vertigo that comes and goes

Overview

Vertigo is a false sense that you or the world around you is spinning or moving, even when you are still. When it comes and goes, you have brief or longer episodes of this spinning feeling, and then it eases or disappears between attacks. It is a symptom, not a disease itself, and it often points to a problem in the inner ear or the balance system.

Yes. Vertigo is a common reason people see a doctor, and episodic vertigo can affect people at any age. Some types become more common as you get older.

Anyone can have vertigo that comes and goes. It is more common in older adults, people with migraine, and those who have had head injuries or ear infections. It can also affect children, though less often.

Symptoms

Common symptoms

• A spinning or swaying sensation that comes in episodes.
• Loss of balance or feeling unsteady on your feet.
• Nausea or vomiting during an attack.
• Sweating or feeling pale when dizzy.
• Ringing in the ears, muffled hearing, or a feeling of fullness in one ear.

Symptoms in children

• Sudden dizziness after moving the head quickly.
• Holding onto furniture or refusing to walk.
• Nausea, vomiting, or motion-sickness symptoms.
• Complaints that an ear feels blocked or sounds are muffled.

Symptoms in older adults

• A higher risk of falling or needing support to stand.
• Feeling unsteady even between vertigo attacks.
• Turning over in bed or tipping the head back can trigger an episode.
• Hearing changes or ringing in the ears are often also present.

Causes

Main causes

• Benign paroxysmal positional vertigo (BPPV): tiny calcium crystals in the inner ear move into a sensitive part of the ear when you change head position.
• Vestibular neuritis or labyrinthitis: inflammation of the inner ear balance nerve, often after a viral infection.
• Ménière's disease: a build-up of fluid in the inner ear that causes repeated episodes of vertigo, hearing loss, ringing, and ear fullness.
• Vestibular migraine: vertigo episodes linked to migraine, even without a headache.
• Head injury or whiplash that affects the inner ear or balance system.
• Certain medicines that can affect balance in rare cases.

Risk factors

• Being over the age of 50.
• A recent viral or respiratory infection.
• A personal or family history of migraines.
• A previous head injury or ear surgery.
• High levels of stress or poor sleep.
• Long periods of bed rest or reduced physical activity.

When to see a doctor

See a doctor urgently if:

• Vertigo with severe headache, chest pain, or trouble speaking.
• Episodes that happen often and interrupt your work, sleep, or daily life.
• New or worsening hearing loss in one or both ears.
• Vomiting that prevents you from drinking fluids.
• You have a history of stroke or heart disease and vertigo begins suddenly.

Book a routine appointment if:

• You have repeated episodes of vertigo but no emergency signs.
• You are unsure what is causing your dizziness.
• Vertigo is making it hard to drive, work, or take part in normal activities.

Diagnosis

A doctor or ear, nose, and throat (ENT) specialist will ask about your episodes, what triggers them, how long they last, and any other symptoms. They may also move your head and body into specific positions to see if that brings on vertigo. This helps them identify positional causes like BPPV.

Tests that may be done

• Dix-Hallpike test or similar head-position tests.
• Hearing tests to check for inner ear problems.
• Balance tests, including video-nystagmography or rotational chair testing.
• MRI or CT scan of the head and inner ear, if needed to rule out other conditions.

What to expect at your appointment

The appointment is usually painless and involves questions plus some simple movements. You do not need to fast or stop your regular routine before most vertigo tests. If the cause is not clear, your doctor may arrange further tests or refer you to an ENT specialist.

Treatment

Treatment depends on what is causing your vertigo. Many episodes can be managed with head repositioning movements, balance exercises, and avoiding triggers. Some people need short-term support with medicines to control nausea or dizziness, but these are only used under a healthcare provider's guidance.

Self-care at home

• Move slowly and hold onto something solid during an episode.
• Avoid sudden head turns, bending down, or looking up when possible.
• Rest in a quiet, dimly lit room if the spinning is intense.
• Drink small sips of water to stay hydrated.
• Use a walking stick or support if you feel unsteady.
• Do not drive or operate machinery during an attack.

Medical treatments

Medical treatment may include canalith repositioning maneuvers to move inner ear crystals back into place, vestibular rehabilitation therapy with a trained physiotherapist, or medicines that help with nausea and dizziness. For conditions like Ménière's disease, a specialist may suggest dietary changes or other procedures. You should always discuss the options with your doctor or ENT specialist.

When is surgery considered?

Surgery is rarely needed for vertigo. It is only considered for severe, long-lasting inner ear conditions that have not improved with other treatments, and always after a full discussion with a specialist team.

Living with this condition

Learn what tends to trigger your vertigo and plan around it. If certain movements bring it on, change how you get out of bed, pick things up, or turn your head. Keep a simple diary of your episodes to share with your healthcare team. Tell family or friends what to do if you feel dizzy.

Lifestyle tips

• Keep a regular sleep schedule; tiredness can make vertigo worse.
• Reduce caffeine, alcohol, and salt if your doctor suggests it.
• Manage stress with relaxation, breathing exercises, or mindfulness.
• Stay active as your doctor advises, but start slowly.
• Avoid rapid head movements, especially in bed.

Diet and exercise

A balanced diet supports your overall health, and some inner ear conditions improve with a lower-salt diet. Gentle balance exercises, such as walking steady, tai chi, or physiotherapy-guided movements, can help your brain adapt. Always get advice from a professional before starting a new exercise routine.

Mental health and emotional wellbeing

Living with vertigo can be frightening, and worrying about when the next episode might happen is normal. If anxiety or frustration starts to feel overwhelming, talk to a healthcare professional. Reaching out for support is a positive step.

Prevention

Not every type of vertigo can be prevented, but you can often reduce the number of episodes. Learning your triggers and avoiding sudden head movements, managing stress, and keeping good sleep habits can help. For some people, treating migraine or other underlying conditions also helps.

Vaccines

There is no vaccine that prevents vertigo itself. Keeping up to date with recommended vaccinations, such as for flu, may reduce the chance of viral infections that can sometimes affect the inner ear.

Screening programmes

There is no routine screening test for vertigo. If you have repeated episodes, your doctor may suggest hearing or balance tests to look for the cause and help guide your treatment.

Complications

If left untreated

• Falls and injuries, especially in older adults.
• Long-term dizziness or balance problems.
• Anxiety about moving or going out.
• Difficulty at work, school, or with driving.
• In rare cases, a serious underlying condition may be missed if emergency symptoms are ignored.

Long-term outlook

The outlook is usually positive. Most causes of intermittent vertigo improve with treatment, exercise, and time. Even long-lasting inner ear conditions can be managed well with the right care. Many people return to their normal activities and feel confident again.

Find support

Local organisations

• Your local ear, nose, and throat (ENT) clinic · Your country or region

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