There are two types of vertigo: peripheral and central.

• Peripheral vertigo occurs if there is a problem with the portion of the inner ear that controls balance (vestibular labyrinth or semicircular canals), or with the vestibular nerve (which connects the inner ear to the brainstem).
• Central vertigo occurs if there is a an abnormality in the brain, particularly in the brainstem or the cerebellum (back part of the brain).

Vertigo related to the inner ear may be caused by:

• Benign positional vertigo (recurrent attacks of vertigo, especially when the head is in certain positions)
• Drugs (aminoglycoside antibiotics)
• Meniere's disease
• Labyrinthitis (sometimes causes vertigo)
• Injury

Vertigo related to the vestibular nerve may be caused by:

• Inflammation (neuronitis)
• Nerve compression (usually a benign tumor such as a meningioma or schwannoma)

Vertigo related to the brainstem may be caused by:

• Multiple sclerosis
• Blood vessel disease
• Migraine
• Drugs (anticonvulsants, aspirin, alcohol)

The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms associated with the condition that is causing the vertigo. Associated symptoms include the following:

• Double vision
• Difficulty swallowing
• Facial paralysis
• Slurred speech
• Weakness of the limbs

Nystagmus (involuntary eye movements) and hearing loss may be present in both central and peripheral vertigo. Other signs such as other eye movement abnormalities, lack of coordination, weakness, or sensory loss suggest a central cause.

Tests to determine the cause of vertigo may include the following:

• Head CT
• MRI scan of head and MRA scan of blood vessels of the brain
• Caloric stimulation (tests eye reflexes)
• Electronystagmography
• EEG, evoked auditory potential studies
• Lumbar puncture
• Blood tests

Medications such as antihistamines, anticholinergics, and benzodiazepines may be prescribed to reduce symptoms of peripheral vertigo. Certain exercises may also be helpful.

To treat central vertigo, the underlying cause must be identified and then treated.

Try to avoid head positions that cause vertigo. Use caution in situations such as driving or operating heavy equipment, where even short episodes of vertigo may be dangerous.

The outcome depends on the cause.

Persistent, unrelieved vertigo can interfere with driving, work, and lifestyle. It can also cause falls which can in turn lead to hip fractures.

Call for an appointment with your health care provider if vertigo is persistent or troublesome.