What Causes Long-Term Vertigo?

7 min readSep 9, 2023

Vertigo, a distressing and often debilitating sensation of spinning or dizziness, is a common ailment affecting millions of people worldwide. While most episodes of vertigo are short-lived and resolved on their own or with medical intervention, there exists a subset of individuals who grapple with the enduring torment of long-term vertigo.

This prolonged and relentless condition, known as chronic or long-term vertigo, can significantly impact a person’s quality of life and daily functioning.

What Causes Long-Term Vertigo — **Source**

In this article, we will delve into the complex world of long-term vertigo, exploring its causes, underlying mechanisms, and potential treatment options.

Understanding Vertigo

Before we delve into the causes of long-term vertigo, it is essential to have a basic understanding of vertigo itself. Vertigo is characterized by a false sensation of spinning or movement, which can be intense and distressing. It is often accompanied by other symptoms such as nausea, vomiting, unsteadiness, and difficulty maintaining balance.

Vertigo can arise from various underlying conditions, and while some cases resolve quickly, others persist for an extended period, leading to chronic or long-term vertigo.

Causes of Long-Term Vertigo

Long-term vertigo can have a multitude of causes, ranging from inner ear disorders to neurological conditions. Identifying the underlying cause is crucial for effective management and treatment.

Here are some common causes of long-term vertigo:

1. Meniere’s Disease:

Meniere’s Disease is a chronic inner ear disorder characterized by recurrent vertigo episodes, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the affected ear. Its exact cause is still not fully understood, but it is thought to result from fluid buildup in the inner ear, which disrupts the balance and hearing mechanisms.

These recurring episodes of vertigo can last for hours and are often accompanied by nausea and vomiting. Meniere’s Disease can progressively affect hearing and significantly impact an individual’s daily life, making it a challenging condition that requires specialized medical management and treatment.

Vestibular Migraine:

Vestibular migraine is a neurological disorder characterized by recurrent vertigo episodes as a prominent symptom, often accompanied by severe headache, light sensitivity, and nausea.

Unlike typical migraines, where headache is the primary feature, vestibular migraines primarily manifest with vertigo and may not always involve a headache. These episodes can last from minutes to hours and vary in frequency.

The exact cause of vestibular migraines remains unclear but is believed to involve abnormal brain activity affecting the vestibular system responsible for balance. Management includes migraine prevention strategies, lifestyle modifications, and medications to alleviate symptoms, making it essential for individuals to work closely with healthcare professionals for proper treatment.

Benign Paroxysmal Positional Vertigo (BPPV):

Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder characterized by brief and intense vertigo spells triggered by specific head movements or positional changes. It occurs when tiny calcium carbonate crystals, known as otoconia, become dislodged from their usual location within the inner ear and migrate into the semicircular canals, disturbing the normal balance signals.

When the head moves, these displaced particles send erroneous signals to the brain, resulting in vertigo. BPPV is typically short-lived, with episodes lasting for seconds to minutes, but it can significantly impact daily life. Treatment often involves specific head-positioning maneuvers to reposition the crystals and alleviate symptoms.

Labyrinthitis and Vestibular Neuritis:

Labyrinthitis and Vestibular Neuritis are inner ear disorders that lead to vertigo, among other symptoms. Labyrinthitis involves inflammation of the labyrinth, which consists of the cochlea for hearing and the semicircular canals for balance.

Vestibular Neuritis, on the other hand, focuses on inflammation of the vestibular nerve, responsible for transmitting balance signals to the brain.

Both conditions can result from viral infections or other inflammatory processes. They lead to vertigo, dizziness, imbalance, and sometimes hearing loss in the case of labyrinthitis. These symptoms can be severe but often improve over time. Treatment may include medication to alleviate symptoms and manage inflammation.

Acoustic Neuroma:

Acoustic Neuroma, also known as vestibular schwannoma, is a benign tumor that develops on the vestibular nerve, which connects the inner ear to the brain.

While noncancerous, it can cause significant issues, including vertigo, hearing loss, tinnitus (ringing in the ears), and balance problems. As the tumor grows, it exerts pressure on the surrounding structures, leading to these symptoms.

Early signs often include unexplained, persistent vertigo or imbalance. The condition is typically slow-growing but can become problematic as it affects nearby cranial nerves. Management options include observation, radiation therapy, or surgical removal, depending on the tumor’s size and the patient’s overall health.

Multiple Sclerosis (MS):

Multiple Sclerosis (MS) is a chronic autoimmune disease that primarily affects the central nervous system, including the brain and spinal cord. While MS is known for its wide range of neurological symptoms, it can also lead to long-term vertigo in some individuals.

This occurs when the disease damages the areas of the brain responsible for balance and coordination, disrupting the normal functioning of the vestibular system.

Vertigo episodes in MS can vary in intensity and duration, and they often accompany other symptoms like fatigue, muscle weakness, and difficulty with coordination. Managing MS typically involves disease-modifying medications, physical therapy, and symptom-specific treatments to address vertigo and other neurological issues.

Stroke:

Stroke, a serious medical condition, can result in long-term vertigo when it affects specific areas of the brain responsible for balance and coordination.

A stroke occurs when the blood supply to the brain is interrupted or reduced, leading to brain cell damage. Depending on the location and severity of the stroke, vertigo can manifest as a persistent spinning sensation or a feeling of unsteadiness.

Individuals who experience vertigo as a consequence of a stroke may also have other associated symptoms like weakness, numbness, speech difficulties, or vision problems. Stroke-related vertigo necessitates prompt medical attention, and rehabilitation therapy is often employed to improve balance and overall recovery.

Medications:

Certain medications, particularly those with effects on the central nervous system, can induce long-term vertigo or dizziness as a side effect. These drugs can disrupt the brain’s balance and coordination centers, leading to persistent feelings of unsteadiness or spinning.

Medications such as antihypertensives, antidepressants, antipsychotics, sedatives, and some anti-seizure drugs are known culprits.

The onset of medication-induced vertigo may occur soon after starting a new drug, with symptoms potentially persisting as long as the medication is taken. Healthcare providers must carefully consider these side effects when prescribing medications and may explore alternative treatments or dosage adjustments to mitigate vertigo in affected individuals.

Head Trauma:

Head trauma can result in long-term vertigo when it damages structures related to balance and the inner ear. Such injuries, including concussions or more severe traumatic brain injuries, can disrupt the vestibular system’s function. The vestibular system comprises delicate structures in the inner ear and the brain, responsible for maintaining balance and spatial orientation.

When trauma affects these components, it can lead to persistent vertigo, dizziness, and problems with coordination. Post-traumatic vertigo may not always manifest immediately after the injury, sometimes emerging weeks or even months later.

Rehabilitation therapies, along with medication and lifestyle adjustments, are often employed to help manage and alleviate these symptoms in affected individuals.

Unknown Causes:

In some perplexing cases, long-term vertigo can persist without a clearly identifiable cause, leading to the term “idiopathic” or “cryptogenic” vertigo.

Despite comprehensive medical evaluations, including imaging studies, vestibular function tests, and thorough clinical assessments, the underlying reason for vertigo remains elusive. It’s a frustrating and challenging scenario for both patients and healthcare providers.

Idiopathic vertigo can vary in severity and may fluctuate over time, making it a vexing condition to manage. Treatment often focuses on symptom relief through medications, lifestyle adjustments, and vestibular rehabilitation therapy, as addressing the root cause is not feasible when the cause is unknown.

Diagnosis and Evaluation

Diagnosing the cause of long-term vertigo can be challenging and typically involves a comprehensive evaluation by a healthcare professional. This evaluation may include:

Medical History: A detailed history of the patient’s symptoms, including the onset, duration, and triggers of vertigo episodes.
Physical Examination: A thorough physical examination, with a focus on the ears, eyes, and neurological system.
Audiometric Testing: Hearing tests to assess for hearing loss or abnormalities in the inner ear.
Vestibular Function Tests: These tests evaluate the function of the balance organs in the inner ear and include electronystagmography (ENG), videonystagmography (VNG), and rotary chair testing.
Imaging Studies: MRI or CT scans may be ordered to rule out structural abnormalities in the brain or inner ear.

Treatment Options

Treatment for long-term vertigo depends on the underlying cause and may involve a combination of medical, surgical, and lifestyle interventions. Here are some common approaches to managing long-term vertigo:

Medications: Medications such as vestibular suppressants, antiemetics (to control nausea and vomiting), and migraine preventatives may be prescribed based on the specific diagnosis.
Physical Therapy: Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy that can help individuals with long-term vertigo improve their balance and reduce symptoms.
Canalith Repositioning Maneuvers: These maneuvers are used to treat BPPV by repositioning displaced ear crystals (otoconia) in the inner ear canals.
Surgery: In cases where medications and other treatments are ineffective, surgical interventions may be considered. For example, Meniere’s disease may be managed with procedures like endolymphatic sac decompression or vestibular nerve section. Acoustic neuromas may require surgical removal.
Lifestyle Modifications: Lifestyle changes such as dietary modifications (for Meniere’s disease), exercises, stress management, and avoiding triggers (for vestibular migraines) can be beneficial.

Conclusion

Long-term vertigo is a complex and multifaceted condition that can significantly impact a person’s life. Identifying the underlying cause is essential for effective management and treatment. While living with chronic vertigo can be challenging, there are various medical, surgical, and lifestyle interventions available to help individuals regain control of their lives and manage their symptoms.

If you or someone you know is experiencing long-term vertigo, it is crucial to seek medical evaluation and guidance to determine the most appropriate course of action and improve overall quality of life.

Note: This article is for informational purposes only and should not replace professional medical advice. If you suspect you have vertigo or any other medical condition, please consult with a healthcare professional.