Why You Feel Dizzy: Vertigo Causes, Diagnosis & Treatment

Vertigo vs. Dizziness — They Are Not the Same

One of the most common things patients say when they walk into my clinic is, "Doctor, mujhe chakkar aa rahe hain." But when I ask them to describe what they feel, the answers are remarkably different from one person to the next. Some feel the room spinning. Some feel lightheaded and about to faint. Some feel unsteady on their feet. These are all forms of dizziness — but only one of them is true vertigo.

Vertigo is a specific illusion of movement. You feel as though you — or the world around you — is spinning, tilting, or rotating, even when you are perfectly still. It is not a feeling of nearly blacking out (that is presyncope). It is not general unsteadiness (that is disequilibrium). Vertigo is that distinct, disorienting sensation that the room is moving around you.

This distinction matters because vertigo has specific causes and specific treatments. Getting the diagnosis right means you get better faster.

"The most frightening part of vertigo is not knowing what is happening to your body. Once patients understand the cause, the fear alone diminishes — and treatment becomes much more effective."

What Causes Vertigo?

The vast majority of vertigo originates in the inner ear — what we call peripheral vertigo. A small percentage comes from the brain or brainstem — called central vertigo — and this requires more urgent attention. Here are the most common causes:

1. BPPV — Benign Paroxysmal Positional Vertigo

This is by far the most common cause of vertigo, accounting for nearly half of all cases. Inside your inner ear, there are tiny calcium carbonate crystals called otoliths or otoconia. These crystals sometimes dislodge from their normal position and migrate into one of the semicircular canals — fluid-filled tubes that sense head rotation. When the crystals settle into the wrong canal, any change in head position causes a false signal of movement to be sent to your brain, triggering a sudden spinning sensation.

BPPV episodes typically last less than a minute and are triggered by specific movements: rolling over in bed, looking up (like reaching for something on a high shelf), bending forward, or getting up quickly. Between episodes, you may feel completely fine.

2. Meniere's Disease

Meniere's disease is caused by excess fluid (endolymph) building up in the inner ear. It tends to cause episodes of intense vertigo lasting 20 minutes to several hours, often accompanied by a sensation of fullness in one ear, fluctuating hearing loss, and tinnitus (ringing in the ear). Attacks can be unpredictable and disabling. Over time, untreated Meniere's can lead to permanent hearing loss.

3. Vestibular Neuritis and Labyrinthitis

These are caused by a viral infection that inflames the vestibular nerve (which carries balance signals from the inner ear to the brain). Vestibular neuritis causes sudden, severe vertigo — often enough to require bed rest — that gradually improves over days to weeks. Labyrinthitis is similar but also affects hearing. Both are often triggered by a recent viral illness like a cold or flu.

4. Central Vertigo

Vertigo that originates from the brain or brainstem is less common but more serious. It can be caused by a transient ischaemic attack (mini-stroke), cerebellar stroke, multiple sclerosis, or a brain tumour. Central vertigo tends to be more constant (rather than episodic), may not have a positional trigger, and is often accompanied by other neurological symptoms.

Signs You Have Vertigo

Beyond the spinning sensation itself, vertigo often comes with a cluster of related symptoms. Recognising these can help confirm what you are experiencing:

• Nausea and vomiting — the brain receives conflicting signals and responds like you are being poisoned
• Balance problems — difficulty walking in a straight line, tendency to drift to one side
• Nystagmus — involuntary rhythmic flickering of the eyes, often visible during examination
• Worsening with movement — symptoms intensify when you move your head or change position
• Ear symptoms — in some conditions, vertigo is accompanied by hearing changes, ear fullness, or ringing

How is Vertigo Diagnosed?

A thorough clinical evaluation is the foundation of vertigo diagnosis. At D.R. Healthcare, the assessment typically includes:

Dix-Hallpike Test

This is the gold-standard bedside test for BPPV. The patient is rapidly moved from a sitting to a lying position with the head turned to one side. If BPPV is present, this maneuver triggers a characteristic burst of nystagmus (eye movement) within a few seconds. The side and direction of the nystagmus tells us exactly which canal the crystals have entered.

Audiometry (Hearing Test)

A pure-tone audiogram helps evaluate whether hearing loss is accompanying the vertigo — important for diagnosing Meniere's disease and distinguishing inner ear from nerve causes.

MRI of the Brain and Inner Ear

If central vertigo is suspected — or if the patient does not respond to standard treatment — an MRI is recommended to look for brain lesions, acoustic neuromas, or other structural causes. This is not needed for every patient but is a critical safety net.

Treatment Options

The Epley Maneuver — For BPPV

The Epley maneuver is a series of specific head movements designed to guide the displaced crystals back to their correct position within the inner ear. In experienced hands, a single session resolves BPPV in 80–90% of patients. Dr. Soumya Saini is trained and certified in this technique and performs it routinely in clinic — no sedation or admission required. Many patients walk out of the clinic significantly better than they walked in.

Vestibular Rehabilitation Therapy (VRT)

For patients with vestibular neuritis or chronic vestibular dysfunction, VRT is a structured programme of exercises that train the brain to compensate for the faulty balance signals from the inner ear. It includes gaze stabilisation exercises, balance training, and gradually increasing movement challenges. Consistency is key — patients who do their exercises diligently see remarkable improvement over 6–8 weeks.

Medications

During an acute episode of severe vertigo, medications such as vestibular suppressants (betahistine, cinnarizine) and anti-nausea drugs can provide relief and help patients function. These are symptom-management tools, not cures — the underlying cause must still be addressed. For Meniere's disease, diuretics and a low-sodium diet can reduce the frequency of attacks.

Surgical Options

Surgery is rarely needed for vertigo but exists as a last resort for severe, refractory Meniere's disease. Options include endolymphatic sac decompression, labyrinthectomy, and vestibular nerve section. These are performed only after exhausting all conservative options.

Living with Vertigo — Practical Tips

While undergoing treatment, certain adjustments can make daily life significantly safer and more manageable:

• Move slowly when getting up from bed — sit on the edge for 30 seconds before standing
• Use adequate lighting at night; install grab rails in bathrooms
• Avoid ladders, scaffolding, or activities at heights during active episodes
• Do not drive if you have had a recent vertigo episode — your reaction times may be impaired
• Stay well hydrated — dehydration can worsen vestibular symptoms
• Limit caffeine and alcohol if you have Meniere's disease, as these worsen fluid buildup
• Sleep with your head slightly elevated (15–20 degrees) if BPPV episodes frequently occur at night