Vertigo, a sensation of movement of the environment or self where there is none, is often associated with nausea and has many causes. Most of them do not reflect serious underlying disease. These include:

  • Medication side-effects
  • Benign paroxysmal positional vertigo (BPPV) is a condition caused by the abnormal presence of tiny “stones” of calcium in the fluid filled tubes of the inner ear. People typically feel a sudden sensation of spinning that is triggered by movement of the head. It is often accompanied by severe nausea, vomiting and difficulty with balance. The symptoms last seconds to minutes and then gradually abate.
  • Vestibular neuritis is inflammation of the nerve that connects the apparatus of the inner ear to the brain and labyrinthitis. Inflammation of the inner ear itself is thought to be caused by viral infections, in most cases. Symptoms of vertigo, nausea, vomiting and balance difficulties will last days to weeks but can sometimes persist for months.
  • Meniere’s disease is characterized by bouts of vertigo associated with a sense of fullness in the ear, “tinnitus,” a sensation of ringing in the ear, and hearing loss. Symptoms last hours but usually recur. Hearing typically recovers in between episodes, but may deteriorate after multiple attacks. The condition is thought to be related to abnormal fluid pressures in the inner ear.
  • Migraine-associated vertigo is vertigo or imbalance resulting from migraines. It may precede or occur with a migraine headache, or occur independently of the headache.

Serious, but fortunately rarer, causes of vertigo include stroke, brain tumors and brain infection.


The evaluation of vertigo will include a detailed history, physical and neurological exam. Frequently, this is enough to make a diagnosis; however, sometimes additional studies are necessary such as lab work and/or imaging of the brain. Further testing, such as an audiogram to evaluate hearing, may need to be performed.


Treatment depends on the cause of the vertigo and most commonly includes medications for symptom management and/or treatment of the underlying condition. Physical therapy and special exercises to reduce symptoms of vertigo and abnormal balance are highly effective in many cases.

The Sentara Martha Jefferson Vestibular and Balance Clinic uses cutting edge technology and highly trained, experienced rehabilitation therapists to evaluate and treat vertigo, balance and gait dysfunction.

When is vertigo an emergency?

Vertigo can sometimes represent a medical emergency such as a stroke. Call 911 if the vertigo has a sudden onset and is accompanied by any of the following:

  • Inability to walk or stand (not to be confused with difficulty walking)
  • Inability to coordinate limb movement, or weakness and/or numbness of an arm and/or leg
  • Difficulty with speech and/or comprehension, confusion or difficulty staying awake
  • Vision changes
  • Following a head injury