Vertigo is most often caused by a problem in the inner ear, where your body’s balance system lives. The single most common cause is a condition called BPPV, where tiny calcium crystals drift into the wrong part of the ear canal. But vertigo has many possible triggers, from viral infections and fluid buildup to migraines, medications, and rare structural defects in the skull bone. Understanding which type you’re dealing with depends largely on how long your episodes last and what other symptoms come with them.
How Your Inner Ear Controls Balance
Your inner ear contains three small, fluid-filled loops called semicircular canals. When you move your head, the fluid shifts inside these loops, and tiny hair-like sensors detect the movement and send signals to your brain. Your brain uses those signals, combined with input from your eyes and joints, to figure out where your body is in space. Vertigo happens when something disrupts this system and your brain receives conflicting signals, creating the sensation that you or the room is spinning.
BPPV: The Most Common Cause
Benign paroxysmal positional vertigo, or BPPV, accounts for more vertigo cases than any other single condition. It happens when tiny calcium carbonate particles, normally anchored in a part of the inner ear called the utricle, break loose and drift into one of the semicircular canals. Once there, these loose particles shift every time you move your head, pushing the fluid around and tricking your brain into thinking you’re moving when you’re not.
BPPV episodes are brief but intense, usually lasting less than a minute at a time. They’re triggered by specific head movements: rolling over in bed, looking up, or tilting your head back. Between episodes, you may feel completely fine. The condition is more common as you age, likely because the crystals become more brittle and easier to dislodge over time. A simple in-office procedure can reposition the loose particles back into the utricle where they won’t cause problems. This works for most people within one or two sessions.
Vestibular Neuritis and Labyrinthitis
These two conditions involve inflammation in the inner ear, most commonly triggered by a viral infection. The key difference between them is hearing. Vestibular neuritis affects the balance nerve only, so hearing stays intact. Labyrinthitis involves inflammation of both the balance structures and the hearing structures, which can cause hearing loss or ringing in the ears that is often permanent.
Both conditions tend to hit suddenly and hard. You may experience severe, continuous vertigo with nausea and vomiting that lasts for days. Balance problems can linger for weeks or even months as your brain gradually recalibrates. Bacterial infections of the middle ear can also cause labyrinthitis in some cases, though viral triggers are far more common.
Ménière’s Disease
Ménière’s disease causes episodes of vertigo that last anywhere from 20 minutes to 12 hours, along with a trio of other symptoms: fluctuating hearing loss (typically in the low frequencies), ringing in the affected ear, and a feeling of fullness or pressure, as if the ear is stuffed. It usually affects only one ear.
The underlying problem is an abnormal buildup of fluid in the inner ear, though exactly why this fluid accumulates isn’t fully understood. A definite diagnosis requires at least two spontaneous vertigo episodes lasting 20 minutes or more, documented hearing loss on a hearing test, and fluctuating ear symptoms that can’t be explained by another vestibular condition. Episodes tend to come in clusters, sometimes with weeks or months of remission in between. Over time, hearing loss in the affected ear often becomes permanent.
Vestibular Migraine
Migraines don’t just cause headaches. Roughly 26% of people who seek care for vertigo are ultimately diagnosed with vestibular migraine, making it one of the most common vertigo causes overall. In children, the rate is even higher, around 33%. Episodes can last minutes to days and may or may not include a headache. Many people experience light and sound sensitivity, visual disturbances, or motion sickness alongside the spinning sensation.
Vestibular migraine is easy to miss because it doesn’t always look like a traditional migraine. Some people have vertigo as their primary symptom, with little or no head pain. A personal or family history of migraines is a strong clue. Common triggers include stress, sleep changes, certain foods, and hormonal shifts.
Superior Canal Dehiscence
This rare condition occurs when a small hole develops in the thin bone separating the inner ear from the brain cavity. The opening doesn’t allow fluid to leak, but it creates an abnormal pathway for sound and pressure to enter the semicircular canal. Normally, the fluid in these canals only moves in response to head movement. With this hole present, loud sounds or pressure changes can push the fluid around, and your brain interprets that movement as spinning or sudden motion.
People with this condition often notice vertigo triggered by coughing, sneezing, straining, or exposure to loud noises. Some also hear their own heartbeat or eye movements unusually loudly. Diagnosis typically requires specialized imaging to identify the bone defect, and surgical repair is an option for severe cases.
Medications That Can Trigger Vertigo
A wide range of medications list vertigo as a possible side effect. Some of the more well-known culprits include certain antibiotics (particularly a class called aminoglycosides), anti-seizure medications, blood pressure drugs, and some anti-inflammatory medications. Proton pump inhibitors used for acid reflux, certain pain medications like codeine, and even some osteoporosis drugs can trigger it. A few of these medications are also ototoxic, meaning they can directly damage the inner ear structures responsible for balance and hearing.
If vertigo starts shortly after beginning a new medication or changing a dose, that timing is worth noting. Drug-induced vertigo often resolves once the medication is stopped or adjusted, but some ototoxic drugs can cause lasting damage, particularly with prolonged use.
Other Possible Causes
Less common causes of vertigo include reduced blood flow to the brain (particularly in the brainstem or cerebellum), head injuries that damage the inner ear, acoustic neuromas (slow-growing tumors on the balance nerve), and multiple sclerosis. These are far less frequent than the conditions above, but they tend to come with additional neurological symptoms like double vision, difficulty swallowing, slurred speech, or limb weakness.
What the Pattern of Your Vertigo Tells You
The duration and triggers of your episodes are the most useful clues for narrowing down the cause. Brief episodes lasting seconds to a minute, triggered by head position changes, point strongly toward BPPV. Episodes lasting 20 minutes to several hours, accompanied by hearing changes and ear pressure, suggest Ménière’s disease. Constant vertigo lasting days that came on suddenly after an illness fits vestibular neuritis or labyrinthitis. Vertigo episodes of variable length with a history of migraines suggest vestibular migraine.
Age is also a factor. The 10-year incidence of vertigo in adults over 55 is roughly 40%, and having a history of migraines raises your risk by about 63%. While vertigo is rarely dangerous on its own, the pattern of symptoms, especially when combined with hearing loss, new headaches, or any neurological changes, helps determine whether you’re dealing with a straightforward inner ear issue or something that needs further evaluation.