Vertigo Disorder

Vertigo is not dizziness in general; it is the specific illusion of movement, usually spinning. The distinction matters because the causes are entirely different from those of lightheadedness or unsteadiness. Benign paroxysmal positional vertigo accounts for the largest share: displaced otoconia in a semicircular canal produce brief, violent spinning triggered by head position change, lasting under a minute. It is diagnosed with the Dix-Hallpike test and cured by the Epley manoeuvre in one or two sessions, with success rates above 80%. Vestibular neuritis produces days of continuous vertigo after a viral illness and resolves through central compensation, which vestibular rehabilitation accelerates. Ménière's disease produces episodic vertigo lasting hours with fluctuating hearing loss and tinnitus. Central causes — stroke in the posterior circulation — are the dangerous minority, flagged by new headache, double vision, slurred speech, limb weakness, or an inability to walk unaided. Betahistine, widely prescribed, has weak evidence outside Ménière's.

• •Spinning sensation triggered by rolling over or looking up
• •Episodes lasting under a minute in BPPV
• •Continuous vertigo over days in vestibular neuritis
• •Nausea and vomiting
• •Involuntary eye movement (nystagmus)
• •Fullness in the ear with hearing change in Ménière's

• •Benign paroxysmal positional vertigo
• •Vestibular neuritis or labyrinthitis
• •Ménière's disease
• •Vestibular migraine
• •Posterior circulation stroke
• •Head injury
• •Ototoxic medication

Displacement of otoconia into the semicircular canals, inflammation of the vestibular nerve, endolymphatic hydrops, or central lesions affecting brainstem and cerebellar vestibular pathways.