlying cause.
Spinning sensation (vertigo) · Feeling of unsteadiness or imbalance · Nausea and vomiting · Lightheadedness or presyncope · Tinnitus or hearing loss (Ménière’s disease) · Nystagmus (involuntary eye movement) · Difficulty walking or maintaining balance
Sudden vertigo with severe headache or vomiting (posterior fossa stroke) · Dizziness with diplopia, dysphagia, or ataxia (brainstem) · Sudden hearing loss with vertigo · Vertigo with unilateral weakness or speech difficulty — call 999 immediately
Sudden vertigo with headache, weakness, speech difficulty, or double vision — call 999. These are stroke signs requiring emergency treatment within minutes.
What Causes Dizziness & Vertigo?
Dizziness and vertigo arise from disturbances in the vestibular system, cardiovascular system, or central nervous system. Identifying the cause determines treatment.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It is caused by displaced calcium carbonate crystals (otoliths) in the semicircular canals, triggering brief positional vertigo. It is cured by the Epley manoeuvre.
Vestibular neuritis is inflammation of the vestibular nerve following viral infection. It causes acute severe vertigo lasting days, without hearing loss. Treated with short-course vestibular sedatives and vestibular rehabilitation exercises.
Ménière’s disease causes episodic vertigo, fluctuating hearing loss, tinnitus, and ear fullness. It results from excess endolymph in the inner ear. Episodes last 20 minutes to 12 hours. Management includes low-salt diet, betahistine, and ENT referral.
Orthostatic hypotension — a drop in systolic BP of >20mmHg on standing — causes lightheadedness and near-syncope. Common causes include dehydration, antihypertensives, and autonomic neuropathy. Lying-to-standing blood pressure confirms the diagnosis.
Central causes of vertigo including posterior fossa stroke, cerebellar haemorrhage, and acoustic neuroma can present with dizziness. HINTS examination (Head Impulse, Nystagmus, Test of Skew) differentiates central from peripheral vertigo.
Migraine-associated vertigo (vestibular migraine) is the most common cause of episodic vertigo with headache. Vertigo episodes last minutes to 72 hours and may occur without headache. It responds to migraine-specific treatment.
Key Risk Factors
Diagnosing Dizziness & Vertigo
Clinical assessment — including the Dix-Hallpike test, lying/standing blood pressure, and neurological examination — identifies the cause in most cases.
Treatment for Dizziness & Vertigo
Treatment is targeted to the underlying cause. BPPV responds immediately to the Epley manoeuvre. Vestibular neuritis responds to short-term vestibular sedatives and rehabilitation exercises.
Supportive Measures
During an acute vertigo attack: lie still in a comfortable position, avoid sudden head movements, stay hydrated, and take prescribed vestibular sedatives only for the first 3–5 days. After recovery, begin vestibular rehabilitation exercises to prevent recurrence.
Chronic & Recurrent Vertigo
Recurrent BPPV, Ménière’s disease, and vestibular migraine all require ongoing specialist management. ENT and audiovestibular referral, vestibular rehabilitation, and in some cases surgical intervention are options for poorly controlled conditions.
When to Seek Help
Sudden vertigo with severe headache, unilateral weakness, speech difficulty, double vision, or difficulty walking — call 999 immediately. These signs suggest a brainstem or cerebellar stroke.
See a GP promptly for persistent dizziness (more than 1 week), recurrent episodes, dizziness with hearing loss or tinnitus, or dizziness significantly affecting balance or daily activities.
Preventing Dizziness & Vertigo
Many causes of dizziness are preventable or manageable through targeted interventions.
Perform the Epley manoeuvre at the first recurrence of BPPV symptoms. Many patients learn to perform it at home. Fall prevention measures — night lights, handrails, and avoiding rapid head movements — reduce BPPV-related injury risk.
Rise slowly from lying to sitting to standing, especially first thing in the morning. Sit on the edge of the bed for 30 seconds before standing. Increase salt and fluid intake if orthostatic hypotension is confirmed.
Maintain cardiovascular health by controlling blood pressure, blood glucose, and cholesterol. Stopping smoking and treating atrial fibrillation reduce the risk of central causes of vertigo, particularly posterior circulation stroke.
Follow a low-sodium diet (less than 1.5g of sodium per day) and stay well hydrated. This reduces endolymph volume and decreases frequency of Ménière’s episodes significantly.
During vestibular neuritis recovery, perform vestibular rehabilitation exercises (Brandt-Daroff, gaze stabilisation). Regular gentle movement promotes central compensation and accelerates recovery. Avoid prolonged bed rest.
Fall prevention is essential for patients with chronic dizziness. Install grab rails, remove trip hazards, use night lights, and wear proper-fitting footwear. Occupational therapy referral is appropriate for those at risk.
Getting Treatment
A GP can perform the Epley manoeuvre for BPPV, manage orthostatic hypotension, arrange audiometry and ENT or neurology referral. An online consultation is a good starting point for non-emergency dizziness.
Expert clinical advice, when you need it.
Dizziness & Vertigo — Frequently Asked Questions
BPPV (benign paroxysmal positional vertigo) is the most common cause. It is caused by tiny calcium crystals displaced in the inner ear, triggering brief spinning sensations when moving the head. The Epley manoeuvre performed by a GP or physiotherapist cures it in 90% of cases.
Call 999 immediately if dizziness is accompanied by sudden severe headache, one-sided weakness, speech difficulty, double vision, or difficulty swallowing. These symptoms suggest a brainstem or cerebellar stroke, which is a medical emergency.
Vestibular neuritis causes acute severe vertigo lasting several days, usually following a viral illness. It occurs without hearing loss, unlike labyrinthitis. Recovery is aided by early mobilisation and vestibular rehabilitation exercises. Short-term vestibular sedatives (prochlorperazine) reduce nausea during the acute phase.
Ménière’s disease causes episodic attacks of severe rotational vertigo, fluctuating hearing loss, tinnitus, and ear fullness. Episodes typically last 20 minutes to 12 hours. A low-salt diet, betahistine, and ENT referral are the cornerstones of management.
Orthostatic hypotension causes lightheadedness on standing due to a drop in blood pressure. Common causes include dehydration, antihypertensive medications, and autonomic neuropathy. Rising slowly, increasing fluid and salt intake, and reviewing medications are effective management strategies.
Yes. Anxiety and panic disorder commonly cause dizziness through hyperventilation and increased vestibular sensitivity. Chronic dizziness and anxiety are frequently interlinked in a condition called persistent postural-perceptual dizziness (PPPD). CBT and vestibular rehabilitation both help.
In BPPV, brief positional vertigo lasting under 1 minute and triggered by specific head movements (lying down, rolling over in bed, looking up) suggests BPPV. In contrast, continuous vertigo, hearing loss, or vertigo with neurological symptoms suggests a more serious cause requiring urgent assessment.
A GP can diagnose and treat BPPV (with the Epley manoeuvre), manage orthostatic hypotension, arrange audiometry, and refer to ENT or neurology for complex or persistent dizziness. An online GP consultation is a good starting point for non-emergency dizziness.