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When Your World is Literally Spinning: Finding the Root Cause of Vertigo

A man holds his temples while the room spins around him during an episode of vertigo

When patients complain of a balance disorder like vertigo or dizziness, the first step doctors take is to determine which of the four categories their balance disorder falls into.

  • Vertigo (room spinning)
  • Nonspecific dizziness
  • Disequilibrium (balance off)
  • Presyncope (lightheadedness, feel like passing out)

Vertigo vs. Dizziness

Many times, people use dizziness and vertigo interchangeably, but there is a difference.

While they are both balance problems, dizziness is an overall feeling of being unbalanced. With vertigo, there is more of a sensation that the room is spinning, or you are moving.

Many people describe vertigo as feeling like motion sickness. They feel like they are spinning, rocking, or tilting. The unbalanced feeling can get worse if you stand, move your head, or change positions.


When patients present with vertigo symptoms, they usually describe feelings of:

  • A spinning sensation that worsens with head movement
  • A loss of balance
  • Tilting or swaying
  • Being pulled to one side

Oftentimes they will describe additional symptoms such as:

  • Feeling nauseous
  • Vomiting
  • Ringing or buzzing in the ear
  • Hearing loss
  • Headaches
  • Sweating
  • Abnormal eye movements

Types of Vertigo

If doctors determine a patient’s disorder is truly vertigo, then they will further try to determine which type of vertigo the patient has, since that will impact what kind of treatment is recommended. They use patient history, a physical exam, and testing to help them determine which kind of vertigo the patient is suffering from.

There are two main types of vertigo:

  • Peripheral vertigo: This is the most common type of vertigo and occurs outside of the brain due to a problem either with the inner ear or hearing nerve (vestibular nerve), which is responsible for balance.
  • Central vertigo: This type of vertigo is a symptom of a brain issue. This could include stroke, traumatic brain injury, infection, or in rare cases, a brain tumor.


There are many different causes, so it is important for doctors to find the correct root cause of vertigo since the treatment is different depending on the cause. The most common causes include:

  • Benign paroxysmal positional vertigo (BPPV):This is one of the most common causes of vertigo. BPPV creates an intense sensation of spinning, which is usually triggered by a sudden change in head position.
  • Head injuries: Vertigo can occur after a traumatic brain injury, including concussions.
  • An ear infection/inner ear fluid build-up: This includes infections such as labyrinthitis or vestibular neuritis.
  • Meniere’s Disease: A chronic inner ear disorder that can cause vertigo, ringing in the ear (tinnitus), and hearing loss.

Other, less frequent causes include:

  • Heart rhythm problems
  • Blood pressure problems (too high or low)
  • Cardiac disease (heart dysfunction)
  • Migraines
  • Peripheral vascular disease (a narrowing of the carotid arteries, which is a stroke risk)
  • Side effects from medication
  • Anemia
  • Tumor
  • Electrolyte problems (blood sugar too high or low)
  • Heat exhaustion or other temperature-related disorders
  • Central brainstem vestibular lesion (e.g., acoustic neuroma)

If all the other causes are ruled out, doctors will evaluate for a mental health disorder. Mental health disorders account for roughly 15 percent of all vertigo cases.


Patient history is very important when someone is being evaluated for vertigo, since not everyone reports the same symptoms. First, the doctor needs to find out what the root cause is. They will do this by:

  1. Asking open-ended questions to determine what’s causing the vertigo.
  2. Listening to the patient describe the symptoms.
  3. Gathering additional information from more specific questions in order to classify the dizziness/vertigo and identify the cause.
  4. Performing a physical exam.
  5. Ordering diagnostic testing as needed.

Once the root cause is found, and test results are in, the doctor can determine which treatment option is best.


There are a variety of treatment options available for vertigo:

  • Medication: This is often used in the case of an infection. Doctors might prescribe an anti-vertigo medication, antibiotic, or decongestant.
  • Lifestyle modifications: These may include training the patient to get up slower (or retraining their body in other ways), and adopting a low-salt diet.
  • Vestibular therapy: This is a specific type of physical therapy for the ear. This is often used in the case of vertigo associated with a concussion.
  • Surgery: Surgery may be considered to correct a problem with the structures of the brain, inner ear, or hearing nerve.

Mental Health

If patients experience chronic vertigo, it can be very distressing. It can severely affect quality of life. It can also complicate or worsen existing mental health disorders.

For more information about mental health care and where to find help, visit

Dr. Dolores Roman

Dr. Dolores Roman joined Independence Blue Cross in 2019. As a 20-year veteran of emergency rooms in and around the Philadelphia area, Dr. Roman has dealt with every kind of emergency. Now as a medical director at Independence, Dr. Roman is involved in utilization management, case management, and quality improvement. What Dr. Roman loves most about this job is the opportunity to collaborate with colleagues in order to enhance the health and well-being of those served by Independence Blue Cross.