Do You Feel Dizzy?

You know what it feels like to be dizzy. You might panic a little, get nauseous, and feel like you’re going to vomit, become sweaty, and think you might topple over so you grab onto something stable. But how do you know whether that feeling is just something unpleasant or something more serious?

4 Types of Dizzy

Of the four types of dizziness – vertigo, lightheadedness, presyncope (usually a cardiovascular condition), and disequilibrium – the most common is vertigo, which accounts for 54 percent of reports about dizziness in primary care.

Put another way, vertigo – the word comes from the Latin vertō, or a whirling or spinning movement – has a specific feeling of movement.  With vertigo, you feeling movement, whether that comes from your body (swaying or other movement), your environment, or both.

“Sometimes associated with states of dizziness, mental confusion, nausea, motion sickness, or general weakness (in more severe cases), vertigo typically results from a sudden change in the functioning of the balance mechanisms of the inner ear (technically, the vestibular system) or in the balance structures’ connections to the brain,” says Pavel Kotlykov, founder of

Vertigo comes in several types, and classifying them can get complicated. For here, let’s divide them as either peripheral or central vertigo, depending on location. When vertigo attacks, it can last seconds, or minutes (as in vestibular paroxysm), or hours (as in Menière’s disease or vestibular migraine). However, severe vertigo can last days or weeks with conditions like vestibular neuritis.

However long vertigo lasts, that feeling becomes deeply discomforting and debilitating.

Vertigo is more common than you might imagine. Epidemiological surveys find 20 – 30 percent of the population may have experienced vertigo or dizziness in their lifetime. In fact, vertigo or dizziness accounted for 2.5 percent of American emergency department visit in 1995 –2004.

Once you hit 60, your chance of experiencing vertigo reaches 30 percent, and experts argue that number will rapidly increase (since more of us are living longer). Dizziness can trigger falls, the leading cause of accidental death in people over 65. It can also lead to hip and wrist fractures.

Vertigo: A Symptom Itself, Not a Disease

Vertigo is actually a symptom of a wide range of disorders, not a disease. “Vertigo is not a single disease entity but the cardinal symptom of different diseases of varying etiology; these may arise from the inner ear, brainstem, or cerebellum or may be of psychic origin,” researchers say in one review.

That can make diagnosing and treating vertigo incredibly challenging. “Experience has shown that the affected persons often make an odyssey of visits to physicians belonging to various specialties, beginning with their family physicians and proceeding through ENT specialists, neurologists, ophthalmologists, internists, and orthopedists, before the correct diagnosis is made and the appropriate treatment is begun,” say Michael Strupp and Thomas Brandt, both MDs.

The most common diseases that lead to vertigo – in about 93 percent of primary care patients – in fact, are benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, and Ménière’s disease. Other causes of vertigo include drugs, alcohol and antidepressants, migraine, and multiple sclerosis.

Signs and Symptoms of Vertigo

Vertigo symptoms include headache and dizziness. Depending on type, vertigo might also trigger ear pressure, hearing loss, nausea, vomiting, loss of vision, slurred speech, or loss of consciousness.

Understanding these and other symptoms becomes crucial because they can help addressing the underlying problem so you get appropriate treatment.

Understanding the Vertigo Symptom Reveals the Vertigo Problem

If you feel a very rapid or irregular heartbeat, for instance, cardiac arrhythmia might be the issue. If symptoms occur only with positional changes (like turning over in bed), BPPV is the most likely cause. A recent viral upper respiratory infection could precede acute vestibular neuronitis or acute labyrinthitis. Significant stress, anxiety, or panic attacks associated with vertigo can point to hyperventilation as a cause. One recent study found potential vertigo occurrence following sleep apnea.

Causes of vertigo can differ in older people, including more nonspecific dizziness and instability, making diagnosis more difficult within this demographic.

That’s why you want to be very specific about symptoms: They can help a healthcare professional find the underlying cause, determine what type of vertigo you have, and treat it appropriately.

Benign Paroxysmal Positional Vertigo (BPPV)

The most common diagnosis of vertigo in both primary care and subspecialty settings is benign paroxysmal positional vertigo (BPPV).  With BPPV, some calcium carbonate crystals normally embedded in gel in your utricle become dislodged and migrate into one or more of your 3 fluid-filled semicircular canals.

These crystals shouldn’t be there, and when particles accumulate in one of the canals, they interfere with normal fluid movement that these canals use to sense head motion. That interference causes your inner ear to send false signals to your brain.

“In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is thought to be due to debris that has collected within a part of the inner ear,” says Tim Hain, MD. “This debris can be thought of as ‘ear rocks,’ although the formal name is otoconia. Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the utricle… The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age.”

BPPV creates brief dizziness episodes of various intensity, usually triggered by specific changes in the position of your head, such as when you move your head up or down, when you lie down, or when you turn over or sit up in bed. Symptoms of BPPV besides dizziness include nausea, vomiting, and unsteadiness that can increase your chance for falls.

BPPV has a lifetime prevalence of 2.4 percent and accounts for eight percent of people with moderate to severe dizziness or vertigoAbout 90 percent of those cases occur in the posterior canal.

Fortunately, BPPV is the easiest type of vertigo to treat, and except for falls, the condition is (as the name implies) benign.

Vertigo: What You Need to Know When Going to the Doctor

With vertigo, you don’t want to self-diagnose yourself with BPPV or another condition. If you suspect that you have vertigo, visit your doctor to rule out other types of dizziness or lightheadedness, determine what type you have (if you do have vertigo), and discuss effective strategies to reduce or eliminate symptoms.

Determining whether you have vertigo or another type of dizziness takes some reflection. In order to make the right diagnosis, your doctor will probably ask:

  • What major symptom triggered the onset?
  • How long did it last?
  • How severe was it?
  • Where their other symptoms that occurred at the same time?
  • Do you have a history of ear pain, drainage, ear trauma, ear infections, and/or head trauma?
  • Does anyone in your family have vertigo and/or hearing loss?
  • Do you have other health problems, such as diabetes mellitus, heart disease, atherosclerosis, or neurologic disorders?
  • Are you taking any medications or were you during your first experience with vertigo?

Depending on your doctor’s approach, treating vertigo may include a combination of medication, physical therapy, and psychotherapy. Rarely, it might require surgical treatment.

To determine whether you have vertigo and if so, what kind, your doctor might conduct neurological, head and neck, and cardiovascular exams. Doctors might also use lab testing (including glucose testing and thyroid function) to determine vertigo. The Dix-Hallpike maneuver, which experts believe might be the most helpful test to perform on patients with vertigo, has a positive predictive value of 83 percent and a negative predictive value of 52 percent for the diagnosis of BPPV.

If you suspect you might have vertigo, please don