What is Dizziness and vertigo?
Balance depends on information from the inner ear (vestibular system), the eyes and sensation in the feet, integrated by the brain. A problem in any of these systems can cause dizziness. Vertigo specifically refers to a false sensation of movement, usually spinning, and typically indicates a problem in the inner ear or its connections in the brain.
Common causes
- Benign paroxysmal positional vertigo (BPPV): short episodes of spinning triggered by turning over in bed, looking up or bending down, caused by small crystals displaced in the inner ear — the most common cause of vertigo
- Vestibular migraine: episodes of vertigo lasting minutes to days in people with a history of migraine, with or without headache
- Vestibular neuritis: sudden, severe, continuous vertigo for days, often after a viral infection
- Ménière’s disease: attacks of vertigo with hearing loss, tinnitus and ear fullness
- Persistent postural-perceptual dizziness (PPPD): chronic unsteadiness worsened by busy visual environments, often after an acute vestibular episode
- Orthostatic hypotension: light-headedness on standing up, common in older adults and with certain medicines
- Central causes: stroke, multiple sclerosis or tumours affecting the brainstem or cerebellum
Dizziness in older adults
In older adults, dizziness and unsteadiness often have more than one cause at the same time: mild inner ear problems, reduced sensation in the feet (neuropathy), poor vision, low blood pressure on standing, and side effects of several medicines. Each factor alone may be small, but together they significantly increase the risk of falls. A comprehensive geriatric neurology assessment looks at all of these factors and addresses each one.
Symptoms of Dizziness and vertigo
- Spinning sensation, either of yourself or the surroundings
- Nausea and vomiting
- Unsteadiness or veering to one side when walking
- Light-headedness or feeling faint
- Symptoms triggered by head movements or changes in position
- Hearing loss, tinnitus or ear fullness
- Sensitivity to light, noise and busy visual environments
- Anxiety and avoidance of activities due to fear of dizziness
Seek emergency care immediately (112) if dizziness occurs with double vision, slurred speech, weakness or numbness, difficulty walking, a severe sudden headache or loss of consciousness — these can be signs of a stroke.
When should you see a neurologist?
- Recurrent episodes of vertigo
- Dizziness lasting more than a few days
- Dizziness with headache or a history of migraine
- Frequent falls or unsteadiness, especially in older adults
- Dizziness that has not been explained after ENT assessment
- Chronic dizziness affecting work and daily life
How is Dizziness and vertigo diagnosed?
The most important information comes from the history: how long episodes last, what triggers them and what other symptoms occur. The examination includes eye movements, positional tests, balance and walking, a neurological examination and blood pressure measurement lying and standing.
- Dix–Hallpike and roll tests to diagnose BPPV
- Head impulse test and examination of eye movements (nystagmus) to distinguish inner ear from brain causes
- Hearing test if there are ear symptoms
- Brain MRI if a central cause is suspected
- ECG and blood tests for light-headedness and fainting
- Videonystagmography or other vestibular tests in selected cases
How is Dizziness and vertigo treated?
BPPV
BPPV is treated with repositioning manoeuvres (such as the Epley manoeuvre) performed during the consultation. These move the displaced crystals back to where they belong. Many people feel much better immediately or within a few days. Exercises can be taught for home use if symptoms recur.
Vestibular migraine
Treatment includes identifying triggers, lifestyle measures (regular sleep and meals, hydration) and, if attacks are frequent, preventive migraine medication.
Vestibular rehabilitation
Specific balance and eye–head exercises help the brain to compensate for inner ear damage and are particularly helpful after vestibular neuritis and in PPPD.
Medication
Anti-vertigo medicines can relieve acute symptoms but should only be used for a short time, as they can slow the brain’s natural compensation. Other medicines are chosen according to the cause.
Ménière’s disease and vestibular neuritis
Ménière’s disease is managed with a low-salt diet, medication to reduce attacks and, in difficult cases, treatment in collaboration with ENT specialists. Vestibular neuritis is treated in the acute phase with symptom relief and sometimes a short course of corticosteroids, followed by early vestibular rehabilitation to support recovery.
Treatment timeline and your stay in Istanbul
The consultation takes about 45 minutes, including positional tests and, if needed, a repositioning manoeuvre. Additional tests can usually be arranged on the same or next day.
For international patients, the assessment and initial treatment can usually be completed in one day in Istanbul, with follow-up online.
Follow-up after treatment
- After a repositioning manoeuvre, follow the advice given about head positions for a day or two
- Practise the home exercises regularly
- Get up slowly from lying or sitting
- Remove trip hazards at home to reduce the risk of falls
- Keep a diary of episodes and possible triggers
Risks and what to watch for
Dizziness increases the risk of falls, especially in older adults. Repositioning manoeuvres may temporarily provoke vertigo and nausea but are safe. Long-term use of anti-vertigo and sedative medicines can cause drowsiness and slow recovery. Missing a central cause such as a stroke is the main risk, which is why a careful neurological examination is important.
Frequently asked questions about Dizziness and vertigo
Is dizziness always caused by the ear?
No. Dizziness can be caused by the inner ear, the brain, the heart and blood pressure, medicines, anxiety or migraine. Identifying the type of dizziness helps to find the cause.
Can BPPV be cured?
Yes. Repositioning manoeuvres are very effective and often relieve symptoms in one or a few sessions. BPPV can recur, but it can be treated again.
Can migraine cause vertigo without headache?
Yes. Vestibular migraine can cause episodes of vertigo with little or no headache. It is one of the most common causes of recurrent vertigo.
Is neck arthritis a cause of dizziness?
It is rarely the main cause. Most dizziness attributed to the neck turns out to be BPPV, vestibular migraine or another identifiable condition.
When is dizziness dangerous?
When it occurs suddenly with double vision, speech difficulty, weakness, numbness, difficulty walking or a severe headache. These require emergency care.
Should I take anti-vertigo pills for a long time?
No. They are useful for a few days during acute attacks, but long-term use can delay recovery.
Why do I feel dizzy in supermarkets or crowded places?
This is typical of persistent postural-perceptual dizziness (PPPD), where the brain becomes oversensitive to visual motion. It responds well to vestibular rehabilitation and specific treatment.
Can I fly with vertigo?
Usually yes. If you have an active episode, medication for nausea may help during the flight. Discuss your travel plans at the consultation.
Can dizziness in older adults be caused by medicines?
Yes. Blood pressure medicines, sleeping pills, sedatives and some others can cause dizziness and falls. A medication review is an important part of the assessment, especially in geriatric neurology.
Do I need an MRI for dizziness?
Not always. BPPV, vestibular migraine and most inner ear causes are diagnosed by history and examination. MRI is recommended when the examination suggests a brain cause or symptoms are atypical.
Can stress and anxiety cause dizziness?
Anxiety can cause or worsen dizziness, and dizziness itself often causes anxiety. Both aspects are addressed in treatment, particularly in chronic dizziness.
This page is for general information only and does not replace a medical consultation. Please consult a physician for diagnosis and treatment. Results vary from person to person.
