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Vertigo is a topic covered in the 5-Minute Clinical Consult.

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  • A symptom, not a disease process. Causes can be peripheral or central, benign or life-threatening. Cause determines treatment.
  • May be described as a sensation of movement (“room spinning”) when no movement is actually occurring
  • However, do not rely on symptom quality—often unreliable. Focus on timing and triggers (1).
  • System(s) affected: nervous, cardiovascular, psych
  • Synonym(s): dizziness


  • Vertigo accounts for half of cases of dizziness reported in primary care; >90% of these patients are diagnosed with peripheral causes (2).
  • Predominant sex: female = male; women are 3x more likely to experience vertiginous migraine (1).
Geriatric Considerations
  • Keep a higher index of suspicion for CVD, arrhythmias, orthostatic hypotension.
  • BPPV is most common among the elderly, is often undiagnosed, and is an important risk factor for falls.

  • Ranges from 5% to 10% within the general population
  • Lifetime prevalence for BPPV is 2.4%.

Etiology and Pathophysiology

  • Dysfunction of the rotational velocity sensors of the inner ear results in asymmetric central processing; combination of sensory disturbance of motion and malfunction of the central vestibular apparatus
  • Peripheral causes: acute vestibular neuritis, BPPV (posterior canal 85–95%, lateral canal 5–15%), Ménière disease, otosclerosis, acute labyrinthitis, cholesteatoma, perilymphatic fistula, superior canal dehiscence syndrome, motion sickness (1,2). BPPV, vestibular neuritis, and Ménière disease account for 93% of all peripheral causes (2).
  • Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (1,2)
  • Drug causes: psychotropic agents, anticonvulsants, aspirin, aminoglycosides, furosemide (diuretics), amiodarone, α-/β-blockers, nitrates, urologic medications, muscle relaxants, phosphodiesterase inhibitors (sildenafil), excessive insulin, ethanol, quinine, cocaine
  • Other causes: orthostasis, arrhythmia, psychological

Family history of CVD/migraines may indicate higher risk of central causes.

Risk Factors

  • History of migraines
  • History of CVD/risk factors for CVD
  • Use of ototoxic medications
  • Trauma/barotrauma
  • Perilymphatic fistula
  • Heavy weight bearing
  • Psychosocial stress/depression
  • Exposure to toxins

General Prevention

If due to motion sickness, consider pretreatment with anticholinergics, such as scopolamine.

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Stephens, Mark B., et al., editors. "Vertigo." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116861/all/Vertigo.
Vertigo. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116861/all/Vertigo. Accessed April 26, 2019.
Vertigo. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116861/all/Vertigo
Vertigo [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116861/all/Vertigo.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Vertigo ID - 116861 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116861/all/Vertigo PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -