Types of Vertigo

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

In my 15 years of treating vertigo patients across Uttar Pradesh, I’ve learned that understanding which type of vertigo you have is the difference between a one-visit cure and months of frustration. Too many patients come to my clinic having been told “you have vertigo” without any clarification about what kind. That’s like telling someone “you have a fever” without knowing if it’s from the flu, pneumonia, or malaria.

The truth is, all vertigo falls into two broad categories—peripheral and central. But within each category, there are distinct conditions with different causes, prognosis, and treatment. Let me walk you through what I see in daily practice.

Peripheral Vertigo: Problems in the Inner Ear

Peripheral vertigo accounts for 80-90% of my cases. It comes from the inner ear—the vestibular system that tells your brain which way is up. About 80% of my peripheral vertigo patients have BPPV (Benign Paroxysmal Positional Vertigo), which I can often treat and resolve in a single office visit.

1. Benign Paroxysmal Positional Vertigo (BPPV)

This is my favorite diagnosis. Why? Because it’s simple, it’s treatable, and I can cure most people completely.

BPPV happens when tiny calcium carbonate crystals (otoconia) get loose inside the semicircular canals of your inner ear. When you move your head—turning over in bed, looking up, reaching for something on a high shelf—these crystals shift, sending false motion signals to your brain. Your brain thinks you’re spinning when you’re not.

Characteristic symptoms of BPPV:

• Brief episodes of intense vertigo triggered by head movement (seconds to minutes)
• Nausea, sometimes vomiting
• Feeling like the room is spinning when you lie down or sit up
• Happening repeatedly in the same position
• No hearing loss or tinnitus (unlike Meniere’s)

Common causes I see:

• Head injury or trauma (most common)
• Prolonged bed rest or immobility
• Aging (crystals naturally loosen with age)
• Osteoporosis
• Inner ear infections (though rare)

Diagnosis is straightforward. I perform the Dix-Hallpike test and almost immediately see characteristic nystagmus (eye movements). Treatment? A repositioning maneuver—the Epley maneuver for most cases, or my Bangalore Maneuver for complex multi-canal involvement. Most patients get relief immediately.

2. Meniere’s Disease

Image Source: Canva

This is a chronic inner ear disease where fluid builds up in the inner ear for reasons we don’t fully understand. Meniere’s is less common than BPPV, but when patients get it, their vertigo episodes are brutal.

The classic Meniere’s pattern (the “tetrad”):

• Sudden, severe vertigo episodes lasting 20 minutes to several hours
• Fluctuating hearing loss (particularly in low frequencies)
• Tinnitus (ringing or buzzing in the ear)
• Aural fullness (feeling of pressure in the ear)

What causes it:

• Fluid buildup in the endolymphatic system (clear cause unknown)
• Autoimmune response (suspected)
• Viral infection (possible trigger)
• Genetic predisposition (some families more prone)
• Salt sensitivity (high salt worsens fluid retention)

In my Hardoi practice, I’ve noticed Meniere’s patients often come back repeatedly because the disease is unpredictable. Management focuses on symptom control through diet (low salt), diuretics, and vestibular rehabilitation. For disabling cases, surgical options exist but are rarely needed.

3. Vestibular Neuritis

This is inflammation of the vestibular nerve, usually from a viral infection. Vestibular neuritis is distinct from labyrinthitis because hearing is typically spared.

How it presents:

• Sudden onset of severe vertigo (often wakes patient at night)
• Intense nausea and vomiting (can’t drink water without vomiting)
• Balance completely disrupted for days
• Gradual improvement over 1-3 weeks
• No hearing loss (that’s how we distinguish it from labyrinthitis)

Causes:

• Viral infections (herpes zoster, herpes simplex, respiratory viruses)
• Reactivation of dormant virus in the nerve
• Post-viral inflammation

My approach: reassure the patient (it will improve), treat nausea and vomiting with medications, and start vestibular rehabilitation exercises early. Bed rest is harmful; movement and balance retraining speed recovery.

4. Labyrinthitis

Similar to vestibular neuritis but with inflammation of the cochlea too—so hearing is affected. This is less common than vestibular neuritis.

The difference from vestibular neuritis:

• Hearing loss accompanies the vertigo
• Tinnitus and ear fullness
• Otherwise identical presentation

Causes:

• Viral infection of the entire inner ear
• Bacterial infection (rare, more serious)
• Post-infection inflammation

Treatment is the same as vestibular neuritis, but I monitor hearing closely because some hearing loss may be permanent.

5. Perilymph Fistula

This is a tear in the membrane separating the middle ear from the inner ear, allowing inner ear fluid to leak. It’s rare but important to recognize.

Symptoms:

• Vertigo triggered by pressure changes (sneezing, coughing, straining, Valsalva)
• Hearing loss
• Ear fullness
• Can follow head trauma or diving accidents

Causes:

• Head injury or trauma
• Barotrauma (diving, flying with pressure changes)
• Physical exertion or heavy lifting
• Chronic middle ear infections

Some cases need surgery; others resolve with rest and pressure precautions.

Central Vertigo: Problems in the Brain

Image Source: Canva

Central vertigo comes from the brain—specifically the brainstem or cerebellum, which control balance. This is less common (10-20% of cases) but more worrisome because it can indicate stroke, tumor, or MS.

1. Vestibular Migraine

This is the most common central cause of vertigo. In my practice, I see a lot of patients who had migraines and now have vertigo episodes without headache.

The pattern I see:

• Vertigo episodes lasting minutes to hours, sometimes days
• Often preceded by migraine prodrome (aura, mood changes)
• Photophobia (light sensitivity) and phonophobia (sound sensitivity)
• Nausea
• May or may not have headache during the vertigo
• Family history of migraines

What’s happening:

Aberrant brain activity affects the vestibular pathways in the brain. The exact mechanism isn’t fully understood, but migraine medications help.

Treatment: Migraine prevention (beta-blockers, tricyclic antidepressants), trigger identification, lifestyle modification.

2. Multiple Sclerosis (MS)

When lesions in the brain affect balance centers, vertigo results. MS vertigo is usually accompanied by other neurological symptoms.

Red flags I look for:

• Persistent vertigo (not brief episodes)
• Weakness or numbness
• Visual disturbances
• Balance problems beyond what you’d expect from vertigo
• Cognitive changes

I refer these patients to neurology for MRI and spinal tap when MS is suspected.

3. Stroke

This is what keeps me up at night. Sudden vertigo can be the first sign of brainstem or cerebellar stroke. Using the HINTS exam (Head Impulse, Nystagmus, Test of Skew), I can identify many strokes quickly—sometimes before MRI.

Warning signs:

• Sudden onset vertigo with other neurological symptoms
• Difficulty walking or balance loss beyond vertigo
• Weakness on one side
• Slurred speech or difficulty speaking
• Numbness or tingling
• Horizontal nystagmus that doesn’t fit BPPV

If stroke is suspected, this is an emergency. Time is brain.

4. Brain Tumor

Tumors near balance centers cause persistent, progressive vertigo. Not the sudden, brief episodes of BPPV.

What I look for:

• Gradually worsening vertigo over weeks to months
• Headaches
• Balance deterioration
• Vision problems
• Hearing loss in one ear

These patients need MRI and neurosurgery consultation.

Practical Summary: How to Know What You Have

Sudden severe vertigo, brief episodes, triggered by head position? Probably BPPV—call me for Dix-Hallpike test.

Severe vertigo with hearing loss and tinnitus, happens repeatedly? Likely Meniere’s disease—needs ongoing management.

Sudden severe vertigo that won’t go away for days, from a virus? Vestibular neuritis—should improve with time and exercises.

Vertigo with migraines? Likely vestibular migraine—migraine prevention helps.

Vertigo with weakness, numbness, or stroke-like symptoms? EMERGENCY—seek immediate care.