Vertigo Symptoms: Signs, Causes, Warning Signs & More

Quick Glance: Common Vertigo Symptoms

Common symptoms of vertigo that people may experience are:

A spinning or rotating sensation
Feeling unsteady or losing balance
Nausea or vomiting
Difficulty walking or standing steadily
Feeling that the surroundings are moving
Visual disturbance or difficulty focusing
Ringing in the ears (tinnitus)
Hearing changes or hearing loss, particularly with some inner ear conditions

Vertigo symptoms can vary considerably from person to person, depending on the underlying cause. Some people experience brief episodes triggered by head movements, while others may develop prolonged vertigo with significant imbalance or nausea.

Symptoms of Vertigo That Should Not Be Ignored

Certain symptoms that occur with vertigo should not be ignored, as they may indicate a neurological, cardiovascular, or other underlying problem. The table below explains the warning symptoms that may require prompt medical assessment and what they could indicate:

Symptom	What It May Indicate
Sudden weakness or numbness in the face, arm or leg	May indicate a neurological problem, including stroke.
Difficulty speaking or understanding speech	May indicate involvement of the brain or brainstem and requires prompt assessment.
Double vision or sudden changes in vision	May occur with neurological conditions that require urgent evaluation.
Severe difficulty walking or sudden loss of coordination	May indicate a significant disruption of the balance system or a central neurological problem.
Sudden severe headache	May occur with serious neurological conditions and requires prompt assessment.
Sudden hearing loss with vertigo	Requires prompt medical assessment because sudden hearing loss can require urgent specialist evaluation.
Fainting or loss of consciousness	May indicate a cardiovascular, neurological or other medical problem rather than vertigo itself.
Chest pain or a rapid or irregular heartbeat	May indicate a cardiovascular problem requiring prompt assessment.

Sudden onset of vertigo accompanied by focal neurological symptoms or significant new imbalance requires urgent assessment because these features can occur with stroke and other serious conditions.

Why Do Vertigo Symptoms Occur?

Vertigo occurs when the brain receives abnormal or conflicting information about body position and movement. The vestibular system in the inner ear works with the eyes, muscles and brain to help the body maintain balance and understand its position in space.

The inner ear contains the semicircular canals, utricle and saccule, which detect head movement and position. These structures send signals through the vestibulocochlear nerve to the brain, where information about movement and balance is processed.

When these signals are disrupted, the brain may interpret normal movement as spinning or produce a false sensation of movement. This can result in vertigo, imbalance, nausea, abnormal eye movements and difficulty walking.

Benign paroxysmal positional vertigo (BPPV) is one of the common causes of vertigo. It occurs when tiny calcium carbonate crystals called otoconia become displaced into a semicircular canal. Changes in head position can then cause the crystals to move abnormally, sending incorrect signals about head movement and triggering brief episodes of vertigo.

Other causes of vertigo can affect the inner ear, the vestibular nerve, or the brain. These include Ménière's disease, labyrinthitis, vestibular neuritis, vestibular migraine, head injury, certain medicines and neurological conditions. The symptoms and their duration can vary depending on the underlying cause.

Symptoms of Vertigo That Require Immediate Medical Attention

The following symptoms of vertigo require immediate medical care:

Sudden numbness or weakness, especially on one side of the body
Double vision or sudden loss of vision
Difficulty speaking or understanding words
Severe difficulty walking or sudden loss of coordination
Sudden, severe headache
Loss of consciousness or fainting
Seizures
Chest pain or significant breathing difficulty
Sudden hearing loss, particularly when it occurs with vertigo

These symptoms do not necessarily mean that a serious condition is present, but they can occur with neurological, cardiovascular or other medical emergencies. In adults with sudden-onset acute vestibular syndrome, NICE recommends appropriate urgent assessment and the use of the HINTS examination when a healthcare professional with suitable training and experience is available.

Symptoms of Vertigo Based on Type

The table below explains the main clinical types of vertigo and the symptoms that may be associated with each pattern:

Clinical Pattern	Symptoms
Peripheral vertigo	Vertigo, nausea or vomiting, imbalance, and tinnitus or hearing changes in some inner ear conditions; symptoms may also be triggered by head movement.
Central vertigo	Vertigo with marked imbalance, difficulty walking, abnormal eye movements, visual symptoms or other neurological features.

Symptoms of Vertigo-Specific Conditions

The following table summarises how symptoms can differ between some recognised conditions that may cause vertigo:

Condition	Common Symptoms
Benign Paroxysmal Positional Vertigo (BPPV)	Brief episodes of spinning triggered by changes in head position, such as turning over in bed, looking up or bending down; nausea and temporary imbalance may also occur.
Ménière's Disease	Episodes of vertigo with hearing loss, tinnitus and a feeling of fullness or pressure in the affected ear.
Labyrinthitis	Prolonged vertigo or dizziness, loss of balance, nausea and vomiting, with hearing loss potentially occurring because the inner ear is affected.
Vestibular Neuritis	Sudden, prolonged vertigo with significant imbalance, nausea and vomiting, generally without significant hearing loss.
Vestibular Migraine	Episodes of vertigo or dizziness that may last minutes to hours or longer, sometimes accompanied by sensitivity to light or sound, visual symptoms, nausea or headache.

Can You Have Vertigo Without Symptoms?

Vertigo itself is a symptom rather than a disease, so it is not usually described as a "silent" condition. However, some conditions that cause vertigo can have periods when a person has no symptoms.

For example, BPPV may cause symptoms only with certain head movements, while some episodic inner ear conditions can leave a person feeling well between attacks. The absence of symptoms between episodes does not identify the underlying cause.

Recurrent, unexplained or persistent episodes of vertigo should be assessed by a healthcare professional rather than self-diagnosed.

When Can Vertigo Symptoms Become Life-Threatening?

Vertigo can indicate a medical emergency when it occurs with symptoms suggesting stroke, another serious neurological condition or a cardiovascular problem. The table below explains the potentially serious situations that may occur alongside vertigo and why they require urgent attention:

Emergency Condition	What May Happen
Stroke	Sudden vertigo with weakness, numbness, speech problems, double vision or severe difficulty walking may occur with a stroke affecting the brain's balance pathways.
Serious neurological condition	Vertigo accompanied by major changes in coordination, vision, speech, swallowing or consciousness requires urgent assessment.
Severe dehydration	Repeated vomiting during prolonged vertigo can cause substantial fluid loss and dehydration.
Serious cardiovascular problem	Vertigo or dizziness accompanied by chest pain, fainting or a rapid or irregular heartbeat may indicate a cardiovascular emergency.
Severe fall or injury	Loss of balance during a vertigo episode can result in falls, head injuries or fractures.

Sudden-onset vertigo with neurological symptoms or significant new unsteadiness is particularly important because these features can occur with posterior circulation stroke.

How are Vertigo Symptoms Diagnosed?

There is no single test that confirms every cause of vertigo. A healthcare professional considers the pattern, duration and triggers of symptoms and performs an appropriate physical and neurological examination. The table below explains the main assessments that may be used to diagnose vertigo:

Diagnostic Test or Assessment	Purpose
Medical history	Identifies when symptoms started, how long they last, their triggers and associated symptoms.
Balance and neurological examination	Assesses posture, walking, coordination and neurological function.
Eye movement examination	Checks for nystagmus and other abnormal eye movements.
Dix-Hallpike manoeuvre	Helps assess for BPPV by observing symptoms and eye movements after specific head-position changes.
HINTS examination	May help assess sudden-onset acute vestibular syndrome when performed by a healthcare professional trained and experienced in the test.
Hearing test (audiometry)	Checks for hearing loss associated with inner ear conditions.
Vestibular tests	Assess how well parts of the inner ear balance system are functioning.
Blood tests	May be used when the symptoms suggest another medical cause.
MRI or other imaging	May be recommended when symptoms or examination findings raise concern about a neurological cause.

FAQs

Q1. What is the first symptom of vertigo?

Ans: The most characteristic symptom of vertigo is a false sensation that you or your surroundings are spinning or moving. Vertigo can also cause imbalance, nausea or difficulty walking, depending on its underlying cause.
Q2. What are the early warning signs of vertigo?

Ans: Early symptoms of vertigo may include spinning sensations, unsteadiness, nausea, visual disturbance or symptoms triggered by head movement. Tinnitus or hearing changes can also occur when the underlying cause affects the inner ear.
Q3. Can vertigo develop suddenly?

Ans: Yes, vertigo can develop suddenly. BPPV may cause sudden spinning when the head changes position. Apart from that, conditions such as vestibular neuritis or labyrinthitis can cause sudden, prolonged vertigo.
Q4. Which symptoms of vertigo should never be ignored?

Ans: Vertigo accompanied by weakness, numbness, difficulty speaking, double vision, severe difficulty walking, sudden severe headache, fainting or chest pain should never be ignored.
Q5. How long do vertigo symptoms last?

Ans: The duration of vertigo symptoms varies according to the underlying cause. BPPV episodes often last less than a minute, while other causes of vertigo can produce symptoms lasting minutes, hours or days.
Q6. Can you have vertigo without hearing loss?

Ans: Yes, vertigo can occur without hearing loss.
Q7. When should I see a healthcare professional for vertigo?

Ans: You should see a healthcare professional if vertigo is recurrent, persistent, severe, starts suddenly without an obvious cause or interferes with daily activities.
Q8. Can vertigo symptoms vary from person to person?

Ans: Yes, vertigo symptoms can vary from person to person. They may range from mild spinning or unsteadiness to severe vertigo with nausea, vomiting and difficulty walking. The duration, triggers and associated symptoms can also differ according to the underlying cause.