What is Vertigo?

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

What is Vertigo? Understanding the Spinning Sensation

Every week, I see patients in my Hardoi clinic who walk in looking genuinely scared — convinced they’re either having a stroke or “going mad.” One lady from Sitapur last month told me, “Doctor saab, mujhe lagta hai ghar goom raha hai.” Her husband had dragged her across three hospitals before reaching me. She had BPPV — completely treatable, took me 8 minutes. But she’d suffered for 4 months.

That’s the real problem with vertigo in India. It’s one of the most common conditions I see, yet most patients have no idea what it actually is or that it can be fixed quickly. So let me explain it plainly, the way I’d explain it sitting across from you in my clinic.

Defining Vertigo: More Than Just Dizziness

Vertigo is a specific kind of dizziness. Not the “I stood up too fast” kind. Not the lightheaded feeling you get when you’re hungry. Vertigo is the false, unmistakable sensation that you — or the room around you — is spinning, tilting, or swaying when absolutely nothing is moving.

The American Academy of Otolaryngology defines it as “the sensation of motion when no motion is occurring relative to earth’s gravity.” In simpler terms: your brain is receiving wrong signals from your balance system, and it’s convinced you’re spinning when you’re perfectly still.

People in North India often say “chakkar aa raha hai” — but there are actually at least 3-4 completely different conditions that get lumped under that phrase. Understanding which one you have changes everything about the treatment. This is why I wrote a full piece on how BPPV, vestibular neuritis, and other chakkar conditions differ — worth reading if you’ve been confused about your diagnosis.

Vertigo vs. Acrophobia — Not the Same Thing

People often use “vertigo” to mean fear of heights. Even Hollywood did this — the Hitchcock film “Vertigo” is about acrophobia, not the medical condition. Medically, acrophobia (fear of heights) and vertigo are completely different. Yes, some people with balance disorders feel worse on heights, but vertigo doesn’t require any height at all. My patient with BPPV got her spinning attack while rolling over in bed at ground level.

Symptoms of Vertigo: What Does It Feel Like?

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The main symptom is that spinning or rotating sensation — as if the world is on a turntable. But it comes in different flavors:

• The room is spinning rapidly (most common in BPPV)
• You feel like YOU are spinning
• A feeling of being pulled sideways or tilted
• The ground feels like it’s moving under your feet
• Everything is rocking, like being on a boat

The duration varies hugely. In BPPV (the most common type), attacks last 10-60 seconds and stop on their own. In vestibular neuritis, it can last days. In Meniere’s disease, attacks run 20 minutes to several hours.

Intensity also ranges wildly. Some patients feel mild unsteadiness. Others vomit, can’t walk, and lie frozen in bed. Both can be the same condition — BPPV — just different canals affected.

Other Symptoms That Come Along

Vertigo rarely shows up alone. In my experience, patients usually also have:

• Nausea and sometimes vomiting (especially in acute attacks)
• Abnormal eye movements — eyes flicking back and forth involuntarily (nystagmus) — this is actually what we look for to confirm the diagnosis
• Headache (especially in vestibular migraine)
• Ringing in the ears (tinnitus) — more common in Meniere’s
• Hearing loss — again, Meniere’s, or vestibular neuritis
• Sweating, pale skin during acute attacks
• Difficulty concentrating, “brain fog” afterward

These associated symptoms are diagnostically useful. When a patient tells me they have ringing AND vertigo AND hear muffled sounds, I’m thinking Meniere’s before they finish the sentence. When it’s pure spinning attacks with head movement and no hearing symptoms, it’s almost certainly BPPV.

Types of Vertigo: Peripheral vs. Central

This is the most important distinction in vestibular medicine, and yet most general practitioners don’t explain it clearly.

Peripheral Vertigo

This is where the problem is in the inner ear or the vestibular nerve connecting it to the brain. 80-85% of all vertigo is peripheral. The good news: peripheral vertigo is nearly always treatable, often quickly.

Common causes:

• Benign Paroxysmal Positional Vertigo (BPPV) — the most common, caused by displaced crystals in the inner ear
• Vestibular neuritis — viral infection of the vestibular nerve, causes days of severe spinning
• Meniere’s disease — fluid buildup in the inner ear, episodic attacks with hearing changes
• Labyrinthitis — inflammation of the entire inner ear
• Superior canal dehiscence syndrome — a bony defect in the inner ear roof

Peripheral vertigo is typically intense and episodic. The nystagmus (eye flicking) follows predictable patterns that a trained ENT can read like a map to the diagnosis.

Central Vertigo

Central vertigo means the problem is in the brain itself — brainstem or cerebellum. This is the 15-20% that concerns us more, because the causes can be serious:

• Stroke or TIA — this is the one nobody wants to miss. I’ve written about how to distinguish vertigo from stroke and it’s reading every patient should do.
• Brain tumors pressing on balance centers
• Multiple sclerosis
• Vestibular migraine (technically central in origin)
• Certain medications — some blood pressure drugs, antibiotics, and antiepileptics can affect the cerebellum

Central vertigo tends to be more constant, less dramatic moment-to-moment, and accompanied by other neurological signs: double vision, slurred speech, limb weakness, severe headache. The nystagmus patterns are “atypical” — they don’t match any inner ear pattern. This is what makes the HINTS exam so valuable in emergency settings.

Common Causes of Vertigo

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Benign Paroxysmal Positional Vertigo (BPPV)

BPPV causes about 32% of all peripheral vertigo cases — and in my clinic, it feels like more. These are patients who get brief, violent spinning episodes when they roll over in bed, look up at a high shelf, or tilt their head. The cause: tiny calcium carbonate crystals (otoconia) have dislodged from their proper home in the inner ear and wandered into one of the semicircular canals.

The treatment is mechanical — we physically reposition the crystals using a specific head maneuver (Epley is most common, but for complex cases I use the Bangalore Maneuver, which I’ve developed for difficult horizontal canal variants). Most patients feel better within one session. No surgery, no long-term medications.

If you suspect BPPV, read my complete BPPV guide — it covers all 3 types, diagnosis, and treatment in detail.

Vestibular Neuritis and Labyrinthitis

This is when a virus attacks the vestibular nerve. Patients typically wake up one morning with severe, constant spinning — often so bad they can’t walk and are vomiting. It lasts days. The acute phase is managed with vestibular suppressants (careful — overuse makes recovery slower). The recovery phase is managed with vestibular rehabilitation exercises.

Labyrinthitis is similar but the infection reaches the cochlea too, causing hearing loss alongside the vertigo.

Meniere’s Disease

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Meniere’s is a chronic inner ear disorder involving excess fluid (endolymph) buildup. It presents as a triad: episodic vertigo (attacks lasting 20 minutes to several hours), fluctuating low-frequency hearing loss, and tinnitus (roaring or whooshing sound, usually one-sided). Many patients also feel “ear fullness” — like the ear is blocked.

This is one of the more challenging conditions to manage long-term, but very manageable with dietary changes (low salt diet primarily), diuretics, and in some cases, intratympanic injections.

Vestibular Migraine

This is massively underdiagnosed in India. Patients get vertigo attacks — sometimes without any headache at all — triggered by hormonal changes, certain foods, bright lights, or stress. It’s the second most common cause of recurrent vertigo and I see it weekly. Read my full vestibular migraine guide if you get recurrent attacks without a clear BPPV diagnosis.

Anxiety and PPPD

Yes, anxiety genuinely causes dizziness — and it’s not “all in the head” in the dismissive sense. There’s a real physiological mechanism. Persistent Postural-Perceptual Dizziness (PPPD) is now a recognized diagnosis — chronic dizziness driven by over-sensitized balance centers, often triggered initially by a real vestibular event like BPPV or neuritis.

Cervicogenic Dizziness

One of the most overtreated “diagnoses” in India is “cervical spondylosis causing vertigo.” Most cervical X-rays are over-read, and most patients labeled with “cervical vertigo” actually have BPPV or vestibular migraine. I wrote about this misdiagnosis problem in detail — it’s one of the most common traps I see patients falling into.

Diagnosing Vertigo: Tests and Procedures

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Diagnosing vertigo properly starts with a good history — when does it happen, how long does it last, what triggers it, does it come with hearing symptoms or headache? From there, the physical exam does most of the work.

Key diagnostic tests I use:

• Dix-Hallpike maneuver — the gold standard for BPPV. I lay the patient flat with their head turned and hanging, and watch the eyes. The nystagmus pattern tells me exactly which canal is involved.
• Supine Roll Test — for horizontal canal BPPV, which Dix-Hallpike misses.
• HINTS exam — Head Impulse, Nystagmus, Test of Skew — used when I’m worried about stroke. More on that here.
• VNG (Videonystagmography) — records eye movements using infrared cameras. Useful for complex cases where the bedside exam alone isn’t conclusive.
• Audiometry — hearing test, essential when Meniere’s or vestibular neuritis is suspected.
• MRI — only when there’s suspicion of central cause. I don’t order MRI for every vertigo patient — in straightforward BPPV, it’s unnecessary and expensive.

Honestly, most clear-cut BPPV is diagnosed and treated in the same appointment. No waiting for lab results.

When to See a Doctor — And When to Go Straight to Emergency

Not every vertigo attack is an emergency. But some red flags need immediate attention:

• Vertigo with sudden severe headache (“worst headache of your life”)
• Vertigo with double vision, facial numbness, or arm/leg weakness
• Vertigo with slurred speech or difficulty swallowing
• Falling toward one side, can’t walk at all
• New vertigo after a head injury

If any of these are present — emergency department, not the local clinic. If it’s just spinning that comes and goes with head movement, no headache, no weakness — book an ENT appointment.

Conclusion

Vertigo is not a single disease — it’s a symptom that points to a cause. Find the cause, treat the cause, resolve the vertigo. In 2026, we have excellent diagnostic tools and highly effective treatments for most vertigo conditions. The majority of patients I see — even those who’ve suffered for months — can be treated effectively once properly diagnosed.

If you or someone in your family is struggling with chakkar, spinning, or balance problems, don’t keep taking betahistine indefinitely without a diagnosis. Come in, get examined properly, and find out what’s actually going on.