Common Symptoms of Vertigo

By Dr. Prateek Porwal, ENT Surgeon & Vertigo Specialist | PRIME ENT CENTER, Hardoi UP
Last Updated: February 2026 | VAI Budapest 2025 Award Recipient

Patients come to me describing a bewildering array of sensations related to their balance disorder: spinning, swaying, floating, nausea, blurred vision, ear symptoms, anxiety. Not all of these are “vertigo” technically, though patients use the term loosely. Understanding what you’re experiencing is the first step to getting proper diagnosis and treatment. Let me break down the common symptoms of vertigo and what each one tells me as a clinician.

The Spinning Sensation (Vertigo Proper)

True vertigo is the sensation that either you’re spinning, or the room is spinning around you. This is a specific sensation, distinct from lightheadedness or unsteadiness.

Different Types of Spinning Sensations

Rotatory spinning: “The room is rotating around me” or “I feel like I’m rotating in space.” Most common type. Associated with inner ear (peripheral) causes like BPPV.

Tilt vertigo: “I feel like the floor is tilted” or “I’m being pulled to one side.” Suggests otolith organ dysfunction or central causes.

Sway sensation: “I feel like I’m swaying” but without clear spinning. More common in central (brainstem, cerebellum) causes.

Duration matters for diagnosis:

• Seconds to 1 minute: Likely BPPV
• Minutes to hours: Could be vestibular migraine, labyrinthitis, or others
• Hours to days: Vestibular neuritis typical timeframe
• Intermittent episodes over time: Meniere’s, vestibular migraine
• Chronic constant sensation: Bilateral vestibular loss, PPPD

Nausea and Vomiting

Very common with vertigo. The brain receives conflicting balance signals and interprets this as poison (since vertigo-like signals normally come from poisoning or motion sickness). Brain’s response: trigger nausea and vomiting to “get rid of the poison.”

Pattern tells diagnostic story:

Severe nausea/vomiting at start: Suggests sudden vestibular loss (vestibular neuritis) or acute inflammation (labyrinthitis). The worse the nausea initially, the more sudden the vestibular insult.

Mild nausea: Suggests less acute process or central cause. True BPPV usually causes some nausea but often not severe because episodes are brief.

Nausea out of proportion to dizziness: May suggest migraine component or central cause (brainstem involvement).

How to manage: Ondansetron (Zofran) is gentler than older anti-nausea meds. Ginger, acupressure wristbands help some people. During acute phase, resting in dark quiet room with eyes closed and minimal head movement helps.

Nystagmus (Eye Jerking)

Involuntary rhythmic eye movements. Patients often don’t notice their own nystagmus but family members do (“your eyes are moving back and forth”). Doctor easily observes it during examination.

Types and Diagnostic Meaning

Horizontal nystagmus: Eyes jerk left-right. Common with peripheral causes (inner ear). Direction of fast component indicates direction of lesion.

Vertical nystagmus: Eyes jerk up-down. Suggests central cause (brainstem lesion, possibly stroke). Less common. If present, warrants MRI.

Torsional nystagmus: Eyes rotate around front-back axis (hard to see without special equipment). Associated with central causes or specific types of BPPV.

Direction-fixed vs. direction-changing: Peripheral causes usually show nystagmus in one direction. Central causes may show different directions with different head positions.

Presence or absence of nystagmus: Not all peripheral vertigo shows obvious nystagmus. Some central causes don’t show nystagmus either. But nystagmus pattern, when present, provides diagnostic clues.

Balance Problems and Unsteadiness

Acute severe vertigo: Patient may be completely unable to stand or walk. Severe imbalance. Usually indicates acute vestibular loss or central cause.

Chronic unsteadiness: Patient can walk but is wobbly, especially in darkness or on uneven surfaces. Suggests ongoing vestibular deficit or proprioceptive problem.

Position-dependent unsteadiness: Worst with head movement in certain direction (common in BPPV). Better if head stayed still.

Fearful gait: Some patients develop exaggerated caution, wide base of support, move very slowly. Suggests anxiety/fear more than objective balance loss.

Tandem walking (heel-to-toe): Simple balance test. Difficulty suggests vestibular or cerebellar problem. Can be done at home to monitor recovery.

Ear Symptoms

Tinnitus (Ringing in the Ears)

Sensation of sound (ringing, buzzing, hissing, roaring) without external sound source.

Associated with: Inner ear problems (Meniere’s disease, labyrinthitis), hearing loss, ototoxic medications, noise exposure.

When it indicates inner ear involvement: New tinnitus with vertigo suggests inner ear problem. Tinnitus alone (without vertigo) may or may not indicate inner ear dysfunction.

Tinnitus in Meniere’s: Part of classic triad with hearing loss and vertigo. Fluctuates with pressure changes in inner ear.

Ear Fullness

Sensation that ear is full, like before a pop, or like ear is underwater.

Indicates: Increased pressure in inner ear (Meniere’s disease) or fluid accumulation (labyrinthitis). Different from middle ear fullness from upper respiratory infection or ear infection.

Progressive hearing loss with ear fullness and vertigo: Classic Meniere’s disease presentation.

Hearing Loss

Sudden sensorineural hearing loss with vertigo: Suggests labyrinthitis (infection affecting both inner ear and vestibular system). Not typical of BPPV (hearing normal in BPPV) or simple vestibular neuritis (hearing usually normal).

Progressive hearing loss with recurrent vertigo: Meniere’s disease likely.

Hearing loss without vertigo: Could be noise damage, age-related (presbycusis), genetic hearing loss, acoustic tumor (requires MRI to rule out).

Important: Any sudden hearing loss is an otologic emergency. Requires urgent evaluation and sometimes emergency corticosteroids. Don’t ignore.

Headache

Headache with vertigo suggests:

• Vestibular migraine: Dizziness or vertigo accompanying or preceding migraine. Headache may be mild or absent
• Migraine-related dizziness: Dizziness without typical headache but with migraine triggers/family history
• Central cause: Brainstem or cerebellar involvement. Urgency here—needs MRI to rule out stroke
• Intracranial pressure: Rarely, increased intracranial pressure causes headache and vertigo together. Needs imaging

Red flag: Worst headache of your life with vertigo needs immediate MRI/CT to rule out serious cause.

Cognitive and Psychological Symptoms

“Vestibular Fog” or “Cognitive Dulling”

Patients report difficulty concentrating, mental fatigue, feeling mentally cloudy during or after vertigo episodes.

Why it happens: Vestibular system is connected to cognitive areas of brain. Vestibular disruption can affect concentration temporarily. Also, fatigue from vestibular struggle and sleep disruption contributes.

Usually temporary: Clears as vestibular symptoms improve.

Anxiety and Fear

Very common psychological response to vertigo. Fear of having another episode, fear of falling, fear of losing control.

Can become problematic: Anxiety itself causes dizziness (vicious cycle). Patient becomes anxious about dizziness, which triggers more dizziness, which increases anxiety. This perpetuates symptoms even as underlying vestibular problem improves.

Important for treatment: Reassurance and education about the benign nature of most vertigo helps. For some, cognitive-behavioral therapy addresses anxiety.

Oscillopsia (Blurred Vision with Movement)

The sensation that the visual world bounces or jiggers when you move your head.

Cause: Vestibulo-ocular reflex impairment. Eyes should automatically track opposite to head movement to keep vision stable. When vestibular system is damaged, eyes don’t track properly. Vision becomes blurry with head movement.

Associated with: Vestibular neuritis, bilateral vestibular loss, central causes.

Improves with: VRT exercises (gaze stabilization) that specifically train eye-head coordination.

Dizziness vs. Vertigo: Important Distinction

Many patients use “dizzy” and “vertigo” interchangeably, but they’re different sensations with different implications:

True Vertigo (rotatory sensation): Room spinning or feeling like you’re rotating. Patient often describes specific direction and speed of spinning. Associated with nausea, nystagmus, severe imbalance acutely. Classic inner ear or central cause.

Lightheadedness (presyncope): Feeling faint, like you might pass out. Vision might gray out. Associated with low blood pressure, low blood sugar, cardiac arrhythmia, anxiety. Not spinning sensation.

Disequilibrium (unsteadiness): Feeling unsteady or wobbly without spinning sensation. Can stand and walk but feel unstable. Associated with balance problems from various causes (vestibular, proprioceptive, neurological).

Why distinction matters: True vertigo usually means peripheral or central vestibular problem. Lightheadedness suggests cardiovascular, metabolic, or anxiety issue. Disequilibrium suggests multiple possible causes requiring different workup. Proper terminology helps guide diagnosis.

Symptom Timing and Patterns

Positional component: Does vertigo only happen with certain head positions? Suggests BPPV (position-dependent). If random, suggests other cause.

Episodic vs. constant: Episodic (attacks separated by symptom-free periods) suggests BPPV, Meniere’s, vestibular migraine. Constant suggests bilateral vestibular loss, chronic balance disorder, or PPPD.

Progression: Worsening over days suggests vestibular neuritis or infection. Worsening over weeks-months suggests progressive problem (tumor, degenerative disease). Fluctuating suggests Meniere’s or migraine-related. Stable suggests chronic adaptation needed.

Symptom Patterns by Condition: Comparative Table

Condition	Spinning	Duration	Nausea	Nystagmus	Hearing	Tinnitus
BPPV	Intense	Seconds-1 min	Mild-moderate	Yes (typical)	Normal	No
Vestibular Neuritis	Severe	Hours-days	Severe	Yes	Normal	Sometimes
Labyrinthitis	Severe	Hours-days	Severe	Yes	Reduced	Yes
Meniere’s	Severe	20 min-several hours	Severe	Yes	Fluctuating loss	Yes
Vestibular Migraine	Mild-moderate	20 min-hours	Mild-moderate	Possible	Normal	Rare
PPPD	Mild/no true spinning	Chronic	Mild	No	Normal	No
Bilateral Vestibular Loss	No acute spinning	Chronic	No	No	Normal	No
Stroke/Central	Possible	Acute onset	Varies	Possible (may be vertical)	Normal	No

Frequently Asked Questions About Vertigo Symptoms

How do I know if I have true vertigo or just dizziness?

True vertigo is the specific sensation that you or the room is spinning. Not vague lightheadedness, not unsteadiness, but actual spinning sensation. If you describe it as the room rotating or you feel like you’re on a merry-go-round, it’s likely true vertigo.

Is nausea always present with vertigo?

No. Some types of vertigo (especially brief BPPV) may cause mild nausea or no nausea. Severe nausea/vomiting suggests more acute vestibular loss (vestibular neuritis). Not all dizziness with nausea is vertigo—could be other causes.

What does nystagmus mean? Is it dangerous?

Nystagmus (involuntary eye jerking) occurs because the brain is confused about eye/head position and compensates by moving eyes. It’s not dangerous itself but indicates vestibular or central problem. Pattern of nystagmus helps diagnose the cause.

Can hearing loss happen with vertigo?

Yes, but not with all types. BPPV doesn’t cause hearing loss. Labyrinthitis and Meniere’s disease do cause hearing loss. New hearing loss with vertigo warrants imaging to rule out acoustic tumor and evaluation by ENT specialist.

Is ear fullness always part of vertigo?

No. Ear fullness suggests Meniere’s disease or labyrinthitis (fluid-related). Simple peripheral vertigo (BPPV, vestibular neuritis) usually doesn’t cause ear fullness. If present, it changes the likely diagnosis.

Why do I get anxious during vertigo episodes?

Natural human response to loss of balance and control. Vertigo is frightening—feeling the room spin makes you fear falling or losing consciousness. This fear is normal. Understanding the condition is benign helps reduce anxiety, which paradoxically helps improve symptoms.

How Symptoms Evolve Over Time

Acute vertigo phase: Initial symptom onset is usually most severe. Spinning sensation intense, nausea can be overwhelming, imbalance severe. This phase often lasts hours to days. During this phase, symptoms dominate and interfere with all activities.

Recovery phase: As underlying condition improves (infection resolves, inflammation decreases, or compensation develops), symptoms gradually decrease. Spinning becomes less intense, duration of episodes shortens, nausea improves. This phase can last days to weeks to months depending on condition and treatment.

Compensation phase: As brain adapts and learns to compensate, patients notice they can tolerate mild residual symptoms. They return to activities gradually. Remaining symptoms become less bothersome. This phase continues for weeks to months as neuroplasticity optimizes.

Why understanding phasing matters: Patients in acute phase who learn symptoms improve over time feel less anxious. Knowledge that recovery is natural process (not permanent disability) psychologically helps. Also guides management—acute phase needs anti-nausea and supportive care; recovery phase needs vestibular rehabilitation and progressive challenge; compensation phase needs confidence-building and return to normal activities.

Chronic symptoms: Some patients develop chronic symptoms despite improvement in acute condition. This may represent PPPD (brain sensitization to balance threats) or incomplete compensation. Chronic symptoms need different approach—cognitive-behavioral therapy, graded exposure, and psychology consultation may help.