Frequently Asked Questions About Vertigo and Imbalance

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

Over 20 years in clinical practice, I’ve received the same questions from hundreds of patients. These are the questions that keep people awake at night, that make them anxious about their symptoms, and that deserve clear, honest answers. This expanded FAQ addresses what patients actually want to know about vertigo and imbalance.

Image Source: Canva

Basic Questions About Vertigo

1. What is vertigo?

Vertigo is the sensation that you or your surroundings are spinning—a false sense of rotational movement. It’s not simply feeling lightheaded or unsteady; it’s a specific illusion of motion.

2. How is vertigo different from dizziness?

Dizziness is a broad umbrella term describing various sensations: lightheadedness, unsteadiness, fogginess in the head, or feeling faint. Vertigo is a specific type of dizziness—the spinning sensation. Not all dizziness is vertigo, and not all vertigo feels the same to every patient.

3. What are the most common symptoms of vertigo?

The primary symptom is spinning sensation. Other symptoms may include nausea, vomiting, headache, abnormal eye movements (nystagmus), ringing in ears (tinnitus), hearing loss, difficulty focusing, sweating, and weakness.

4. What causes vertigo and imbalance?

Vertigo can be caused by inner ear disorders (BPPV, vestibular neuritis, Meniere’s disease), neurological conditions, migraines, infections, head injuries, medication side effects, and anxiety-related conditions. The causes are diverse, which is why proper diagnosis matters.

5. Is vertigo a symptom or a disease?

Vertigo is a symptom—not a disease itself. It indicates something is affecting your balance system, but identifying what requires medical evaluation.

Understanding Types of Vertigo

6. What is peripheral vertigo?

Peripheral vertigo occurs when there is a problem with the inner ear or the vestibular nerve connecting it to the brain. Examples include BPPV, vestibular neuritis, and Meniere’s disease. Peripheral vertigo is the most common type (about 80% of cases).

7. What is central vertigo?

Central vertigo occurs when there’s a problem in the brain—specifically the brainstem or cerebellum. Causes include stroke, brain tumors, multiple sclerosis, or migraines. Central vertigo is less common (20% of cases) but requires careful evaluation.

8. What is BPPV?

Benign Paroxysmal Positional Vertigo is the most common cause of vertigo. It occurs when tiny calcium carbonate crystals (otoconia) become dislodged from their normal location in the inner ear and migrate into the fluid-filled semicircular canals, causing false spinning signals.

9. What are the symptoms of BPPV?

BPPV causes brief, intense episodes of vertigo triggered by specific head movements—looking up, bending over, rolling over in bed, or lying back. Episodes typically last seconds to minutes. Many patients experience nausea but usually maintain consciousness.

10. What are vestibular neuritis and labyrinthitis?

These are inner ear disorders caused by inflammation of the vestibular nerve (neuritis) or the inner ear structure itself (labyrinthitis), usually from viral infections. Both cause sudden, severe vertigo lasting several days, often with nausea and balance problems.

11. What is Meniere’s disease?

Meniere’s disease is an inner ear disorder characterized by episodes of vertigo, fluctuating hearing loss, tinnitus (ringing), and ear fullness. It’s thought to be caused by a buildup of fluid in the inner ear. Episodes can last hours.

12. Can migraines cause vertigo?

Yes. Vestibular migraines cause episodes of vertigo (minutes to hours) that may or may not be accompanied by headache. This is increasingly recognized as a common cause of vertigo.

Causes and Risk Factors

13. Can head or neck injuries cause vertigo?

Yes. Vertigo is a common symptom after traumatic head or neck injury, especially if the vestibular system is damaged. Cervical vertigo (from neck problems) can also cause dizziness.

14. Can medications cause vertigo?

Yes. Certain medications can cause vertigo as a side effect, including some antibiotics (aminoglycosides), blood pressure medications, anticonvulsants, and even aspirin at high doses. If you suspect medication is causing symptoms, discuss with your doctor—don’t stop taking it without guidance.

15. Can anxiety cause vertigo?

Anxiety doesn’t directly cause true vertigo, but can cause dizziness, lightheadedness, and unsteadiness. However, chronic vestibular conditions often develop secondary anxiety. The relationship is complex and requires proper assessment.

Diagnosis and Testing

16. How are vertigo and imbalance diagnosed?

Diagnosis involves a detailed medical history, physical examination, and specialized tests such as Dix-Hallpike testing, hearing tests, balance tests, vestibular function tests (VNG/ENG), and sometimes imaging (MRI or CT scans).

17. What is the Dix-Hallpike maneuver?

The Dix-Hallpike is a diagnostic test for BPPV. The doctor rapidly moves your head to trigger vertigo symptoms while watching your eye movements. If you have BPPV, characteristic eye movements (nystagmus) will appear. It’s the gold standard for BPPV diagnosis.

18. What is the head impulse test?

The head impulse test assesses how your eyes respond to rapid head movements. It helps determine whether vertigo comes from the inner ear or the brain. It’s a quick, bedside test requiring no equipment.

19. What are vestibular function tests?

Vestibular function tests like electronystagmography (ENG) or videonystagmography (VNG) record eye movements in response to head movements or visual targets. They measure how well your vestibular system is working.

20. What imaging tests may be used to diagnose vertigo?

MRI or CT scans may be ordered if central causes are suspected (stroke, tumor, MS). However, most vertigo cases don’t require imaging—diagnosis often comes from clinical testing. Your doctor will order imaging only if warranted by your symptoms.

Treatment and Management

21. How is vertigo treated?

Treatment depends on the underlying cause and may include vestibular rehabilitation therapy, canalith repositioning maneuvers (for BPPV), medications, lifestyle changes, stress management, and rarely, surgery.

22. What is vestibular rehabilitation therapy?

Vestibular rehabilitation therapy (VRT) is specialized physical therapy using specific exercises to help the brain adapt to vestibular dysfunction. It improves gaze stability, enhances balance, and reduces dizziness over weeks to months.

23. What are canalith repositioning maneuvers?

Canalith repositioning maneuvers, such as the Epley maneuver or Semont maneuver, are treatments for BPPV. They involve specific head and body movements that guide displaced crystals back to their proper location in the inner ear. Success rates are 80-90%.

24. What medications are used to treat vertigo?

Medications include antihistamines (meclizine), benzodiazepines (diazepam), anticholinergics (scopolamine), and others. These manage symptoms but don’t cure the underlying condition. For vestibular migraine, migraine-specific medications are used. For Meniere’s disease, diuretics and other agents help.

25. What lifestyle changes help manage vertigo?

Helpful changes include staying hydrated, getting adequate sleep, managing stress, avoiding sudden head movements and known triggers, using assistive devices (cane, walker), maintaining balance, avoiding screens during acute episodes, and staying active (avoiding bed rest when possible).

26. Is surgery ever necessary for vertigo?

Surgery is rarely needed and only considered for severe, treatment-resistant cases or specific conditions like acoustic neuroma or severe Meniere’s disease. Most cases resolve or improve significantly with conservative treatment.

Prognosis and Timeline

27. Can vertigo be prevented?

While not all cases can be prevented, you can reduce risk by maintaining a healthy lifestyle, managing stress, avoiding head injuries, protecting ears from infection, treating migraines, and addressing any cardiovascular or metabolic issues.

28. When should I seek medical attention for vertigo?

Seek care if: vertigo persists beyond a few days, keeps returning, is severe, or is accompanied by hearing loss, severe headache, vision changes, speech difficulties, weakness, or numbness. Don’t wait if it’s affecting your quality of life.

29. What specialists treat vertigo?

Vertigo may be treated by ENT specialists (otolaryngologists), neurologists, primary care physicians, or physical therapists specializing in vestibular rehabilitation. An ENT specialist with vestibular focus is ideal for most inner ear disorders.

30. How long does vertigo typically last?

Duration varies: BPPV episodes last seconds to minutes but may recur over days. Vestibular neuritis lasts days to weeks. Vestibular migraine lasts minutes to hours. Meniere’s disease episodes last hours. Chronic vertigo persists for weeks or months. Early treatment often shortens duration.

Serious Concerns

31. Can vertigo be a sign of a serious condition?

In rare cases, yes. Vertigo can be a symptom of stroke, brain tumor, or multiple sclerosis. This is why proper medical evaluation is important—though most vertigo cases are benign, serious causes must be ruled out.

32. What warning signs suggest serious vertigo?

Red flags requiring urgent evaluation include: sudden severe vertigo with headache, vertigo with speech slurring or facial droop, vertigo with arm/leg weakness or numbness, vertigo with vision loss, or vertigo lasting more than a week without improvement.

33. How can I tell if my vertigo is from my inner ear or my brain?

Peripheral (inner ear) vertigo typically causes nystagmus that can be observed, spinning sensation, nausea, and no neurological symptoms. Central (brain) vertigo may cause headache, weakness, speech changes, or vision problems. Only testing can confirm, but your doctor’s examination provides strong clues.

Quality of Life and Coping

34. How does vertigo impact quality of life?

Vertigo can significantly affect daily functioning—difficulty with work, driving, childcare, housework, and social activities. Many patients develop anxiety or depression related to their condition. These impacts are real and matter—which is why treatment is important.

35. What should I do during a vertigo attack?

During an attack: find a safe place to sit or lie down, avoid sudden movements, focus on a fixed point, breathe slowly, and stay calm. If severe or accompanied by other symptoms, seek medical care. Keep your environment safe to prevent falls.

36. Can vestibular rehabilitation be done at home?

Some exercises can be done at home, but initial therapy should be supervised by a trained physical therapist who can assess your specific condition and create an individualized program. Your therapist can teach you exercises to continue at home.

37. Where can I find support for living with vertigo?

Support groups exist online and in communities. The Vestibular Disorders Association provides resources and education. Your doctor can recommend local support options. Connecting with others experiencing vertigo can be reassuring and educational.

Additional Questions

38. Is vertigo more common in women than men?

Yes. Certain types of vertigo, particularly BPPV and vestibular migraines, are more common in women. The female-to-male ratio is approximately 2:1 to 2.5:1.

39. Can pregnancy cause vertigo?

Yes. Vertigo can develop during pregnancy due to hormonal changes, low blood sugar, pressure on blood vessels when lying on your back, and vestibular changes. Most improve postpartum, but medical evaluation is still important.

40. Is vertigo hereditary?

Some forms of vertigo have a genetic component. Familial benign recurrent vertigo and vestibular migraine can run in families. If your family has a history of vertigo or migraines, your risk may be higher, but environmental factors also play a role.