Almost everybody has felt faint at some time or other. But many people experience a spinning or falling sensation—vertigo—that can be frightening. Attacks of vertigo come on suddenly, and they may recur.

Vertigo is often caused by problems with the body's sense of balance. Your body uses three kinds of information to determine balance: visual, tactile and internal signals from the vestibular structure in the inner ear, which acts as the body's "level." Fluid moves through the vestibular structure, bending tiny hairs that send signals to the brain.

Several conditions can throw the vestibular structure off balance, such as migraines or inner-ear infections. Dizziness can also be the first symptom of a stroke or other disorders, or it may be a side effect of some medications, particularly high blood pressure drugs such as angiotensin-converting enzyme (ACE) inhibitors. You'll need medical advice to rule these out as a cause.

The common cause of vertigo

Often, however, vertigo is caused by some malfunction of the vestibular structure, including a condition known as benign paroxysmal positional vertigo (BPPV). This occurs when calcium carbonate crystals inside the vestibular structure break down and collect inside the semicircular canals. BPPV is the most common type of vertigo, with more than 50 percent of people in their 70s experiencing at least one episode.

The spinning sensation is commonly triggered by movements that change the head's position, such as:

  • Rolling over in bed
  • Getting in and out of bed
  • Looking up or down
  • Looking over the shoulder

The dizzy spell lasts a few seconds to minutes and can be accompanied by:

  • Nausea
  • Vomiting
  • Hearing loss
  • Imbalance
  • Vision problems

Rehabilitation exercises

Many people put off going to a doctor after suffering an attack. But it's not normal to have spontaneous episodes of vertigo, so it's reasonable to get an evaluation after one occurs. Your doctor may refer you to an otolaryngologist. Once you discover the exact cause of your vertigo, you can start on a course of treatment, which usually consists of vestibular rehabilitation exercises supervised by a physical therapist.

The exercises that compensate for decreased function of vestibular structures are simple movements that retrain the central nervous system. For example, you may focus on an object and move your head from side to side, or walk back and forth while turning or nodding the head. Once a physical therapist gets you started, you can continue at home. A rehabilitation course can last four to 10 weeks, depending on your needs.

If you have BPPV, your exercises will be designed to move calcium carbonate crystals out of the semicircular canal. One method is called the Epley maneuver. A physical therapist shows you how to move your head through a sequence of positions. Relief usually comes quickly—within a week.

A common myth about vestibular rehabilitation is that movement should be avoided. When you start rehab, the exercises may initially bring on vertigo symptoms. Don't let that stop you: Movement is the key to improvement. If you suffer from vertigo, don't let it spiral out of control. With the help of your doctor, you can get your life back in balance.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 15 Jul 2013

Last Modified: 16 Mar 2015