What causes vertigo

Vertigo happens when your brain receives mixed or incorrect signals about your body's position and movement in space. Your inner ear, eyes, and the balance sensors throughout your body normally work together to keep you oriented. When something disrupts this system—whether it's a problem in your inner ear, your brain, or the nerves connecting them—your brain interprets the signals as spinning or movement that isn't actually happening.

The two main categories are peripheral vertigo, which comes from problems in your inner ear, and central vertigo, which comes from your brain or brainstem. Peripheral vertigo is far more common and usually less serious, though it can be just as disorienting. Central vertigo is rarer but often signals a condition that needs medical attention.

Key Takeaways

  • Vertigo results from a mismatch between signals from your inner ear, eyes, and balance sensors, not from low blood pressure or being afraid of heights.
  • Benign paroxysmal positional vertigo (BPPV) is the most common cause and happens when calcium crystals in your inner ear shift out of place.
  • Vestibular neuritis and labyrinthitis—inflammation or infection of the inner ear—can cause sudden, severe vertigo that lasts days or weeks.
  • Ménière's disease causes vertigo along with hearing loss and ear fullness, and typically affects one ear.
  • Central vertigo from stroke, multiple sclerosis, or other brain conditions usually comes with other neurological symptoms like weakness or slurred speech.

Benign paroxysmal positional vertigo (BPPV)

BPPV is the single most common cause of vertigo. It happens when tiny calcium carbonate crystals—called otoliths or "ear rocks"—become dislodged from their normal location in your inner ear and float into the semicircular canals, which sense rotational movement. When you move your head in certain directions, these crystals shift and trigger false signals that your head is spinning.

BPPV typically strikes suddenly when you turn over in bed, look up, or bend down. The spinning usually lasts only seconds to a minute, but the sensation can be intense. You might feel fine between episodes. BPPV is more common as you age and can follow a head injury, but often no clear trigger exists. A doctor can diagnose it using the Dix-Hallpike test, where you lie back quickly with your head hanging off the edge of the exam table to see if it triggers vertigo and a specific eye movement pattern called nystagmus.

Vestibular neuritis and labyrinthitis

Vestibular neuritis is inflammation of the vestibular nerve, which carries balance information from your inner ear to your brain. Labyrinthitis is inflammation of the inner ear itself. Both usually follow a viral infection—often an upper respiratory infection you had a week or two earlier—though the exact virus is rarely identified. Bacterial infection can also cause labyrinthitis, though this is less common.

These conditions cause sudden, severe vertigo that often comes with nausea, vomiting, and difficulty walking. Unlike BPPV, the spinning doesn't depend on head position—it's constant or nearly constant. Symptoms typically peak within the first day or two and gradually improve over one to three weeks, though some people experience dizziness for months. Your doctor may order an MRI or other imaging to rule out stroke or other serious causes, especially if you have other neurological symptoms.

Ménière's disease

Ménière's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus (ringing in the ear), and a feeling of fullness or pressure in the affected ear. Episodes typically last 20 minutes to several hours. The condition usually affects only one ear, though it can eventually involve both ears in about 15 percent of cases.

The exact cause is unknown, but it appears to involve a buildup of fluid in the inner ear. Ménière's typically develops in adults between ages 40 and 60. Attacks can be unpredictable, though some people notice they're triggered by stress, caffeine, salt, or lack of sleep. Over time, repeated episodes can lead to permanent hearing loss in the affected ear. There is no cure, but doctors can manage symptoms with dietary changes, medications, or procedures to reduce fluid pressure in the inner ear.

Central vertigo from brain or neurological conditions

Central vertigo originates in your brain or brainstem rather than your inner ear. Common causes include stroke, multiple sclerosis, brain tumors, migraines, and traumatic brain injury. Central vertigo is less common than peripheral vertigo but more likely to signal a serious condition requiring urgent evaluation.

The key difference is that central vertigo usually comes with other neurological symptoms. You might experience weakness on one side of your body, slurred speech, difficulty swallowing, loss of vision, or loss of coordination. The vertigo itself may be less severe than with peripheral causes, but the presence of these additional symptoms means you need imaging—usually an MRI—and evaluation by a neurologist. Do not delay seeking care if you have vertigo accompanied by any of these warning signs.

Migraine-associated vertigo

Some people experience vertigo as part of a migraine, either during the headache phase or separately. This is called vestibular migraine. The vertigo can last minutes to hours and may occur with or without a visible headache. Vestibular migraine is more common in people with a history of motion sickness and can be triggered by the same things that trigger your migraines—stress, certain foods, hormonal changes, or lack of sleep.

Vestibular migraine is diagnosed based on your history of migraines and the pattern of your vertigo episodes. Imaging is usually normal. Treatment focuses on migraine prevention through lifestyle changes and medications that prevent migraines, which often reduces vertigo episodes as well.

Less common causes

Other conditions can cause vertigo, though they are less frequently seen. Perilymph fistula is a small tear in the membrane separating your inner ear from the middle ear, usually caused by head trauma or sudden pressure changes. Superior semicircular canal dehiscence is a rare condition where part of the bone covering one of your inner ear canals is missing or thin, allowing sound and head vibrations to trigger vertigo. Acoustic neuroma is a benign tumor on the nerve connecting your inner ear to your brain, which typically causes gradual hearing loss and dizziness rather than sudden spinning.

These conditions are diagnosed through imaging (CT or MRI) and specialized hearing and balance tests. Your doctor will consider these possibilities if your vertigo doesn't fit the pattern of more common causes or if you have other symptoms like progressive hearing loss.

Frequently Asked Questions

Can low blood pressure or anemia cause vertigo?

Low blood pressure and anemia can cause dizziness or lightheadedness, but these are different from true vertigo. Vertigo is the sensation that you or the room is spinning. Dizziness from low blood pressure or anemia usually feels more like faintness or unsteadiness. If you have true spinning sensations, the cause is usually in your inner ear or brain, not your blood pressure.

Is vertigo a sign of a stroke?

Vertigo alone is not a reliable sign of stroke—most vertigo comes from inner ear problems. However, if vertigo comes with weakness, slurred speech, facial drooping, difficulty walking, or loss of vision, stroke is possible and you need emergency care. Call 911 if you have vertigo plus any of these other symptoms.

Can anxiety or panic attacks cause vertigo?

Anxiety and panic attacks can cause dizziness, lightheadedness, and a sensation of unreality, but they do not cause true vertigo—the spinning sensation where the room appears to move. If you have true spinning, the cause is physical, not psychological, though anxiety can make the experience more distressing.

Why does vertigo get worse when I move my head?

Head movement triggers vertigo in conditions like BPPV because moving your head shifts the calcium crystals in your inner ear, sending false signals to your brain. In other conditions like vestibular neuritis, head movement may worsen nausea or dizziness but doesn't necessarily trigger the spinning itself. Your doctor can determine which pattern you have.

Can an ear infection cause vertigo?

A middle ear infection (the most common type) usually does not cause vertigo. However, if infection spreads to the inner ear, causing labyrinthitis, it can cause severe vertigo. Inner ear infections are less common than middle ear infections but more likely to cause balance problems.