"Dizziness" means several different things
The single most useful thing a patient can describe is what the sensation actually feels like, because the answer largely determines the diagnosis.
- Vertigo — a false sense of spinning or movement, of yourself or the room. This usually points to the inner ear or its connections.
- Light-headedness — feeling faint or about to black out. More often related to blood pressure, heart rhythm, dehydration or medication.
- Imbalance — unsteadiness on walking without spinning. May involve the vestibular system, vision, nerves in the legs or the brain.
- Visually triggered dizziness — provoked by supermarket aisles, crowds, scrolling screens or patterned floors, characteristic of visual vertigo and persistent postural-perceptual dizziness.
Common causes and what they need
BPPV — benign paroxysmal positional vertigo
The commonest cause of true spinning vertigo. Displaced crystals in the inner ear trigger brief but intense vertigo on rolling over in bed, lying down, looking up or bending. Episodes last seconds to a minute. It is diagnosed by positional testing in the clinic and treated with repositioning manoeuvres — frequently resolving in one or two visits. Medication does not fix BPPV; positioning does.
Vestibular neuritis
Sudden severe vertigo lasting days, usually with nausea and vomiting, following a viral illness. Treatment is supportive in the acute phase, but prolonged use of vestibular sedatives actually delays recovery — early vestibular rehabilitation is what restores balance.
Meniere's disease
Episodes of vertigo lasting minutes to hours with fluctuating hearing loss, tinnitus and a sensation of fullness in the affected ear. Managed with dietary salt reduction, medication and, in resistant cases, further intervention. Diagnosis requires documenting the hearing changes, not the vertigo alone.
Vestibular migraine
A frequently missed diagnosis. Recurrent vertigo, often with light or sound sensitivity, that may occur with or entirely without headache. It responds to migraine-directed treatment rather than to vestibular sedatives, which is why identifying it correctly changes everything about the management.
Persistent postural-perceptual dizziness (PPPD)
Continuous unsteadiness and visually triggered dizziness that persists after an initial vestibular event has settled. It is real, common, and treated effectively with graded vestibular rehabilitation, sometimes with medication.
Record how dizziness affects you
The Dizziness Handicap Inventory is a standardised questionnaire recording the physical, functional and emotional effects of dizziness. Your answers stay on your own device.
Open the questionnaire →How assessment is done
Most vestibular diagnoses are made from a careful history and clinical examination rather than from scans. What matters is the pattern: how long episodes last, what provokes them, whether hearing is affected, and what happens between episodes.
- Detailed history — duration, triggers, associated hearing symptoms, headache features, medication
- Positional testing (Dix-Hallpike and roll test) to diagnose BPPV and identify which canal is involved
- Eye movement examination — nystagmus patterns distinguish inner-ear from central causes
- Hearing assessment where hearing symptoms are present
- Balance and gait testing, and fall-risk assessment in older patients
- Imaging only where the history or examination suggests a central cause
Treatment
- Repositioning manoeuvres for BPPV — highly effective and often immediate
- Vestibular rehabilitation — a graded exercise programme that retrains the balance system. This is the single most underused treatment in dizziness, and it works for uncompensated vestibular loss, visual vertigo and PPPD
- Disease-specific medical treatment — migraine prevention for vestibular migraine, Meniere's-directed management, and so on
- Reducing vestibular sedatives — drugs such as betahistine and prochlorperazine have a place in acute severe vertigo, but taken long term they suppress the very compensation the brain needs to recover
Sudden severe headache, double vision or visual loss, slurred speech, weakness or numbness of the face or limbs, difficulty walking out of proportion to the dizziness, sudden hearing loss, or chest pain. These may indicate a stroke or other serious cause and need emergency assessment rather than an outpatient appointment.
തലകറക്കം — ചുരുക്കത്തിൽ
തലകറക്കത്തിന് പല കാരണങ്ങളുണ്ട്; ഓരോന്നിനും ചികിത്സ വ്യത്യസ്തമാണ്. അതുകൊണ്ട് കൃത്യമായ രോഗനിർണ്ണയമാണ് ഏറ്റവും പ്രധാനം.
BPPV: കിടക്കയിൽ തിരിഞ്ഞു കിടക്കുമ്പോഴോ മുകളിലേക്ക് നോക്കുമ്പോഴോ കുനിയുമ്പോഴോ ഏതാനും സെക്കൻഡ് നേരം കടുത്ത കറക്കം. ഇതാണ് ഏറ്റവും സാധാരണ കാരണം. മരുന്നല്ല, പ്രത്യേക തലചലന ചികിത്സയാണ് (repositioning manoeuvre) ഫലപ്രദം — പലപ്പോഴും ഒന്നോ രണ്ടോ സന്ദർശനത്തിൽ ഭേദമാകും.
ശ്രദ്ധിക്കുക: തലകറക്കത്തിനുള്ള ഗുളികകൾ (ബീറ്റാഹിസ്റ്റിൻ പോലുള്ളവ) ദീർഘകാലം കഴിക്കുന്നത് തലച്ചോറിന്റെ സ്വാഭാവിക പൊരുത്തപ്പെടലിനെ തടസ്സപ്പെടുത്തും.
അടിയന്തരം: തലകറക്കത്തോടൊപ്പം കടുത്ത തലവേദന, സംസാരം കുഴയുക, കൈകാലുകൾക്ക് ബലക്ഷയം, ഇരട്ടക്കാഴ്ച, പെട്ടെന്നുള്ള കേൾവിനഷ്ടം — ഉടൻ ആശുപത്രിയിൽ എത്തുക.
Frequently asked questions
What is the commonest cause of vertigo?
Benign paroxysmal positional vertigo (BPPV) is the commonest cause of true spinning vertigo. Displaced crystals in the inner ear cause brief intense vertigo triggered by rolling over in bed, lying down, looking up or bending. It is diagnosed by positional testing and treated with repositioning manoeuvres, often resolving within one or two visits.
Do tablets cure vertigo?
Not usually. Vestibular sedatives can relieve severe acute vertigo and vomiting for a few days, but they do not treat the underlying cause and taken long term they suppress the brain's natural compensation, delaying recovery. BPPV needs repositioning manoeuvres, vestibular migraine needs migraine treatment, and chronic imbalance needs rehabilitation exercises.
Is vertigo caused by a problem in the brain?
Most vertigo arises from the inner ear rather than the brain. However, certain features suggest a central cause and need urgent assessment: severe headache, double vision, slurred speech, limb weakness or numbness, or difficulty walking out of proportion to the dizziness. The pattern of eye movements on examination helps distinguish the two.
What is vestibular rehabilitation?
It is a graded programme of specific eye, head and balance exercises that retrains the balance system after vestibular injury or in chronic dizziness. It is effective for uncompensated vestibular loss, visual vertigo and persistent postural-perceptual dizziness, and is one of the most underused treatments in dizziness care.
Why does my dizziness get worse in supermarkets and crowds?
This pattern is called visual vertigo and is characteristic of persistent postural-perceptual dizziness and uncompensated vestibular disorders. Busy visual environments overload a balance system that has become over-reliant on visual input. It responds well to graded visual-motion exposure as part of vestibular rehabilitation.
Can vertigo be a sign of hearing disease?
Yes. Vertigo with fluctuating hearing loss, tinnitus and a feeling of fullness in one ear suggests Meniere's disease. Vertigo with sudden hearing loss requires urgent assessment. Any vertigo accompanied by hearing symptoms should include a hearing test as part of the evaluation.
Related information
This page is general health information about vertigo and balance disorders and is not a substitute for a personal medical consultation. Every patient is different; treatment decisions — including whether surgery is appropriate — should be made after an examination by a qualified ENT surgeon. If you have sudden severe symptoms such as difficulty breathing, heavy bleeding, sudden hearing loss or severe headache, seek emergency medical care immediately.