Vertigo

Also called BPPV, Benign paroxysmal positional vertigo, Labyrinthitis, Ménière's disease

A spinning sensation, not just dizziness. The commonest cause is fixed by a manoeuvre that takes two minutes.

What it is

Vertigo is the illusion of movement: the room spinning, or the person spinning. It is not the same as light-headedness, and telling them apart matters because they have completely different causes.

The commonest cause is benign paroxysmal positional vertigo, BPPV, where tiny crystals in the inner ear come loose. It is triggered by head movement, lasts under a minute at a time, and it is treated with a repositioning manoeuvre, usually the Epley, which resolves it in most people in one or two sessions.

That treatment is free, takes minutes, and is startlingly under-used. People are prescribed vestibular sedatives instead, which do not fix it and which impair the brain's own compensation.

Other causes include vestibular neuritis, labyrinthitis, Ménière's disease and, rarely, stroke.

Signs you might notice

A spinning sensation, often triggered by turning over in bed, looking up, or bending down.

Brief attacks in BPPV, seconds to a minute.

Continuous vertigo for days with nausea in vestibular neuritis.

Vertigo with hearing loss, tinnitus and a feeling of fullness in one ear suggests Ménière's.

Vertigo with double vision, slurred speech, weakness, severe headache or inability to walk is a stroke until proved otherwise. Call 999.

How it can affect day-to-day life

Falls are the main hazard, particularly in older people, and vertigo is a substantially under-recognised cause of them.

Fear of the next attack causes people to restrict head movement and activity, which prevents the brain's natural compensation and prolongs the problem.

Long-term prochlorperazine, which many people are left on, actively hinders recovery.

Supporting someone well

Ask for an assessment that includes the Dix-Hallpike test, and for the Epley manoeuvre if it is BPPV. Ask by name.

Do not stay on vestibular sedatives long-term. They are for the acute phase of a few days only.

Move. Vestibular rehabilitation exercises promote compensation, and avoiding movement prevents it.

Get up slowly and use a light on at night.

Treat falls risk while the vertigo is being sorted out.

Recognise the stroke pattern: vertigo with any other neurological sign is an emergency.

Where to get help

A GP, physiotherapist or audiologist can perform the manoeuvre. Many areas have direct-access vestibular physiotherapy.

Ménière's & Vestibular UK support people with all forms of vestibular disorder.

Sudden vertigo with neurological signs, or with new deafness, needs emergency assessment.