Treatment for vertigo depends on the cause and severity of your symptoms.
During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea and reduce the sensation of spinning. You may be advised to take medication.
You should also try to avoid stressful situations, as anxiety can make the symptoms of vertigo worse. Read more about how to deal with stress and anxiety.
Labyrinthitis is an inner ear infection that causes the labyrinth (a delicate structure deep inside your ear) to become inflamed. It's usually caused by a viral infection and clears up on its own without treatment. In rare cases, where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed.
If you've experienced any hearing loss, your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular physician. This is a doctor who specialises in hearing and balance disorders. You may need emergency treatment to restore your hearing.
Labyrinthitis may also be treated with vestibular rehabilitation – also called vestibular rehabilitation training or VRT (see below).
See treating labyrinthitis for more information.
Vestibular neuronitis, also known as vestibular neuritis, is inflammation of the vestibular nerve (one of the nerves in your ear that's used for balance). It's usually caused by a viral infection.
The symptoms of vestibular neuronitis often get better without treatment over several weeks. However, you may need to rest in bed if your symptoms are severe. See your GP if your symptoms get worse or don't start to improve after a week.
You may find your balance is particularly affected if you:
- drink alcohol
- are tired
- have another illness
Avoiding these can help to improve your condition.
Vestibular neuronitis can also be treated with vestibular rehabilitation and medication.
Benign paroxysmal positional vertigo (BPPV)
Like vestibular neuronitis, benign paroxysmal positional vertigo (BPPV) often clears up without treatment after several weeks or months. It's thought that the small fragments of debris in the ear canal that cause vertigo either dissolve or become lodged in a place where they no longer cause symptoms. BPPV can sometimes return.
Until the symptoms disappear or the condition is treated, you should:
- get out of bed slowly
- avoid activities that involve looking upwards, such as painting and decorating or looking for something on a high shelf
BPPV can be treated using a procedure called the Epley manoeuvre.
The Epley manoeuvre
The Epley manoeuvre involves performing four separate head movements to move the fragments that cause vertigo to a place where they no longer cause symptoms. Each head position is held for at least 30 seconds. You may experience some vertigo during the movements.
Your symptoms should improve shortly after the Epley manoeuvre is performed, although it may take up to two weeks for a complete recovery. Return to your GP if your symptoms haven't improved after four weeks. The Epley manoeuvre isn't usually a long-term cure and may need to be repeated.
If the Epley manoeuvre doesn't work, or if it's not suitable – for example, because you have neck or back problems – you can also try Brandt-Daroff exercises. These are a series of movements you can do unsupervised at home.
Your GP will need to teach you how to do the exercises. You repeat them three or four times a day for two days in a row. Your symptoms may improve for up to two weeks.
Referral to a specialist
Your GP may refer you to a specialist, such as an ear, nose and throat (ENT) specialist if:
- the Epley manoeuvre doesn't work or can't be performed
- you still have symptoms after four weeks
- you have unusual signs or symptoms
In rare cases, where the symptoms of vertigo last for months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist can give more advice on this.
If your vertigo is caused by Ménière's disease, there are a number of treatment options for both the vertigo and other symptoms caused by the condition.
Possible treatments for Ménière's disease include:
- dietary advice – particularly a low-salt diet
- medication to treat attacks of Ménière's disease
- medication to prevent attacks of Ménière's disease
- treatment for tinnitus (ringing in your ears) – such as sound therapy, which works by reducing the difference between tinnitus sounds and background sounds, to make the tinnitus sounds less intrusive
- treatment for hearing loss – such as using hearing aids
- physiotherapy to deal with balance problems
- treatment for the secondary symptoms of Ménière's disease – such as stress, anxiety and depression
See treating Ménière's disease for more information.
Central vertigo is caused by problems in part of your brain, such as the cerebellum (which is located at the bottom of the brain) or the brainstem (the lower part of the brain that's connected to the spinal cord).
Causes of central vertigo include migraines and, less commonly, brain tumours.
If your GP suspects you have central vertigo, they may organise a scan or refer you to a hospital specialist, such as a neurologist or an ENT (ear, nose and throat specialist) or audiovestibular physician.
Treating your migraine should relieve your vertigo if it's caused by a migraine.
Vertigo with an unknown cause
If the cause of your vertigo is unknown, you may be admitted to hospital if:
- you have severe nausea and vomiting, and can't keep fluids down
- your vertigo comes on suddenly and wasn't caused by you changing position
- you possibly have central vertigo
- you have sudden hearing loss, but it's not thought to be Ménière's disease
Alternatively, you may be referred to a specialist, such as:
- a neurologist – a specialist in treating conditions that affect the nervous system
- an ENT specialist – a specialist in conditions that affect the ear, nose or throat
- an audiovestibular physician – a specialist in hearing and balance disorders
While waiting to see a specialist, you may be treated with medication.
Vestibular rehabilitation, also called vestibular rehabilitation training or VRT, is a form of "brain retraining". It involves carrying out a special programme of exercises that encourage your brain to adapt to the abnormal messages sent from your ears.
During VRT, you keep moving despite feelings of dizziness and vertigo. Your brain should eventually learn to rely on the signals coming from the rest of your body, such as your eyes and legs, rather than the confusing signals coming from your inner ear. By relying on other signals, your brain minimises any dizziness and helps you to maintain your balance.
An audiologist (hearing specialist) or a physiotherapist may provide VRT. Your GP may be able to refer you for VRT, although it depends on availability in your area.
In some cases, it may be possible to use VRT without specialist help. Research has shown that people with some types of vertigo can improve their symptoms using a self-help VRT booklet. However, you should discuss this with your doctor first. If it's likely to be useful, you can download a copy of this booklet from the Ménière's society.
Medication can be used to treat episodes of vertigo caused by vestibular neuronitis or Ménière's disease. It may also be used for central vertigo or vertigo with an unknown cause.
The medicines are usually prescribed for 3 to 14 days, depending on which condition they're for. The two medicines that are usually prescribed are:
If these medicines are successful in treating your symptoms, you may be given a supply to keep at home, so you can take them the next time you have an episode of vertigo.
In some cases you may be advised to take long-term medication, such as betahistine, for conditions like Ménière's disease.
Prochlorperazine can help relieve severe nausea and vomiting associated with vertigo. It works by blocking the effect of a chemical in the brain called dopamine.
Prochlorperazine can cause side effects, including tremors (shaking) and abnormal or involuntary body and facial movements.
It can also make some people feel sleepy. For the full list of possible side effects, check the patient information leaflet that comes with your medicine.
Antihistamines can be used to help relieve less severe nausea, vomiting and vertigo symptoms. They work by blocking the effects of a chemical called histamine.
Possible antihistamines that may be prescribed include:
- promethazine teoclate
Like prochlorperazine, antihistamines can also make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.
A medication called betahistine works in a similar way to antihistamines. It has been used to treat Ménière's disease and may also be used for other balance problems. It may have to be taken for a long period of time. The beneficial effects vary from person to person.
If you have vertigo, there are some safety issues to consider. For example:
- you should inform your employer if your job involves operating machinery or climbing ladders
- you may be at increased risk of falls – see preventing falls for advice on making your home safer and reducing your risk
Vertigo could also affect your ability to drive. You should avoid driving if you've recently had episodes of vertigo and there's a chance you may have another episode while you're driving.
It's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could affect your driving ability. Visit the GOV.UK website for more information on driving with a disability.