What is Vertigo and What Are Its Types?
Dizziness, medically defined as “vertigo” in which the person feels that he or his surroundings are spinning. Most people have said the sentence "I feel dizzy" at least once in their lives, but the severity, duration and accompanying symptoms of this complaint can be a sign of many different diseases.
Vertigo is divided into two main groups:
- True vertigo (peripheral or central): There is a violent illusion of movement, as if the world or the person were actually spinning. It usually originates from the inner ear or brainstem-cerebellum.
- Pseudo-dizziness: It consists of dizziness, feeling empty, feeling like fainting, blackout. It is caused by systemic causes such as low blood pressure, anemia, and low sugar.
Vertigo is also classified as:
- Acute vertigo: Sudden onset and lasting hours to days (e.g. vestibular neuritis)
- Recurrent vertigo: Comes with attacks lasting minutes (BPPV, migraine)
- Chronic vertigo: Lasting for days to weeks (Meniere's, acoustic neuroma)
This distinction is very important because treatment depends entirely on the underlying cause.
What Causes Dizziness? 20 Most Common Reasons
1. Benign Positional Paroxysmal Vertigo (BPPV – Shifted Ear Crystals)
It constitutes 35-40% of those who consult a doctor with complaints of dizziness in Turkey and the world, meaning it is by far the most common cause. Calcium carbonate crystals (otoconia) in the semicircular canals of the inner ear become dislodged and create a strong spinning sensation in certain head positions (for example, when turning left and right in bed, when throwing the head back). Attacks usually last 10-60 seconds and may be accompanied by nausea and vomiting. It is more common in women over the age of 50. The treatment is very simple: The crystals are replaced with Epley or Semont maneuvers and most patients recover completely in 1-2 sessions.
2. Vestibular Neuritis (Inner Ear Nerve Inflammation)
Usually, sudden and very severe dizziness begins 1-2 weeks after an upper respiratory tract infection. The patient cannot turn over in bed, vomiting is very severe and does not go away for 2-3 days. It gradually improves within 4-6 weeks. It occurs when viruses (such as herpes simplex) infect the vestibular nerve. Cortisone and vestibular rehabilitation exercises are used in the treatment.
3. Meniere's Disease
It occurs due to increased endolymphatic fluid pressure in the inner ear. A typical attack is as follows: severe vertigo lasting from 20 minutes to 12 hours + feeling of fullness in the ear + low-frequency hearing loss + tinnitus. It may feel completely normal between attacks. Salt restriction, betahistine and diuretics are the basic treatment.
4. Vestibular Migraine
It is seen in 30-50% of women with migraine. There may be only a dizziness attack without a headache. Attacks range from 5 minutes to 72 hours. It is triggered by light, sound, odors and some foods (chocolate, cheese, red wine). Anti-migraine medications (propranolol, topiramate, amitriptyline) are very effective.
5. Orthostatic Hypotension (Dizziness Upon Standing Up Suddenly)
If the blood pressure drops more than 20 mmHg when you stand up suddenly while lying down or sitting, blood cannot flow to the brain and blackout + dizziness occurs. It is very common in the elderly, people using blood pressure medications, and Parkinson's patients. Drinking plenty of water, wearing compression socks and getting up slowly are the solutions.
6. Anemia and Vitamin Deficiencies
In iron, B12 or folate deficiency, not enough oxygen can be transported to the tissues. It is accompanied by constant dizziness, rapid fatigue, hair loss, and collapsed nails. Diagnosis is made through a blood test and complaints improve when the missing vitamin/mineral is replaced.
7. Hypoglycemia (Low Sugar)
In those who use diabetes medications or starve for a long time, when blood sugar drops below 60 mg/dL, sweating, tremors, palpitations and dizziness occur. Drinking a sugar cube or fruit juice will fix it in a few minutes.
8. Medication Side Effects
Blood pressure medications (especially beta blockers, ACE inhibitors), epilepsy medications, some antidepressants, sleeping pills and chemotherapy drugs can cause dizziness. If the drug dose is reduced or changed, the complaint disappears.
9. Cervicogenic Dizziness (Neck Originated)
Neck straightening, arthritis or hernia can compress the nerves and vessels and disrupt the blood flow to the cerebellum. Dizziness that increases with neck movements is typical. It improves greatly with physical therapy, neck exercises and posture correction.
10. Panic Attacks and Anxiety Disorder
The brain overworks the system that keeps us balanced in times of danger. The person goes to the emergency room with the fear of "I'm having a heart attack", but all the tests come back normal. It can be completely controlled with breathing exercises and, if necessary, medication.
11. Dehydration (Thirst)
In those who do not drink enough water, especially in the summer months, blood volume decreases and not enough oxygen reaches the brain. Headache, weakness and dizziness occur. Drinking 2-2.5 liters of water a day is often sufficient.
12. Maze
It is the more severe form of vestibular neuritis; Hearing loss is also added as the inner ear becomes completely inflamed. Antibiotic and cortisone treatment is required.
13. Acoustic Neuroma
It is a benign nerve tumor, but diagnosis may be delayed because it grows slowly. It causes unilateral hearing loss, tinnitus and imbalance. It is diagnosed with MRI and treated with gamma knife or surgery.
14. Multiple Sclerosis (MS)
The immune system attacks its own nerve sheaths. Sudden onset of dizziness in young people may be the first symptom of MS. Diagnosis is made by MRI and lumbar fluid examination.
15. Brain Stem and Cerebellum Infarction (Stroke)
It is the most urgent situation! It is vital to call 112 if you have sudden and very severe dizziness + slurred speech + double vision + weakness in arms/legs.
16. Thyroid Diseases
Especially hypothyroidism (thyroid laziness) slows down metabolism, disrupts circulation and causes constant dizziness.
17. Heart Rhythm Disorders
If the heart cannot pump enough blood, the brain is left without oxygen for a short time and dizziness occurs.
18. Eye Problems
Amblyopia, strabismus, or newly worn glasses with the wrong prescription can create a feeling of imbalance.
19. Barotrauma (Pressure Change)
The pressure difference in the eardrum after plane landing-takeoff or diving can disrupt the balance system in the inner ear.
20. Pregnancy
It is common, especially in the first 3 months, due to hormones and blood pressure changes. It is usually not serious, but if it is accompanied by severe vomiting, hospitalization should be sought.
Dizziness Which Doctor Should You See?
The first two specialists to consult with complaints of dizziness are Ear, Nose and Throat (ENT) and Neurology. If the attacks last seconds and occur with head movement, ENT will most likely resolve it (BPPV, Meniere's). If it lasts for hours or days, and there is headache, numbness, or visual impairment, a neurologist should be seen. If there are internal problems such as anemia, diabetes or thyroid, Internal Medicine comes into play; if there is a suspicion of heart rhythm disorder, Cardiology comes into play.
What is Good for Dizziness at Home? (Methods That Can Be Applied Under Doctor's Control)
- If BPPV is suspected, you can perform Epley or BBQ roll maneuvers at home after being shown by the ENT doctor.
- Drinking 2.5-3 liters of water daily reduces most dizziness.
- Meniere's patients should limit salt to 1.5-2 grams per day.
- Brandt-Daroff exercises can be done 3 sets every day.
- Fresh ginger tea or ginger capsule reduces nausea.
- Stress is one of the biggest triggers of dizziness; breathing exercises and meditation are very effective.
- Avoid sudden head movements, get out of bed slowly.
- Sleeping with 2 pillows at night balances the inner ear pressure.
- If you are at risk of falling, do not hesitate to use a cane or walker.
When Is Dizziness Serious? Emergency Symptoms
If you have any of the following conditions, contact the nearest emergency service immediately:
- Weakness and numbness in the arm or leg with severe dizziness
- Speech disorder, inability to form words
- Double vision or vision loss
- Severe headache (more than you've ever experienced)
- Confusion or fainting
- Vertigo that lasts longer than 1 hour and never gets better
These symptoms may be a sign of vital conditions such as brain hemorrhage, stroke or cerebellum tumor.
Frequently Asked Questions
1. What causes dizziness and how to get rid of it? There are more than 100 causes of dizziness, but the most common in Turkey are ear crystals (BPPV), migraine, inner ear infection and low blood pressure. Treatment is completely directed towards the cause: if the crystal has moved, maneuvers are required, if there is migraine, migraine medication is required, if blood pressure drops, plenty of water and salt are required.
2. Is dizziness a sign of cancer?Although very rare, benign tumors such as acoustic neuroma or brain tumors can cause dizziness. If it is accompanied by unilateral hearing loss and tinnitus, an MRI should be performed.
3. Do ear crystals (BPPV) resolve spontaneously? It resolves spontaneously within 1 month in 20-30% of patients, but the probability of recurrence is 50%. With the Epley maneuver, permanent improvement of over 90% is achieved in 1-2 sessions.
4. Is tinnitus accompanied by dizziness normal? Yes, tinnitus is accompanied by many conditions such as Meniere's disease, acoustic neuroma, inner ear inflammation and migraine. It is more noticeable if it is one-sided.
5. Is dizziness dangerous during pregnancy? Most of the time, no; Hormonal changes and blood pressure fluctuations are normal. However, if there is severe vomiting, fainting or abdominal pain, evaluation for ectopic pregnancy or preeclampsia is required.
If your dizziness lasts longer than 2-3 days, recurs frequently, or has one of the red flags above, please consult an Ear, Nose, Throat or Neurologist without delay. Early diagnosis saves lives in many cases and can return your quality of life to normal in a few days. Get well soon!
