Vertigo: When the Room Spinning Needs a Visit

Vertigo is the false feeling that you or the room around you is spinning, tilting or moving. Most vertigo comes from the inner ear, and the most common cause, a condition called BPPV, is not dangerous, though it can be miserable. But sudden vertigo can occasionally be a sign of a stroke, so it's worth knowing which symptoms mean 911 and which mean a same-day visit.

Call 911 or go to the ER if… vertigo or dizziness comes on suddenly with any of these: weakness or numbness on one side of the body, a drooping face, slurred or confused speech, double vision or loss of vision, a sudden severe headache, trouble walking or being unable to stand; or you also have chest pain, a racing or irregular heartbeat, or you fainted; or it started after a head injury; or you suddenly lost hearing in one ear. Note the time symptoms started and don't drive yourself.

Is it vertigo or just dizziness?

"Dizzy" covers a few different feelings, and telling them apart helps a clinician narrow down the cause. Vertigo is a sense of motion: spinning, rocking or the room moving. Lightheadedness is feeling faint or like you might pass out, which often relates to blood pressure, dehydration or heart rhythm rather than the ear. Unsteadiness is feeling off balance on your feet without a spinning sensation. It's common to have more than one.

What causes vertigo?

BPPV (benign paroxysmal positional vertigo). Tiny calcium crystals in the inner ear drift into a part of the balance canal where they don't belong. The result is short bursts of spinning, usually under a minute, triggered by changing head position: rolling over in bed, lying down, looking up at a shelf or bending over. Between spells you may feel fine or a little off. BPPV is often treated with a series of guided head movements (repositioning maneuvers) that move the crystals back.

Vestibular neuritis and labyrinthitis. Inflammation of the balance nerve or inner ear, often after a cold or other viral illness. It typically causes constant, intense vertigo for a day or more, with nausea and vomiting, then gradually eases over days to weeks. Labyrinthitis also affects hearing in that ear.

Ménière's disease. Repeated episodes of vertigo lasting from about 20 minutes to several hours, along with ringing, fullness and fluctuating hearing loss in one ear. It's usually managed long term with an ear specialist.

Vestibular migraine. Some people with migraines get vertigo attacks, with or without a headache, sometimes with sensitivity to light, sound or motion.

Less common but serious causes. A stroke or bleeding in the back of the brain can cause sudden vertigo, sometimes with only subtle other signs such as trouble walking or double vision. This is more likely in people with high blood pressure, diabetes, heart disease, or a history of smoking, and it's why the warning signs in the box above matter.

What to do during a vertigo spell

• Sit or lie down right away, in whatever position makes the spinning settle, and keep your head still.
• Don't drive, climb ladders or operate machinery until it has fully passed.
• Get up slowly, and use a wall or a person for support. Falls are one of the biggest risks of vertigo, especially for older adults.
• Sip fluids if you've been vomiting, and turn down bright lights and screens.

When does vertigo need an urgent care visit?

If none of the 911 warning signs apply, come in the same day if:

• This is the first time you've had vertigo
• Spells keep coming back with head movement and are getting in the way of work, sleep or driving
• You've been vomiting and can't keep fluids down well
• You also have ear pain, ear fullness, ringing or a fever
• You started a new medication and the dizziness began afterward

At the visit, a clinician asks how the dizziness feels, how long spells last and what triggers them, then checks your ears, your eye movements, your balance and walking, and a basic neurological exam. Those details often point to the cause. If something suggests a more serious problem, they'll tell you and direct you to emergency care. Otherwise they can discuss treatment, which may include medication for nausea, fluids if you're dehydrated, and guidance on repositioning exercises, plus a referral to an ear, nose and throat specialist or physical therapy when vertigo keeps coming back.

What does it cost?

Self-pay in-clinic visits are $175 for a standard visit, $250 with one moderate service, and $330 for a procedure or two moderate services; the tier depends on the care you actually receive. If you're using insurance: we contract with all major commercial and government plans, including Colorado Medicaid and Medicare. We can't guarantee a particular commercial plan has us in network, and if you turn out to be out of network or your benefits are denied, we bill you at the self-pay rates. See our cost and insurance page for details.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

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