It starts with something small. You rise from bed and the ground shifts. The walls blur for a moment, then everything steadies. It lasts only seconds, sometimes minutes, and you brush it off, blaming it on standing up too quickly. But what seems minor could be the early sign of vertigo.
Vertigo vs. ordinary dizziness
“Dizziness” is a broad term people use for many sensations such as feeling faint, lightheaded, or unsteady. Vertigo is more specific. It’s the false sense that you or the space around you is moving when it isn’t, more often described as spinning. Some say it feels like “the room is spinning,” while others compare it to being pulled sideways. Episodes can last only seconds or much longer, sometimes triggered by rolling over in bed, looking up quickly, or turning your head, other times with no obvious reason at all.
When asked about the most common causes of vertigo and how patients might distinguish benign conditions such as benign paroxysmal positional vertigo (BPPV) from more serious issues, ENT specialist Dr Leong explains that three primary culprits are seen most often: BPPV, vestibular neuritis and vestibular migraine.
“BPPV is definitely the most common cause of vertigo I see in my clinic,” says Dr Leong. “Patients typically describe short episodes of spinning sensations triggered by changes in head position such as turning over in bed, bending forward to put on their shoes, or tilting the head back to wash their hair in the shower. With careful questioning, there is often a clear activity that first set it off, such as a yoga class involving poses like the downward dog just days earlier.
It’s important to differentiate between true vertigo, the spinning sensation or the illusion that the room is moving around you, and generalised dizziness, which is a non-specific term that can describe a range of sensations.
There are several red-flag symptoms patients should watch out for, as these may signal a serious underlying condition such as an acute stroke affecting the brainstem or cerebellum (the part of the brain that controls balance and coordination):
- Persistent nausea and vomiting
- Ongoing or severe headache
- Neck pain or stiffness
- Facial weakness
- Blurry vision
- Slurred speech
- Weakness in the limbs
- Numbness of the limbs or face
- Difficulty swallowing or speaking
- Vertigo that is constant and does not improve with changes in head position
In many cases where dizziness continues without a clear explanation or diagnosis, a secondary condition known as functional dizziness can develop. This is often experienced as a giddy, non-vertiginous sensation (not the spinning type of dizziness), more like lightheadedness, and may at times resemble the feeling of an anxiety attack.
Who’s most affected
Vertigo can happen at any age, but some patterns stand out:
Risk increases as we get older. Research shows that about 30% of people over 60 experience dizziness or vertigo, and it’s strongly linked with falls.
Migraine, diabetes, cardiovascular disease can all increase the likelihood of vertigo. A history of inner-ear disorders adds to the risk. Viral infections are another trigger, sometimes causing inner-ear inflammation known as vestibular neuritis or labyrinthitis.
How to describe your symptoms to the doctor
One of the challenges in diagnosing vertigo is how people described their symptoms. Saying “I feel dizzy” gives doctors little detail to work with. It could mean spinning, faintness, imbalance, or something else entirely. The clearer and more specific your description, the better your doctor can understand what you’re experiencing and move toward the right diagnosis.
Here’s what to include, with examples you can adapt to your own experience:
Describe it as a short timeline: what it felt like, what set it off, how long it lasted, what else happened, and how it affected you. That level of detail gives doctors a clearer picture and makes it easier for them to work toward the right diagnosis.
When it comes to identifying the cause of vertigo, the most effective approach is a detailed history and thorough clinical examination, ideally by a specialist familiar with ear and balance disorders, such as an ENT doctor. This can be especially valuable for patients who may have already consulted several doctors across different specialties, including neurology, ophthalmology, cardiology, psychiatry or general practice.
While specialised vestibular or balance tests are available and may be useful in selected cases, most patients with dizziness do not require them. Importantly, a diagnosis of benign paroxysmal positional vertigo (BPPV) can usually be made without these tests. Imaging, such as an MRI scan of the brain, cannot detect BPPV.
The risks of ignoring vertigo
Leaving unaddressed vertigo can have serious consequences:
Night-time trips to the bathroom, using stairs, or even getting out of bed can become dangerous, especially for older adults.
Some disorders worsen if untreated, for example vertigo linked to Ménière’s disease may lead to hearing loss, while vestibular migraine can cause recurring attacks.
Vertigo is sometimes the first warning sign of a serious condition such as a stroke. Delaying medical evaluation can mean missing the chance for urgent treatment.
Fear of another episode often leads people to stop driving, avoid crowded places, or give up travelling. Over time, this can limit independence and reduce quality of life.
According to Dr Leong, vertigo can be a very distressing and troublesome symptom, often disrupting daily life by undermining mobility and confidence. Patients may become anxious about falling, which limits their independence, and some avoid going out alone or driving altogether. Many adopt makeshift “preventive” measures, such as avoiding head movements toward the provoking side, sleeping nearly upright instead of lying flat, or giving up physical activities they once enjoyed, including yoga.
She emphasises that early treatment is important. The sooner vertigo is managed, the better the chances of full recovery and the lower the risk of developing secondary functional dizziness, also known as persistent postural perceptual dizziness (PPPD). This condition compounds the original problem, making symptoms even harder to live with. Early intervention, therefore, can make a significant difference in preventing long-term disruption to quality of life.
Daily habits that may help
These won’t cure vertigo but they can reduce risks and make daily life more manageable:
When getting up from bed or a chair, pause for a few seconds before standing to steady yourself.
Quick head turns or looking up suddenly can trigger episodes in some people.
This helps prevent dips in blood pressure or blood sugar.
Fatigue can worsen dizziness.
Both can affect balance, and in some people, may trigger or worsen vertigo.
Improve lighting, remove trip hazards, and install grab bars where needed.
Hold the handrail on stairs or use a walking aid if you feel unsteady.
In older adults, vertigo often occurs alongside other underlying conditions that contribute to imbalance and dizziness. While the spinning sensation may be linked to benign paroxysmal positional vertigo (BPPV), additional factors such as diabetes, poor circulation in the lower limbs, vision problems from cataracts, or neurological impairment from reduced blood supply can also play a role. Recognising and identifying all possible causes is essential. Vertigo may be the most recent and acute event, but when layered on top of other health issues it significantly raises the risk of falls, increasing the likelihood of serious complications such as hip fractures or head injuries that cause bleeding inside the skull (intracranial bleeding).
Once the underlying causes are understood, targeted support can be highly effective. A trained vestibular physiotherapist can help retrain balance and strengthen muscles through daily rehabilitation exercises, while an occupational therapist can assess the home environment to reduce fall risks, for example by addressing broken floor tiles or uneven ground.
When to seek urgent care
Call emergency services immediately if vertigo is new and severe, especially if it comes with any of these warning signs:
- Facial droop
- Arm weakness or numbness
- Speech problems
- Sudden trouble seeing
- Trouble waking or loss or balance
- Sudden, severe headache
These symptoms can be signs of a stroke or transient ischemic attack (TIA). You should also seek immediate medical help if vertigo or dizziness happens together with chest pain, a racing or irregular heartbeat, or shortness of breath, as these can signal a heart problem.
According to Dr Leong, vestibular rehabilitation therapy (VRT) plays a vital role in managing vertigo and imbalance, particularly for patients with chronic symptoms. One of the most effective components is gaze stabilisation exercises, which retrain the vestibulo-ocular reflex (VOR). This reflex allows the eyes and inner ear to work together to send coordinated information to the brain and stabilise vision during head movements.
The VOR is what enables someone to keep reading a steady line of text in a book even while turning the head from side to side. When vestibular function is impaired, as in conditions such as vestibular neuritis, one inner ear fails to provide accurate signals to match those from the eyes and the opposite ear. This mismatch leaves patients feeling unsteady and imbalanced. Targeted rehabilitation exercises can help the brain adapt, restore coordination and gradually improve stability.
Vertigo isn’t a single disorder. It can start in the inner ear (peripheral) or the brain (central). What helps doctors tell the difference is how symptoms are described. The clearer the account—what you felt, when it happened, how long it lasted, and what came with it—the easier it is for doctors to narrow down the cause. For some people vertigo passes quickly, for others, it signals a condition that needs ongoing care. Either way, giving a precise account makes diagnosis and management more effective.
Dr Annabelle Leong
ENT Specialist for children and adults
ENTcare Clinic, Singapore
Instagram: @annabelleent
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