Vertigo
This page is not about feeling generally woozy. Vertigo is the sensation that you, or the room around you, is turning, tilting or drifting sideways.
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Medicines commonly prescribed for Vertigo
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 16 mgActive substance: betahistineManufacturer: Bluefish Pharmaceuticals Ab (Publ)Prescription requiredDosage form: RECTAL LIQUID, 5 mg diazepamActive substance: diazepamManufacturer: Faes Farma S.A.Prescription requiredDosage form: TABLET, 8 mgActive substance: betahistineManufacturer: Tarbis Farma S.L.Prescription required
This page is not about feeling generally woozy. Vertigo is the sensation that you, or the room around you, is turning, tilting or drifting sideways. The world genuinely appears to move while you stay still. It is a symptom in its own right with its own set of causes, and most of them sit not in the head but in the inner ear, where the balance organ lives. The good news is that the commonest cause of vertigo can be cleared by a manoeuvre in the clinic in one or two sessions. The bad news is that a picture which looks much the same occasionally turns out to be a stroke in the cerebellum. So the one thing worth taking away from this page is this: work out what kind of dizziness you have and how long an attack lasts.
Vertigo or faintness: where the doctor starts
The first question at the appointment is not "when did it start" but "describe in your own words what you actually feel". Everything else follows from the answer, because people use the single word "dizzy" for four quite different states.
- Spinning, tumbling, tilting: you are pulled to one side, the ceiling slides past. This is vertigo, and it points to the balance organ in the inner ear or to the parts of the brain connected to it.
- Feeling faint: vision darkens, there is a rushing sound, you break into a sweat, you feel you are about to go down. This usually comes from blood pressure, heart rhythm, dehydration or medicines, not from the ear.
- Unsteadiness: your head is clear, but walking feels like being on the deck of a ship. This happens with nerve damage in the legs, with Parkinson's disease, after a stroke, and in older people with poor eyesight.
- A vague floating feeling with anxiety and a sense of unreality, often in shops and crowds. That is a real symptom too, but it is treated in an entirely different way.
Try to describe the sensation rather than reaching for "dizzy" as a label. The sentence "when I roll onto my right side in bed, the room spins for about twenty seconds" is worth more to the diagnosis than any scan.
How long the attack lasts is the biggest clue
The second most useful question is duration and circumstance. Those two split the causes fairly cleanly.
- Seconds, up to half a minute, brought on by moving the head — rolling over in bed, lying down, sitting up, tipping the head back towards a high shelf. Between attacks everything is normal. This is benign positional vertigo, the commonest cause of all.
- Minutes to an hour, in bouts, often with headache, dislike of light and noise, and sometimes with no headache at all. Vestibular migraine; such people usually have a history of migraine or of travel sickness.
- Twenty minutes to several hours, with nausea and vomiting, a blocked, full feeling in one ear, ringing, and hearing that drops during the attack and at first recovers between attacks. That is the pattern of Ménière's disease.
- A day or more, continuously, with severe nausea, building up over hours, often a week or two after a cold. Vestibular neuritis; if hearing drops in the same ear as well, it is called labyrinthitis. The worst passes in a few days, mild unsteadiness lingers for weeks.
- Seconds on standing up from lying or sitting, with vision going dark. That is usually not vertigo at all but a drop in blood pressure on standing — a common side effect of blood pressure tablets, water tablets and antidepressants.
Other causes do not fit this list: certain medicines, a plug of earwax, a head injury, an anxiety disorder. Sometimes no cause is ever found.
Positional vertigo: the one a manoeuvre can cure
This deserves its own section, because a great many people spend years with attacks that one visit could stop. Inside the ear are tiny crystals that normally stay put. Sometimes they slip into one of the semicircular canals and float about as the head moves, stirring the balance receptors. The brain is told the head is spinning while the eyes report that everything is still — and you get a few seconds of whirling.
The diagnosis is made not by imaging but by a positioning test: the doctor lies you down in a particular way, brings on the attack and watches the flicker of your eyes — its direction shows which canal is involved. Then comes the repositioning manoeuvre: a set sequence of turns of the head and body that rolls the crystals back where they belong. It takes minutes, often works the first time, and can be repeated if needed.
Learning these manoeuvres off video clips is a poor idea: they differ from canal to canal, and picking the wrong one can worsen the symptoms or drive the crystals somewhere else. The point is to reach a clinician who performs them — not to spend years lying still and dreading turning onto your side.
When vertigo is a stroke
A stroke in the cerebellum or brainstem can look exactly like vestibular neuritis: the same spinning, the same vomiting, the same pallor. The difference lies in what comes with it, and those signs are worth knowing.
Call an ambulance — 112 is the single emergency number across Europe — if the vertigo comes with any of the following:
- double vision, a drooping eyelid, a missing patch in the field of view;
- slurred speech, trouble finding words, choking when swallowing;
- weakness or numbness of an arm, a leg or one side of the face;
- being unable to stand or walk even with support — with vestibular neuritis a person sways badly, but can still take a few steps;
- a severe headache or new neck pain, particularly after a sharp turn of the head or an injury;
- sudden loss of hearing in one ear together with marked loss of balance.
Be wary in particular of severe vertigo appearing for the first time in someone over sixty, or in someone with high blood pressure, diabetes, an irregular heart rhythm or a smoking history, or who has already had a stroke. In that situation neuritis must not be assumed until a vascular cause has been ruled out. Do not drive yourself to hospital.
What to do during an attack
In the acute minutes the simple things help: sit or lie down, fix your gaze on something that is not moving, dim the light, breathe steadily. Leave sharp head movements for later. If you feel sick, sip water so that you do not become dehydrated.
After that, though, there is a common mistake. Many people spend weeks lying down after a bad attack, guarding the head against any movement. Do not do this: the brain only learns to cope with faulty signals from the ear when it gets the experience of moving. Prolonged rest slows that adaptation down, and the unsteadiness drags on for months. Return to ordinary movement as fast as you can tolerate.
While attacks are still unpredictable, do not drive, work at height or around moving machinery, or swim alone. Ask your doctor when you can drive again: the rules differ from one country to another. At home, clear away anything you could trip over, put a mat in the shower, leave a dim light on in the hallway overnight, and use a walking stick if you are at risk of falling.
What genuinely helps and what does not
Treatment depends on the cause, and that is not a dodge: different causes respond to completely different things.
- Positional vertigo is treated with the repositioning manoeuvre. Tablets do not clear it.
- In vestibular neuritis, medicines that damp down the spinning and the nausea — antihistamines, anti-sickness drugs — are used briefly in the first days. They are not continued beyond that, because they get in the way of the brain adapting. A short course of steroids is sometimes prescribed. Antibiotics are of no use in a viral neuritis.
- Ménière's disease is approached differently: cutting down salt, regular routine and sleep, water tablets, and procedures with an ear specialist if that is not enough.
- Vestibular migraine is treated as migraine, not as an ear condition.
Two things deserve saying plainly. Betahistine is not a universal remedy for dizziness: it is used mainly in Ménière's disease, and even there the evidence is mixed; in positional vertigo and in neuritis it does not solve the problem. And medicines and drips sold as "improving blood flow to the brain" have no convincing basis in vertigo — instead of real help, they cost you weeks.
What works across almost all inner-ear causes is vestibular rehabilitation: a tailored set of eye, head and balance exercises done every day, which retrains the brain to handle the signals. The benefit builds over weeks rather than appearing after the first session.
What happens at the appointment
The conversation does most of the work. Be ready to say how long an attack lasts, what sets it off, whether there is ringing or hearing loss, what the first days were like, and which medicines you take. Keeping brief notes on your attacks for a week is genuinely useful.
The examination includes positioning tests, checks of eye movement and a quick head turn, an assessment of your gait and steadiness, a look in the ears, and blood pressure measured lying and standing. If hearing is a complaint, a hearing test is arranged.
Imaging is far from routine — it is for signs pointing to the brain rather than the ear. One thing is worth knowing here: an ordinary CT scan sees the cerebellum and the brainstem poorly, and a normal CT does not rule out a stroke in that area. Where that is the question, an MRI is what is needed. Your doctor will also go through your medicine cabinet: blood pressure tablets, water tablets, sleeping tablets and sedatives, antidepressants and certain antibiotics all cause dizziness.
Online consultation
Vertigo is exactly the situation in which the questioning yields more than the examination, so a remote appointment is genuinely useful here. A doctor can help you sort your sensations into categories, tell vertigo apart from faintness, use the length and circumstances of your attacks to suggest a cause, and say who to see: a neurologist, an ear specialist, or blood tests and a blood pressure check first. They can also comb your medicine list for drugs that cause dizziness in their own right, explain the tests you have already had, and show you how vestibular rehabilitation works.
What cannot be done remotely: the positioning test and the repositioning manoeuvre have to be performed by hand, so if positional vertigo is suspected the consultation ends with a referral to be seen in person. With double vision, slurred speech, limb weakness, severe headache or an inability to stand, you need an ambulance rather than a chat window.
This material is for information only and does not replace medical advice.
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