Overview of Vertigo

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

When patients walk into my clinic in Hardoi describing that unmistakable spinning sensation—the feeling that the room is rotating or they’re about to fall—I know they’re experiencing vertigo. After more than a decade managing balance disorders across Uttar Pradesh, I can tell you that this isn’t just dizziness. Vertigo is a specific, terrifying sensation that can disable a person in seconds. In my practice, I see patients from across UP who’ve been misdiagnosed, given unnecessary imaging, or worse—prescribed long-term medications when a single repositioning maneuver would solve their problem in minutes.

This article is my comprehensive guide to vertigo based on what I see and treat every day at my clinic. I’ll walk you through exactly what vertigo is, why it happens, and most importantly—how to distinguish it from other types of dizziness that don’t require the same treatment approach.

What Is Vertigo, Really?

Image Source: Canva

Vertigo is NOT dizziness. Let me be blunt about this because the confusion costs patients months of ineffective treatment. Vertigo is the specific sensation that you or your surroundings are spinning, rotating, or moving when they’re not. When a patient tells me the room is “going round and round,” they have vertigo. When someone says they feel “lightheaded” or “woozy,” that’s something different entirely—we call that presyncope or general dizziness.

In my experience treating hundreds of patients from rural Hardoi and urban centers across UP, about 80% of people who come in saying they have “vertigo” actually don’t. They have anxiety-induced dizziness, low blood pressure on standing, or motion sickness. But the 20% who truly have vertigo—they need specific diagnosis and treatment. That’s where my understanding of what is vertigo becomes critical.

True vertigo can range from mild—a brief spinning sensation when you turn your head—to severe, where you can’t stand without vomiting. The intensity depends on what’s wrong with your balance system.

Understanding the Two Main Types of Vertigo

Peripheral Vertigo (Inner Ear Problems)

About 80-90% of vertigo cases I see are peripheral in origin. This means the problem is in the inner ear—the vestibular system that controls your balance. The inner ear contains fluid-filled chambers and hair cells that sense your head’s position and movement. When these go wrong, your brain gets false signals about which way is up.

Peripheral vertigo is usually intense but brief. It comes on suddenly and often makes patients nauseous. I’ve had patients from villages around Hardoi who experience sudden severe vertigo for a few minutes to several hours, then it goes away.

Common peripheral causes include:

• Benign Paroxysmal Positional Vertigo (BPPV) – calcium crystals loose in the inner ear canals. This is my bread and butter. With the right Dix-Hallpike test, I can diagnose BPPV in 30 seconds, and I can treat it in 5 minutes
• Vestibular Neuritis – inflammation of the balance nerve, usually from a viral infection. Sudden, severe, but usually gets better over weeks
• Vestibular Neuritis and related conditions – where the nerves controlling balance swell
• Meniere’s Disease – fluid buildup in the inner ear, causing recurring attacks with hearing loss and tinnitus

Central Vertigo (Brain Problems)

About 10-20% of my vertigo cases come from the brain—the brainstem or cerebellum. This is where careful diagnosis matters because central vertigo can be a symptom of stroke, tumor, or multiple sclerosis. These cases worry me more because they need MRI and sometimes neurologist involvement.

Central vertigo tends to be more subtle, longer-lasting, and often comes with other neurological symptoms like weakness, numbness, or speech difficulty. When I suspect central vertigo, I use the HINTS exam to rule out stroke—a simple bedside test that’s faster and sometimes more accurate than MRI for acute stroke.

Common Symptoms You’ll Experience

When vertigo hits, here’s what patients typically describe to me:

• Spinning or rotating sensation – the hallmark symptom. Some say the room spins, others say they spin
• Severe nausea and vomiting – often so bad patients can’t walk
• Balance problems – difficulty walking straight, fear of falling
• Eye movements (nystagmus) – involuntary eye jerking that I can observe during examination
• Headache – especially if it’s vestibular migraine
• Hearing changes or tinnitus – ringing or muffled hearing, suggesting inner ear involvement
• Sweating and anxiety – the body’s fight-or-flight response to the spinning

In my practice in Hardoi, I’ve noticed that patients often report their vertigo is triggered by specific head movements—rolling over in bed, looking up, or turning quickly. This is a classic BPPV sign that I look for on the first visit.

Why Does Vertigo Happen? The Main Causes

Let me categorize the causes the way I think about them clinically.

Peripheral (Inner Ear) Causes

• BPPV – calcium carbonate crystals in the inner ear canals get loose. Most common, most treatable
• Meniere’s Disease – fluid buildup in the inner ear from unknown causes
• Labyrinthitis – infection-related inflammation of the inner ear
• Vestibular Migraine – migraines that trigger vertigo in the brain’s balance centers
• Head injury – trauma that damages the vestibular system

Central (Brain) Causes

• Stroke – particularly in the brainstem or cerebellum
• Tumor – pressing on balance centers in the brain
• Multiple sclerosis – less common but serious
• Migraine – certain migraines cause vertigo
• Cervical vertigo – from neck problems, which I often see misdiagnosed

In UP, I also see patients whose vertigo is triggered by anxiety or stress—what we call anxiety-related dizziness and persistent postural-perceptual dizziness.

How I Diagnose Vertigo in My Clinic

Image Source: Canva

Accurate diagnosis is everything. I’ve seen patients who’ve had multiple unnecessary CT scans and MRI’s before coming to me, when a simple clinical exam would have solved it in 5 minutes. Here’s my diagnostic approach:

Step 1: Medical History (The Foundation)

I ask specific questions: When did it start? What position triggered it? How long does it last? Is it spinning or lightheadedness? Have you had hearing loss? I’m listening for patterns that point to BPPV, Meniere’s, or central causes. A patient from a village who tells me their vertigo only happens when they turn over in bed? I already know it’s likely BPPV.

Step 2: Physical Examination (Where the Magic Happens)

• Dix-Hallpike maneuver – I tip the patient backward to see if vertigo reproduces. If it does and I see characteristic eye movements (nystagmus), BPPV is confirmed
• Supine roll test – another test for BPPV variants
• Romberg test – balance and proprioception assessment
• Head impulse test – how well your eyes stay fixed when your head moves
• Nystagmus observation – involuntary eye movements tell me a lot

Step 3: Testing When Needed

• VNG (Videonystagmography) – objective measurement of eye movements during vestibular testing. I have this at PRIME ENT Center
• Hearing test (Audiometry) – if hearing loss suggests Meniere’s or labyrinthitis
• MRI or CT – only if I suspect stroke, tumor, or other central causes. I don’t order imaging for straightforward BPPV

The Bangalore Maneuver, which I’ve developed for complex BPPV cases that don’t respond to standard Epley treatment, combines multiple repositioning sequences and is particularly effective for patients with multiple canal involvement.

Treatment: From Acute to Chronic

Image Source: Canva

Treatment depends entirely on the cause. This is why accurate diagnosis matters.

For BPPV (My Most Common Case)

I perform a canalith repositioning maneuver—usually the Epley maneuver or, for complex cases, the Bangalore Maneuver. About 80-90% of BPPV resolves after one session. Some patients need a second treatment. This is NOT long-term medication; this is a cure.

For Vestibular Neuritis or Labyrinthitis

I use vestibular rehabilitation exercises combined with short-term anti-nausea medication. The key is activity—lying in bed makes it worse. I teach patients gaze stabilization exercises they can do immediately.

For Meniere’s Disease

Salt restriction, diuretics, and vestibular rehabilitation. Some patients need preventive migraine medications. Surgery is rare.

For Vestibular Migraine

Migraine prevention (beta-blockers, tricyclic antidepressants), trigger identification, stress management. I always rule out BPPV first.

For Central Causes (Stroke, Tumor)

These need neurologist or neurosurgeon involvement. I focus on identifying them quickly.

Practical Steps You Can Take Now

• Don’t panic – vertigo is frightening but often very treatable
• Seek accurate diagnosis – don’t accept “you probably have vertigo” without specific testing
• Avoid bed rest – movement and balance exercises speed recovery
• Stay hydrated – dehydration worsens symptoms
• Reduce salt if you suspect Meniere’s – this can help significantly
• Practice slow, controlled movements – avoid sudden position changes

When This Becomes an Emergency

Seek immediate care if you experience:

• Vertigo with severe headache, fever, or neck stiffness (possible meningitis)
• Vertigo with weakness, numbness, or speech difficulty (possible stroke)
• Vertigo after head injury with loss of consciousness
• Persistent severe vertigo lasting days with no improvement
• Sudden hearing loss with vertigo