Coping With Recurring Vertigo

Overview

Vertigo is not the same as feeling light-headed. It is a false sense that you or the room is spinning or moving. 'Recurring' means these spells come back again and again, often with weeks or months in between. Vertigo usually comes from a problem in the balance system of the inner ear, the nerve that connects the ear to the brain, or the parts of the brain that handle balance. Most causes are not dangerous, and many improve with the right help.

Yes. Dizziness and vertigo are among the most common reasons people visit their family doctor, and inner-ear balance problems become more common as people get older.

Anyone can get recurring vertigo, at any age. Some causes are more likely in older adults, others are more common in people who get migraines, and some inner-ear problems follow a cold or flu at any age.

Symptoms

Common symptoms

• A spinning or whirling feeling that starts suddenly and lasts from seconds to hours
• Feeling unsteady, as if you are being pulled to one side
• Nausea and sometimes vomiting
• Cold sweat and a racing heartbeat during a spell
• Eyes flickering or jumping sideways (this is called nystagmus - the eyes beating back and forth)
• Feeling worse when you move your head, roll over in bed, or look up
• Ringing or buzzing in the ear (tinnitus), or muffled hearing, in some causes
• Being extra sensitive to motion, such as in a car or on a lift

Symptoms in children

• Young children often cannot describe spinning. They may cling on, look frightened, go pale, vomit, or refuse to walk
• Unsteady walking or clumsy balance that comes and goes
• Squinting, head tilting, or holding the head still on purpose
• Vertigo linked to migraine is common in children, sometimes with headaches and sometimes without

Symptoms in older adults

• Vertigo plus age-related balance changes raises the risk of falls and fractures
• Fear of falling can lead to becoming less active, which makes balance worse over time
• Symptoms can be caused or made worse by blood pressure drops on standing, dehydration, or side effects of existing medicines
• Hearing loss and ear conditions are more common with age

Causes

Main causes

• BPPV - tiny calcium crystals in the inner ear drift into a balance canal and trigger short spells of spinning when you change position
• Inflammation of the balance nerve, often after a viral illness (sometimes called vestibular neuritis or labyrinthitis)
• Meniere's disease - recurring vertigo with hearing changes, ringing, and a feeling of fullness in the ear
• Migraine-related vertigo, which can happen with or without a headache
• Blood pressure that drops when you stand up, dehydration, or low blood sugar
• Side effects of some medicines, including ones for blood pressure or mood
• Anxiety and panic, which can cause dizziness and make vertigo feel worse
• More rarely, problems in the brain or neck, including stroke - this is why some symptoms need urgent checking

Risk factors

• Getting older
• A previous head injury or a bang to the head
• Recent cold, flu, or ear infection
• A personal or family history of migraine or Meniere's disease
• Long periods of bed rest or reduced movement
• Stress, poor sleep, dehydration, and skipping meals
• Taking several medicines, or a recent change in dose

When to see a doctor

See a doctor urgently if:

• Your first attack of vertigo, so the cause can be checked
• Vertigo with hearing loss, ear pain, or ear discharge
• Repeated vomiting or signs of dehydration
• Any new weakness, numbness, speech change, or vision change - call your local emergency number first
• Vertigo that stops you from walking or caring for yourself

Book a routine appointment if:

• Spells that keep coming back, even if each one settles
• Vertigo that is affecting your work, driving, or confidence
• You feel anxious or low because of the spells
• You want to review whether any of your medicines could be contributing
• You have had a fall or a near-fall

Diagnosis

There is no single test for vertigo. Your doctor will mostly work it out by listening carefully to your story: what the spinning feels like, how long it lasts, what triggers it, and whether your hearing is affected. They will then check your eyes, ears, balance, blood pressure, and nervous system. Often this is enough to identify the cause without any scans.

Tests that may be done

• A physical exam where your doctor moves your head into certain positions to see if it triggers the spinning (this is called the Dix-Hallpike test)
• Checking how your eyes follow a moving target, and looking for eye flickering
• Blood pressure checks lying down and then standing up
• A hearing check, and sometimes a pressure or balance test of the inner ear
• Blood tests to rule out other causes such as anaemia, thyroid problems, or low blood sugar
• Rarely, a scan of the brain - usually only if the pattern suggests something other than the inner ear

What to expect at your appointment

The visit is usually quick and painless, though the positional test can briefly bring on the spinning. That is expected and it settles within a minute or so. Some people need a second appointment or a referral to an ear, nose and throat specialist or a balance clinic, especially if the cause is unclear or symptoms do not improve.

Treatment

Treatment depends completely on the cause. Many people improve a lot with simple, non-medicine approaches: specific head and body movements done by a trained clinician, balance rehabilitation exercises, and treating the underlying problem. The aim is to reduce how often spells happen, shorten them when they do, and keep you safe and confident in between.

Self-care at home

• During a spell, sit or lie down somewhere safe and hold still. Do not try to walk it off.
• Move your head slowly and avoid sudden bending, looking up, or rolling over quickly
• Get up in stages from lying to sitting to standing, and hold onto something steady
• Keep the room well lit and clear of loose rugs and clutter to reduce fall risk
• Stay hydrated and eat regular meals - both help prevent dizzy spells
• Avoid driving, cycling, or operating machinery during a spell and until you feel fully steady
• Keep a symptom diary to spot patterns and triggers
• Only do balance or repositioning exercises that a clinician has taught you, and stop if they make you feel worse

Medical treatments

Your doctor may offer short courses of medicines to calm severe nausea or reduce the spinning during an attack. These are prescribed and monitored by a healthcare professional, and are usually for short-term use because long-term use can slow down the brain's natural rebalancing. For certain inner-ear causes, a trained clinician performs a short series of guided head-and-body movements that reposition the crystals - this is done in the clinic and often works within one or two sessions. Balance rehabilitation (vestibular rehabilitation) is a tailored exercise programme that retrains the brain and inner ear to work together, and it is very effective for many people. If an underlying condition such as migraine, blood pressure problems, or an ear infection is found, treating that condition usually reduces the vertigo. Always ask your doctor or pharmacist before starting, stopping, or changing any medicine.

When is surgery considered?

Surgery is rarely needed for vertigo. It may be considered only for a small number of specific inner-ear conditions when other treatments have not worked and symptoms are severe and disabling. This is a specialist decision, made together with an ear, nose and throat surgeon.

Living with this condition

Recurring vertigo can be disruptive, but most people find a routine that keeps them steady and confident. Plan the day around your good hours, keep essential items within easy reach, and tell the people around you what helps if a spell starts. Keep a small 'just in case' kit with you - water, a bag in case of sickness, and your phone.

Lifestyle tips

• Pace yourself and avoid over-tiring, since tiredness often triggers spells
• Prioritise regular sleep and keep a steady daily routine
• Reduce stress with simple techniques such as slow breathing, walking, or a relaxing hobby
• Avoid sudden head movements and bending forward sharply where you can
• Use night lights and keep floors clear to prevent falls
• Ask your pharmacist to review your medicines for ones that can cause dizziness
• Limit alcohol, which can worsen balance and dehydrate you

Diet and exercise

Eat regular meals and drink enough water through the day, as low blood sugar and dehydration both make dizziness more likely. Some people with Meniere's disease find that reducing salt helps, so ask your doctor whether that applies to you. Exercise is one of the best treatments for balance: walking, tai chi, and simple standing-balance practice (holding a counter for safety) all train the balance system. Start gently, and if you have been given a rehabilitation programme, stick with it - it often takes a few weeks before you notice real benefit.

Mental health and emotional wellbeing

It is very normal to feel anxious about when the next spell will come. That worry can lead to avoiding outings, driving, or social plans, and can make dizziness itself feel worse, because anxiety and the balance system are closely linked. This is not weakness, and it is treatable. If anxiety or low mood is building, tell your doctor - talking therapies and relaxation techniques can help a great deal. If you ever feel overwhelmed or have thoughts of harming yourself, please reach out for crisis support straight away - contact your local emergency number or a crisis line in your country, or speak to a trusted person who can stay with you.

Prevention

Some causes can be prevented or greatly reduced, and others cannot. You can lower your risk by staying hydrated, eating regularly, sleeping well, keeping physically active, and having your medicines reviewed if they make you dizzy. If you have a known trigger such as a positional cause, learning the right manoeuvre from a clinician can stop a spell quickly. If you have migraine-related vertigo, avoiding your personal migraine triggers helps.

Vaccines

There is no vaccine for vertigo itself. Keeping up with routine vaccinations, including flu and any recommended by your local health service, can reduce the infections that sometimes trigger inner-ear inflammation.

Screening programmes

There is no routine screening test for vertigo. Screening does matter for related conditions, though - for example, regular blood pressure checks, and hearing checks if you notice changes. If vertigo runs in your family or you have another condition linked to it, ask your doctor whether extra monitoring is sensible for you.

Complications

If left untreated

• Falls and injuries, especially in older adults
• Dehydration and weakness from repeated vomiting
• Anxiety, low mood, and loss of confidence
• Avoiding driving, work, and social life, which can lead to isolation
• Poorer sleep and daytime tiredness
• Rarely, a serious cause going unrecognised - which is why certain symptoms need urgent checking

Long-term outlook

The outlook is generally good. Many causes, especially the common positional one, improve quickly with the right manoeuvre, and balance rehabilitation helps most people get back to normal activity. Some conditions come and go over years, and the aim then is good control rather than a permanent cure - and control is very achievable for most people. With a clear diagnosis, a plan you understand, and a little support, you can keep doing the things that matter to you. Do speak to your doctor about any concerns along the way.

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