• Vertigo is a sensation of perceived motion with no motion is happening; differs from dizziness, which is a disturbance of orientation without movement (1)
  • A symptom, not a disease process; causes can be peripheral or central (1)
  • Often described as a sensation of movement (room spinning) when no movement is actually occurring (1)
  • One of the four types of dizziness (vertigo, presyncope, lightheadedness, disequilibrium) (1),(2)
  • System(s) affected: nervous, cardiovascular, psychiatry
  • Synonym(s): dizziness



  • Vertigo/dizziness accounts for >4 million ED visits a year in the United States, of which only 15% has a serious underlying condition (2),(3).
  • Women are three times more likely to experience vertiginous migraine (2).

Geriatric Considerations

  • Higher index of suspicion for cardiovascular disease, arrhythmias, and orthostatic hypotension
  • Benign paroxysmal positional vertigo (BPPV) is more common in ages 50 to 70 years.
  • Medications are implicated 1/4 of the time (1),(2).

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 (1)
  • Peripheral causes: acute vestibular neuritis, BPPV caused by otoliths in the posterior canal 85–95% and lateral canal 5–15%, Ménière disease, otosclerosis, acute labyrinthitis, cholesteatoma, perilymphatic fistula, superior canal dehiscence syndrome, motion sickness; BPPV, vestibular neuritis, and Ménière disease account for the majority of peripheral causes (1).
  • Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (1)
  • Numerous drug causes (1),(2)


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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