Vertigo symptoms: What are the early signs of vertigo?

Overview: What does vertigo feel like?

Vertigo is a type of dizziness where the world appears to be spinning, tilting, or swaying, even when standing completely still. In addition to the spinning, the eyes usually go back and forth like they’re trying to track the motion. People can feel off-balance and wobbly, walk differently, and fall. The spinning can cause motion sickness and nausea. It can even make people throw up if it lasts long enough. Vertigo has many causes, but all are centered on the inner ear or brain. The exact nature of the vertigo—how often it happens, when it happens, how long it lasts, how it’s triggered, how the eyes react, and associated symptoms—can often help a doctor discover the cause.

What are the early signs of vertigo?

The core symptom of vertigo is:

• A feeling that the world is moving even when standing still—this movement is typically a spinning feeling, but could also appear like the world is tilting or swaying

Other primary signs of vertigo are:

• Unsteadiness or balance difficulties

• Difficulty walking

• Nystagmus—abnormal eye movements from side to side, up and down, or in circles as the eyes seem to be following a perceived movement

• Nausea

• Vomiting

RELATED: Going round and round: what it’s like experiencing vertigo

Secondary symptoms that may be related to the cause of vertigo include:

• Ringing or buzzing in the ear (tinnitus)

• Severe headache

• Hearing loss

• A “full feeling of sound” in one or both ears

• Light sensitivity

• Sound sensitivity

Types of dizziness: How can I tell which one I have? 

Not everyone who thinks they’re dizzy is experiencing vertigo. Healthcare professionals distinguish between four types of dizziness: vertigo, disequilibrium, presyncope, and lightheadedness.

Vertigo is the feeling that the world is moving, usually spinning around, similar to coming off of a spinning ride. About half of the people who go to a healthcare professional with dizziness have vertigo.

Disequilibrium is a loss of balance. People feel wobbly, off-balance, and walk differently. They may fall. About 15% of people who complain of dizziness have a balance problem.

Presyncope is what people feel when they’re about to faint. They feel lightheaded and the world starts to go dark. They may also feel off-balance, fall, or lose consciousness. About 15% of people who say they feel dizzy are experiencing presyncope.

Lightheadedness is a less specific cluster of symptoms. It’s the same feeling you get if you breathe very fast for a while. The world doesn’t spin, but people feel like they’re floating, off-balance, or about to faint. 

Types of vertigo: How can I tell which one I have? 

Healthcare professionals distinguish between peripheral vertigo and central vertigo. 

Problems in the inner ear cause peripheral vertigo. These problems are typically not very serious and account for about 80 to 90% of vertigo cases. Episodes can be severe, but they are often short-lived, usually only lasting seconds. Head movements often trigger them. 

Problems in parts of the brain, such as the cerebellum, brainstem, and midbrain, cause central vertigo. These central nervous system problems can sometimes be serious or life-threatening, such as multiple sclerosis, stroke, or cancer. However, some causes of central vertigo are less serious, such as medication side effects or migraine headaches. Episodes of central vertigo typically last longer than peripheral vertigo episodes. Central vertigo episodes can sometimes last for days, weeks, or months.

When to see a doctor for vertigo symptoms

If vertigo happens just once or twice, then goes away, it is usually not something that should cause worry. If vertigo has an obvious cause, such as spinning around in circles or coming off of an amusement park ride, it is normal. 

However, if vertigo happens regularly for no identifiable reason or for reasons that shouldn’t cause vertigo, like sitting up, then see a doctor. If vertigo doesn’t go away, immediate medical care may be needed. 

A healthcare provider will first seek to determine if a patient is actually experiencing vertigo. The next step is determining if the vertigo is peripheral or central. The doctor will start with a medical history. The healthcare professional will want to know:

• What does it feel like?

• How often does it happen?

• How long do episodes last?

• Does anything trigger the dizziness?

• Are there other symptoms?

• What medications are being taken?

From there, the goal is to diagnose the underlying cause. This will start with a physical examination that includes neurological, head and neck and cardiovascular exams. Depending on the results, the doctor may order an MRI scan of the brain. A final diagnosis may require a specialist in neurology or otolaryngology.

Complications of vertigo

Since vertigo is only a symptom, the most significant complications involve untreated disorders causing vertigo. The most problematic disorders are:

• Brain cancer

• Inner ear tumor (acoustic neuroma)

• Stroke

• Infections

How to treat vertigo symptoms

Doctors will either treat the underlying cause of vertigo or try to relieve vertigo through drugs or physical therapy.

Three medical conditions are responsible for 93% of vertigo cases.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and primarily affects older adults. Free-floating calcium crystals cause BPPV in the semicircular canals, the part of the inner ear responsible for sensing motion and maintaining balance. When the head moves, the fluid in the canals sloshes around. Based on the fluid movement, the canals tell the brain what direction the head is moving. If there are free-floating crystals in the canals, they throw the mechanism off and cause vertigo whenever the head position is changed.

Meniere’s disease is when fluid builds up in the semicircular canals. Episodes of vertigo can last for hours, and people with Meniere’s will have other symptoms, such as tinnitus and hearing problems.

Acute vestibular neuritis (AVN) results from inflammation of the vestibular nerve, the nerve that connects the movement of sensory nerves in the semicircular canals to the brain.

Vertigo can also be caused by other vestibular disorders, inner ear infections (labyrinthitis), trauma, vestibular migraines, stroke, brain tumors, brain infections, multiple sclerosis, anxiety, alcohol abuse, and drugs. 

People with BPPV, the mildest cause of vertigo, are usually treated by practicing head movements such as the Epley maneuver. Called canalith repositioning (CRP), these maneuvers move loose calcium crystals back to a place in the inner ear where they won’t cause vertigo.

The most common treatment options used to relieve vertigo include:

• Prescription drugs, such as antihistamines, benzodiazepines, and antinausea drugs, to relieve long episodes of vertigo

• Corticosteroids to reduce inner swelling that may be causing vertigo 

• Diuretics to reduce inner ear fluid buildup that may be causing vertigo

• Physical therapy and vestibular rehabilitation for people with permanent inner ear problems

• Lifestyle changes

RELATED: Vertigo treatments and medications

Living with vertigo

Episodes of vertigo may be a chronic or even lifelong problem in some people. Here are a few tips to prevent vertigo and minimize problems:

• Take prescribed medications as instructed

• Keep all medical and physical therapy appointments

• Keep a symptoms journal to chronicle episodes, their duration, and triggers—share this journal with the doctor

• Organize the home to avoid bending over or looking up

• Manage or avoid stress

• Get enough sleep

RELATED: Can stress cause vertigo?

FAQs about vertigo symptoms

What does vertigo feel like?

Vertigo feels like you’re moving, or the world is moving, but you’re standing still. It’s what most people mean when they say they’re dizzy. Most of us have experienced vertigo, usually after spinning around, running in tight circles, or coming off of an amusement park ride.

How long does vertigo last?

If there’s no medical problem or a benign inner ear disorder, vertigo gradually improves and goes away in a few seconds. If it’s caused by a serious medical problem, such as inner ear infections, ear tumors, brain tumors, fluid buildup, or stroke, vertigo episodes may last for hours, days, weeks, or months. 

How can I tell which ear is causing vertigo?

People with benign paroxysmal positional vertigo get dizzy when they move their heads. This is due to calcium crystals floating loose in one or both ear canals. It is possible to see if one or both ears are causing the problem. 

• Sit upright on a bed

• Turn the head to the right or left

• Focus the eyes on one object

• Sit in that position for about 45 seconds

• Lie down with the head still turned

• In a few seconds, you should feel vertigo if that ear is the problem

• Now do the same on the other side

What’s next? Additional resources for people with vertigo symptoms

Test and diagnostics

• Initial evaluation of vertigo, American Family Physician

• Vertigo, StatPearls

Treatments

• Home Epley maneuver, Johns Hopkins Medicine

• Treatment of vertigo, American Family Physician

• Vertigo treatments and medications, SingleCare

Scientific studies and clinical trials

• Benign paroxysmal positional vertigo, Laryngoscope Investigative Otolaryngology

• Review of the pathology underlying benign paroxysmal positional vertigo, Journal of International Medical Research

More information on related health conditions

• Anxiety treatments and medications, SingleCare

• Dizziness: a diagnostic approach, American Family Physician

• Meniere’s disease treatments and medications, SingleCare

• Migraine medications and treatments, SingleCare