Vertigo.Care & specialists in Germany

Vertigo is the false sensation of motion — most often spinning. Dizziness is a broader term that also covers light-headedness, near-fainting, and unsteadiness. The distinction matters because true vertigo points to the inner ear or central vestibular system, while non-vertigo dizziness more often reflects blood pressure, cardiac, or metabolic causes.

Benign paroxysmal positional vertigo (BPPV) is the single most common cause, responsible for roughly 20-30% of all vertigo presentations and up to 50% in older adults. It produces brief spinning lasting under a minute triggered by head-position changes, and it responds to the Epley maneuver in 80-90% of patients.

BPPV is diagnosed with the Dix-Hallpike maneuver — a brief positional test in which the clinician lowers the patient backward with the head turned to one side. A positive test shows up-beating and torsional nystagmus lasting under a minute. The 2017 AAO-HNS guideline (Bhattacharyya) recommends treating immediately on a positive test without imaging.

Yes. The Epley canalith-repositioning maneuver resolves vertigo in 80-90% of patients with posterior-canal BPPV within one to three sessions. The 2014 Cochrane review (Hilton) found a number-needed-to-treat of approximately 3. It can be performed in the clinic in 3-5 minutes and is the first-line treatment per AAO-HNS 2017.

Duration depends on the cause. BPPV episodes last seconds to a minute and are triggered by head movement. Vestibular neuritis produces continuous severe vertigo for days. Meniere episodes last 20 minutes to 12 hours. Vestibular migraine episodes last 5 minutes to 72 hours. Posterior circulation strokes cause continuous vertigo until the stroke is treated or stabilises.

Vertigo signals possible stroke when it appears with severe headache, facial droop, slurred speech, double vision, weakness, numbness, or trouble walking. A trained clinician can apply the HINTS exam (head-impulse, nystagmus, test of skew) to distinguish stroke from peripheral causes with over 96% sensitivity (Kattah 2009 Stroke).

Vestibular migraine is recurrent vertigo lasting 5 minutes to 72 hours in a person with a current or past migraine diagnosis, often without headache during the vertigo itself. Per the Barany 2012 criteria (Lempert), at least half of episodes must include migrainous features such as headache, photophobia, phonophobia, or visual aura. It is the leading cause of recurrent spontaneous vertigo.

Meniere disease is a chronic inner-ear disorder defined by episodes of vertigo lasting 20 minutes to 12 hours, fluctuating low-frequency hearing loss, tinnitus, and aural fullness in one ear. Lopez-Escamez 2015 and AAO-HNS 2020 criteria require at least two qualifying vertigo episodes plus documented hearing loss on audiometry.

HINTS is a three-part bedside test (head-impulse, nystagmus, test of skew) that distinguishes peripheral vestibular neuritis from posterior circulation stroke in acute continuous vertigo. A normal head-impulse, direction-changing nystagmus, or vertical skew indicates a central cause. It outperforms early MRI in the first 48 hours (Kattah 2009 Stroke).

Recurrence depends on cause. BPPV recurs in 30-50% of patients within 5 years. Meniere disease produces clusters of recurrent attacks over years. Vestibular migraine recurs whenever underlying migraine is poorly controlled. Vestibular neuritis is usually a single lifetime event, though residual unsteadiness can persist.

Vertigo with hearing loss points to a specific group of causes — Meniere disease, labyrinthitis, labyrinthine artery occlusion, or vestibular schwannoma. Hearing tests (audiometry) are a key diagnostic step whenever vertigo is accompanied by ear-related symptoms. Vertigo without hearing involvement most often reflects BPPV, vestibular neuritis, or central causes.

Treatment combines trigger avoidance (regular sleep, hydration, dietary triggers) with migraine prophylactic medications. First-line options include propranolol, topiramate, amitriptyline, venlafaxine, or flunarizine, each trialled for 8-12 weeks. Magnesium and riboflavin supplementation are reasonable adjuncts. Acute episodes are treated like migraine headaches.

Yes. The 2015 Cochrane review (Hillier, 39 trials) found moderate-to-strong evidence that vestibular rehabilitation therapy improves symptoms and function in unilateral peripheral vestibular dysfunction, PPPD, bilateral vestibulopathy, and post-concussive dizziness. Programs typically last 4-12 weeks and require daily home practice.

Meclizine, dimenhydrinate, and benzodiazepines suppress vertigo symptoms acutely but slow the brain's central compensation if used beyond 24-72 hours. The 2017 AAO-HNS BPPV guideline explicitly recommends against routine use of vestibular suppressants. They are reasonable short-term for severe acute episodes but not a long-term solution.

The mismatch between vestibular, visual, and proprioceptive signals during vertigo activates the same brainstem pathways that produce motion sickness, triggering intense nausea and vomiting. Anti-nausea medications such as ondansetron or prochlorperazine can manage the symptom while the underlying cause is treated.

Yes, although less commonly than adults. Pediatric causes include benign paroxysmal vertigo of childhood (a migraine variant), vestibular migraine, otitis media with secondary labyrinthitis, and rarely vestibular neuritis. A child with vertigo plus any neurologic sign should be evaluated promptly to exclude central causes.

Anxiety and vertigo influence each other strongly. Acute vertigo provokes anxiety, and pre-existing anxiety predicts the transition from a single vestibular event to chronic persistent postural-perceptual dizziness (PPPD). Treatment of PPPD combines vestibular rehabilitation, cognitive behavioral therapy, and SSRI or SNRI medication.

PPPD is chronic non-spinning dizziness and unsteadiness lasting three months or more, worsened by upright posture, head and body motion, and complex visual environments. It often follows an acute vestibular event such as BPPV or vestibular neuritis. Diagnostic criteria were set by the Barany Society in 2017 (Staab).

In a randomized trial of 957 patients with recurrent BPPV (Jeong NEJM 2020), vitamin D 400 IU twice daily plus calcium 500 mg twice daily reduced recurrence rate by approximately 24% over a year. Supplementation is reasonable in patients with documented vitamin D deficiency and recurrent BPPV.

Routine MRI is not needed for typical BPPV or simple vestibular neuritis. MRI is indicated when there are focal neurologic signs, central HINTS findings, asymmetric sensorineural hearing loss suggesting vestibular schwannoma, severe headache, or vertigo that fails to respond to standard treatment. Use is targeted, not universal.

An office Epley maneuver and a typical primary care or ENT visit are inexpensive and widely covered by insurance. Vestibular rehabilitation is similar in cost to other physical therapy. MRI, audiometry, VNG, and intratympanic injections are more expensive but generally covered when clinically indicated. Generic migraine prophylactics and diuretics cost a few dollars per month.

Go to the emergency department for vertigo with severe headache, facial droop, slurred speech, double vision, limb weakness, sudden hearing loss, inability to walk, or vertigo following head or neck trauma. These features raise concern for stroke, dissection, or other serious causes that require urgent imaging and treatment.