Introduction
Headache and dizziness are common complaints. However, are they the same? Let’s take a closer look at what vertigo is, its causes, and how to manage it.
Although often used interchangeably, headache and dizziness are not the same. Understanding the distinction can help identify the root cause of symptoms and rule out differential diagnoses.
Distinguishing Headache and Dizziness
A headache refers to pain experienced in the head, neck, or face area. Headaches can present in different forms, including migraines, tension-type headaches, and cluster headaches.
Dizziness, on the other hand, is a sensation of spinning, imbalance, or light-headedness. One common cause of dizziness, especially when described as a spinning sensation, is vertigo.
What is Vertigo?
Vertigo is a symptom, not a standalone diagnosis. When someone experiences vertigo, it’s important to investigate the underlying cause.
Vertigo is generally classified into two main types:
Central vertigo, caused by disorders of the central nervous system
Peripheral vertigo, related to problems in the inner ear or vestibular nerve
Recognizing the difference between the two can guide accurate diagnosis and appropriate treatment. Typically, central vertigo presents with milder symptoms than peripheral vertigo.
Symptoms
1. Central Vertigo
Originates from issues in the brainstem or cerebellum
Presents with mild spinning sensation
Accompanied by poor balance, making it difficult to stand or walk
May include neurological symptoms:
Double vision
Weakness or numbness on one side of the body
Speech difficulties
Symptoms often last longer and tend to recur
Common causes of central vertigo:
Stroke
Brain tumors
Head trauma or brain injury
Cerebrovascular disorders
Autoimmune conditions like multiple sclerosis
Side effects of medications (e.g., anticonvulsants)
2. Peripheral Vertigo
Caused by problems in the inner ear or vestibular nerve
Presents with intense spinning sensation
Often accompanied by nausea and vomiting
May be position-triggered or sudden in onset
Duration tends to be shorter than central vertigo
Common causes of peripheral vertigo:
Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular neuritis
Labyrinthitis
Meniere’s disease
Risk Factors
Risk factors for vertigo vary depending on the type:
Ear-related disorders (e.g., Meniere’s disease, BPPV) increase the risk of peripheral vertigo
Head trauma or brain injury heightens the risk of central vertigo
Chronic conditions such as uncontrolled hypertension, diabetes, and dyslipidemia may lead to vascular issues or stroke
Genetic factors and family history (especially of Meniere’s disease) can raise susceptibility
Certain medications (e.g., anticonvulsants, diuretics, antidepressants, specific antibiotics) can cause vertigo as a side effect
Environmental factors, such as sudden head movement (BPPV) or loud noises, may trigger vertigo
Pregnancy-related hormonal and blood pressure changes can also contribute
Unhealthy lifestyle habits—including dehydration, fatigue, stress, and alcohol consumption—may increase the risk
Diagnosis
1. Medical History (Anamnesis)
The initial step involves a detailed interview to understand:
Onset, duration, and severity of vertigo
Associated symptoms (e.g., nausea, neurological deficits)
Risk factors and potential triggers
Classification: central or peripheral vertigo
2. Physical Examination
Vital signs (blood pressure, heart rate, respiratory rate, temperature) are assessed. In early stages, they may be normal. If dehydration is present, hypotension and compensatory increased heart and respiratory rates may occur.
If ear involvement is suspected, an otoscopic exam checks for infection or structural abnormalities.
For central vertigo, a neurological exam evaluates motor strength, reflexes, coordination, and sensory function.
Dix-Hallpike manoeuvre may confirm BPPV.
Romberg Test and Fukuda Stepping Test assess balance.
Nystagmus (involuntary eye movement):
Horizontal nystagmus → peripheral vertigo
Vertical or torsional nystagmus → central vertigo
3. Diagnostic Tests
Audiometry: Evaluates hearing and inner ear function
MRI or CT scan: Used if central causes are suspected (e.g., stroke, tumor, MS)
Caloric test: Assesses vestibular response to stimulation
Treatment
Treatment depends on the underlying cause:
For Peripheral Vertigo
BPPV: Treated with Epley manoeuvre (performed by a physician or physiotherapist). Follow-up at home may include Semont manoeuvre or Brandt-Daroff exercises
Meniere’s disease: Managed with low-salt diet, diuretics, and medications (anti-inflammatories, antibiotics if needed)
For Central Vertigo
Requires more complex treatment based on the primary illness:
Stroke (ischemic): Treated with antiplatelet or anticoagulant therapy
Brain tumors: May require surgical intervention, chemotherapy, or radiotherapy
Multiple sclerosis: Treated with corticosteroids
Symptomatic Treatment
Antiemetics for nausea and vomiting
Betahistine to alleviate vertigo symptoms
Prevention
Preventive strategies should address root causes:
Avoid sudden head movements, particularly for those with BPPV
Maintain a healthy lifestyle:
Balanced diet
Adequate hydration
Reduced salt, caffeine, alcohol, and nicotine
Stress management
Regular physical activity
Sufficient rest
Patients with chronic conditions that increase vertigo risk should undergo regular medical check-ups.
Complications
Peripheral vertigo rarely leads to severe complications but may impair daily activities and increase the risk of falls, accidents, and injuries
Persistent nausea and vomiting may lead to dehydration and malnutrition
Meniere’s disease, if untreated, can cause permanent hearing loss
Central vertigo related to stroke or brain tumors requires prompt intervention to prevent permanent neurological damage
When to See a doctor
Vertigo can significantly disrupt daily life and productivity. Medical evaluation is advised if symptoms are persistent or recurrent, to identify the underlying cause and begin appropriate treatment before complications arise.
Vertigo may also be an early sign of serious central nervous system conditions such as stroke, vascular disorders, or brain tumors. Early detection is key for optimal outcomes.
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