Can stress cause vertigo?

If you’ve ever been under serious stress, you know it can cause some unpleasant physical symptoms—such as dizziness, disorientation, and nausea. Many of these sensations resemble vertigo, so you may have wondered: Can stress cause vertigo?

The relationship between vertigo and stress is complicated, and experts are trying to understand how the two are connected. What’s known is that stress alone doesn’t trigger vertigo, but it can exacerbate it. Not only that, experiencing vertigo can be stressful in itself, and can cause stress and anxiety to increase.

Let’s look at the way that stress influences vertigo and vice-versa, as well as some strategies and treatments for keeping both your stress and vertigo at bay. 

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What causes vertigo?

The most common cause of vertigo is when  small calcium crystals, called otoconia, become loose in the inner ear. This is called benign paroxysmal positional vertigo (BPPV). These crystals move around and make you feel off-balance. People with BPPV will notice symptoms most often when they go from a lying down position to upright position, or anytime they change position suddenly. 

The first signs of BPPV can be alarming and quite uncomfortable. “It initially manifests through sudden minute-long episodes of spinning that can even prompt vomiting,” says Christine Kingsley, APRN, a provider at the Lung Institute in Connecticut.

 Other symptoms of BPPV involve room-spinning dizziness. These bouts can last from several seconds up to several minutes. “Typically, symptoms of BPPV are brought on by head turns, turning over in bed, or when getting out of bed in the morning,” says Amy Sarow, AuD, a Michigan-based audiologist. 

BPPV often resolves spontaneously in a few days as the body absorbs the loose crystals, Dr. Sarow says. Other people may require treatment, including repositioning maneuvers to resolve symptoms. The modified Epley maneuver can be done at home by yourself to help reposition the crystal and resolve symptoms. Vitamin D supplementation has been shown to decrease recurrence of BPPV.

Benign paroxysmal positional vertigo is only one cause of vertigo. Other medical conditions can cause or contribute to vertigo, such as:

• Meniere’s disease
• Labyrinthitis
• Vestibular neuritis
• Cholesteatoma (abnormal epithelial cells in the inner ear)
• Migraines
• Diabetes
• Stroke
• Head trauma
• Multiple sclerosis
• Prior ear surgery 
• Low blood pressure
• Acoustic neuroma

Certain medications can also affect your sense of balance and lead to vertigo.

Can stress cause vertigo?

Many people experience vertigo-like symptoms during stressful times. Stress can make you lightheaded, cause a rapid heartbeat, and make you feel dizzy. But stress on its own doesn’t cause vertigo. “The truth is, mental stress can only catalyze vertigo and make it worse, but it’s not a stand-alone cause for vertigo,” Kingsley explains. Even though stress does not cause vertigo, it can contribute to the intensity of vertigo symptoms—or make the spells feel like they are lasting longer. 

According to a review published in Frontiers of Neurology, stress hormones—such as cortisol and corticosterone—that are released in response to stressors may affect the functioning of your inner ear, which can exacerbate vertigo symptoms. Additionally, people who experience vertigo from other causes may notice an uptick in their stress and anxiety levels. In other words, experiencing vertigo can be a stressful experience.

 Vertigo associated with stress will look different than other types of vertigo, says Kingsley. One of the defining characteristics of stress-related vertigo is that it’s shorter lived, usually lasting less than a minute, she explains. On the other hand, medically induced vertigo often lasts longer and can only be relieved by treating the underlying condition itself.

“At the end of the day, benign paroxysmal positional vertigo is an issue caused by inner-ear dysfunction,” Kingsley says, “while vertigo caused by stress is usually a product of the combined effects of increased cortisol levels and other imbalances within the body such as vascular issues.”

Vertigo from anxiety 

Anxiety and stress are related, but anxiety usually causes more intense symptoms and is often a symptom of a nervous system disorder, such as generalized anxiety disorder, panic disorder, post-traumatic stress disorder, or phobias. Many of these disorders have symptoms similar to vertigo, like lightheadedness and dizziness.

In fact, there is such a strong link between anxiety disorders and dizziness that there is a term to describe it: persistent postural perceptual dizziness (PPPD). “PPPD is a type of dizziness that can be provoked or exacerbated by anxiety,” Dr. Sarow says. “Episodes of this type of dizziness may last from minutes to hours.”

PPPD is not the same as vertigo, but it shares many symptoms. People who experience migraines, motion sickness, or vestibular system disorders are more likely to develop the condition, says Dr. Sarow.

A study published in BMC Psychiatry found another connection between vestibular disorders and anxiety: People with anxiety disorders are more likely to develop BPPV, especially women and people with cerebrovascular disease.

Anxiety is also often something that develops as a result of experiencing vertigo. Think about it: Vertigo can be frightening and debilitating. Many experience anxiety and panic thinking about a recurrence of vertigo. It’s no wonder that a study published in Current Opinion in Neurology found that 50% of people with vestibular disorders went on to develop anxiety, panic disorders, or depression.

How to prevent vertigo caused by stress

Although stress isn’t the main cause of vertigo, it can make vertigo worse. Reducing stress is a good idea. Simple lifestyle changes can have a profound impact on reducing stress. These include:

• Eating a well-balanced, nutrient-rich diet
• Engaging in routine physical activity
• Making sure to get enough sleep
• Staying hydrated
• Practicing mindfulness
• Meditateing
• Journaling 
• Practicing gratitude
• Speaking to a therapist or mental health counselor

 If you are experiencing vertigo see your healthcare provider. You need vital signs and an exam and to discuss your current medications. Treating the underlying issue should cause the vertigo to resolve.

Often, medications are prescribed to help treat symptoms of vertigo, such as dizziness and nausea. Treatment options may include:

• Antihistamines
• Benzodiazepines
• Anticholinergics
• Dopamine receptor antagonists
• Calcium channel antagonists

Sometimes physical therapists or physiotherapists can perform vestibular rehabilitation  exercises to treat vertigo. In cases of BPPV, the Epley maneuver can help dislodge the crystals that are causing the vertigo.

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The bottom line—stress contributes to vertigo

Many people wonder if stress causes vertigo, especially because the two are often experienced at the same time. While stress isn’t a main cause of vertigo, it likely contributes to the condition. Moreover, experiencing vertigo can lead to feelings of stress and anxiety, which can make the experience of vertigo more challenging.

You can’t know what’s causing your vertigo for sure unless you get an evaluation from a healthcare provider. If vertigo is a new symptom for you, or if your symptoms are severe, you should seek professional medical advice. Although most cases of vertigo resolve on their own in time, they can be symptoms of serious health conditions, such as a brain tumor, high blood pressure, diabetes, head injuries, or stroke.