Vertigo: when the room is spinning

Vertigo is not the same as feeling you might faint: it is a spinning sensation. If you are not sure which one you have, see dizziness. The most common causes are in the inner ear, which controls balance:

• Benign paroxysmal positional vertigo (BPPV): the most common type. Tiny calcium crystals in the inner ear break loose and move inside the balance canals. It causes intense spinning, for seconds to minutes, when you roll over in bed, lie down, sit up or look up.
• Labyrinthitis: an infection or inflammation of the inner ear that causes vertigo and loss of balance.
• Vestibular neuritis: inflammation of the balance nerve caused by a virus.
• Ménière’s disease: attacks of vertigo with hearing loss, ringing and a feeling of fullness in the ear.

Less often, vertigo comes from the brain, as in a stroke. That is why the signs above matter so much.

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The typical signs are:

• Feeling that you or the room is spinning
• Spinning that starts when you move your head, lie down or roll over in bed
• Nausea or vomiting
• Loss of balance
• Abnormal eye movements or jumpy vision

BPPV is treatable: the Epley maneuver, a series of head movements, works best according to MedlinePlus. Medicines ease the nausea and spinning but often do not cure BPPV. It can come back without warning, even after treatment.

In the meantime:

• When it hits, keep still, sit or lie down, and avoid bright lights and screens.
• Move slowly and avoid the head positions that set it off.
• Prevent falls: handrails, a night light and shoes with good grip.
• Do not drive or climb ladders until the attacks pass.

Ordinary vertigo does not need lab tests. If the doctor suspects another cause, she gives you a lab order for a lab near you or we refer you for other tests. You can keep working on your plan through virtual primary care.

For your safety, call 911 or go to the emergency room if vertigo comes with any of these signs. See when to go to the ER.

• A drooping face, or weakness or numbness in an arm or a leg
• Trouble speaking or understanding
• Double vision or loss of vision
• You cannot walk or stand without falling
• A sudden, severe headache
• Fainting, seizures, or vertigo after a blow to the head