This can be a wide ranging problem, from light-headedness, to spinning, to imbalance (such as feeling like you are rocking on a boat). There are a number of causes that can be examined.

Benign Positional vertigo

This is caused by loose crystals, called otoliths, in the inner ear being dislodged and thereby activating the balance mechanism in the inner ear depending on the patient’s position.

Symptoms typically involve positional vertigo – ie. spinning depending on the position of the head. Typically, this involves lying down and turning and looking up. Treatment involves repositioning the patient in an Epley manoeuvre once diagnosed correctly. This can resolve symptoms in up to 85% of patients.

Diagram of Benign Positional Vertigo
An explanation of the mechanism of benign positional vertigo: loose crystals called otoliths in the inner ear form a plug (lower panel) which causes pressure on the hair cells (balance organs) and mimic movement

Meniere’s disease

Meniere’s disease is a disease of the inner ear, characterised by increased pressure, leading to activation of the hearing and balance system and possible long term damage after repeat episodes.

Symptoms include:

  • Vertigo
  • Tinnitus
  • Fullness in the ear
  • Hearing loss

It is treatable with medications and surgically.

Migrainous vertigo / Vestibular Migraine / Migraine associated Vertigo

Around 30-50% of patients with migraine experience at times an abnormal sense of motion, at times clearly vertigo (a sense of spinning), at others a more non-specific sense of imbalance. This may be accompanied by other migraine symptoms, such as photophobia (discomfort with bright light) or headache. An increased sensitivity to motion, particularly to movements of the head, or fast-moving objects are often part of the attack. Patients with migraine and certainly with migrainous vertigo have increased likelihood of motion sickness.

It is said that up to 1% of the population of Western countries suffers from this disorder. It is estimated that whilst 60% of vertigo patients seek medical attention, as few as 20% of patients are correctly diagnosed with vestibular migraine. Women are 1.5-5 times more likely than men to be affected.

The mechanism at this stage is unclear, but an increased sensitivity to balance stimuli or a failure of integration of different types of balance stimuli are at this stage possibilities.

Migrainous vertigo is often well controlled with certain migraine (especially preventative) medications. Clinical studies have shown a reduction in duration, severity and frequency of the episodic vertigo with preventative medications in these patients.

It has only been recently recognised by the International Headache Society as a separate disorder and research into the area is growing rapidly.

Other conditions

Numerous other disorders of the brain, especially of the part of the brain called the posterior fossa (where the balance inputs enter the brain) may need to be excluded depending on the symptoms the patients has.

This needs to be undertaken under the supervision of a neurologist.