A spinning sensation with a specific set of causes — and a specific set of warning signs that need emergency care.
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Vertigo is the sensation that you or the world around you is spinning or moving. It is not lightheadedness or feeling faint — those are different problems, covered on our dizziness page.
Most vertigo comes from the inner ear, and the single most useful question is how long each episode lasts. That one answer sorts out the majority of cases:
BPPV is worth knowing about because it is so satisfying to treat. It is the commonest cause, it responds to the Epley manoeuvre — often resolving in one session — and people are frequently given tablets for months instead, which do not treat it and prevent recovery.
The one thing not to sit on: vertigo with double vision, slurred speech, facial or limb weakness, numbness or difficulty swallowing is a stroke until proven otherwise. Call 999.
Increasingly recognised and frequently missed. Vertigo lasting minutes to days, often without any headache at all, with light and sound sensitivity and a personal or family history of migraine.
Tiny crystals normally embedded in one part of the inner ear become dislodged into a semicircular canal. Head movement then makes the fluid move abnormally, producing a brief violent spin.
Nothing is damaged, and it is entirely mechanical — which is exactly why a repositioning manoeuvre works. It follows head injury or infection sometimes, and often occurs for no identifiable reason. Commoner with age.
Inflammation of the balance nerve, usually viral, often after a cold. Severe for a few days, then a gradual recovery as the brain compensates.
Excess fluid pressure in the inner ear. Attacks come in clusters, and hearing can deteriorate over years — which is why it warrants specialist involvement.
A migraine variant affecting the balance system. Frequently occurs without headache, which is why it is missed — and it responds to migraine treatment rather than to vestibular sedatives.
Long-term prochlorperazine and similar vestibular sedatives. They are appropriate for a few days in acute severe vertigo with vomiting. Beyond that they prevent the brain from compensating, prolong the dizziness, and cause drowsiness and movement side effects.
Being on them for weeks or months is one of the commonest and most correctable problems in this area — and it is a particular issue for BPPV, where they do nothing for the underlying cause.
Vertigo is diagnosed from the history — and a careful conversation gets to the answer more reliably than any test. A video consultation covers this well, with one important exception noted below.
Distinguishing an inner ear cause from a stroke reliably requires an in-person bedside examination of eye movements. No history is good enough on its own where any neurological feature is present. Acute severe vertigo with any red flag goes to hospital, not to a video call — and we will say so immediately.
The Dix-Hallpike test, which confirms BPPV, also has to be done in person.
The Epley manoeuvre resolves BPPV in a single session for most people, and often immediately. It works by moving the displaced crystals back where they belong.
Reducing salt, caffeine and alcohol; betahistine; diuretics in some cases. Referral to ENT, since hearing needs monitoring and specialist options exist.
Treated as migraine — trigger identification, and migraine preventers where attacks are frequent. Often transformative in someone who has been treated for "inner ear problems" for years.
Call 999 immediately for vertigo with any of:
These suggest a stroke affecting the brainstem or cerebellum, which can present as vertigo alone. Time matters.
Seek same-day medical assessment for:
Book an appointment for:
Movement is the treatment. After the first day or two, avoiding head movement feels sensible and is actively counterproductive — the brain can only recalibrate by receiving the signals it is finding confusing.
Vestibular rehabilitation exercises deliberately provoke mild symptoms in order to retrain the system. Feeling slightly dizzy while doing them means they are working, not that you are harming yourself.
You must not drive if you are liable to sudden disabling vertigo, and depending on the cause and pattern there may be a legal duty to notify the DVLA. This applies particularly to Ménière's disease and unexplained recurrent attacks. It is worth asking directly rather than assuming.
Reduce salt, caffeine and alcohol; keep regular sleep; manage stress. Keep an attack diary — it identifies patterns and is what makes specialist review productive.
If you have been taking prochlorperazine, cinnarizine or a similar tablet for more than a couple of weeks, raise it. They help acutely, then start to hold recovery back — and stopping them, alongside vestibular exercises, is often what finally allows improvement.
The most effective treatment for the commonest cause of vertigo is a manoeuvre, not a medicine — and it is free. BPPV is treated with the Epley manoeuvre, which resolves it in a single session in most people. It is done by a GP, physiotherapist or audiologist, takes a few minutes, and needs no prescription.
That is the central point here: prochlorperazine and similar drugs suppress the symptom while doing nothing about the cause, and prolonged use actually delays the brain's own compensation. Being handed repeat prescriptions for vestibular sedatives is a common and unhelpful pattern.
Your NHS GP assesses vertigo free, and NHS vestibular physiotherapy — which is what genuinely helps persistent vestibular problems — is free on referral.
The honest limitation of remote assessment is real here. Distinguishing the causes of vertigo relies on positional testing and examining eye movements — the Dix-Hallpike manoeuvre, and looking for nystagmus — and neither can be done properly over video. We can take a careful history, which does a great deal of the work, but where the examination is the deciding factor we will say so.
What needs emergency assessment: vertigo with new headache, double vision, slurred speech, weakness, numbness, difficulty walking, or sudden hearing loss. Those can indicate a stroke, and vertigo of central origin is the one presentation not to manage remotely.
NICE Clinical Knowledge Summary, Vertigo, is the principal primary care reference — covering the differentiation of BPPV, vestibular neuronitis, labyrinthitis and Ménière's disease, and the limited role of vestibular sedatives.
NICE CKS, Benign paroxysmal positional vertigo, recommends the Dix-Hallpike test for diagnosis and the Epley manoeuvre as treatment, which is the basis for what this page says about manoeuvres over medication.
CKS advises that vestibular sedatives such as prochlorperazine should be used for the shortest possible time, since prolonged use impairs central vestibular compensation.
ENT UK guidance covers vestibular assessment and the role of vestibular rehabilitation therapy, which has good evidence in persistent symptoms.
The HINTS examination and stroke guidance underpin the emergency features listed: acute vestibular syndrome with neurological signs, or with sudden hearing loss, requires urgent assessment to exclude posterior circulation stroke.
How long each episode lasts. Seconds means BPPV; minutes to hours with hearing changes means Ménière's; days of constant severe vertigo means vestibular neuritis. That single answer, plus whether your hearing is affected and what triggers it, sorts out most vertigo.
That is almost certainly BPPV — the commonest cause, and the most satisfying to treat. The Epley manoeuvre resolves it in a single session for most people, sometimes immediately. Ask specifically for it. Tablets do nothing for BPPV and delay recovery.
Almost certainly not. These tablets are for a few days of acute severe vertigo with vomiting — no longer. Beyond that they prevent the brain compensating, prolong the dizziness, and cause drowsiness and movement side effects. Long-term use is one of the commonest and most correctable problems here, and stopping them alongside vestibular exercises is often what finally allows improvement.
When it comes with double vision, slurred speech, weakness or numbness, difficulty swallowing, or an inability to walk or sit unsupported. A stroke affecting the balance centres can present as vertigo alone, and those additional features are what distinguish it. Call 999.
Only for the first day or two of a severe attack. After that, movement is the treatment — the brain recalibrates only by receiving the signals it is finding confusing. Vestibular rehabilitation exercises deliberately provoke mild dizziness in order to retrain the system, and feeling slightly wobbly while doing them means they are working.
Not during attacks, and not at all if attacks come without warning. Depending on the cause there may be a legal duty to inform the DVLA — particularly with Ménière's disease or unexplained recurrent vertigo. Worth asking directly rather than assuming, and worth avoiding swimming too, since vertigo underwater is genuinely dangerous.
Yes — vestibular migraine frequently occurs without any headache at all, which is exactly why it is missed. Suspect it with vertigo lasting minutes to days, light or sound sensitivity, and a personal or family history of migraine. It responds to migraine treatment, which can be transformative for someone treated for years as an inner ear problem.
It can, and recurrence is common — but it is not a failure of treatment, and the manoeuvre works again. If you recognise the pattern returning, you do not need to start from scratch; ask for the repositioning treatment directly.
August 24, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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