Central vertigo: when spinning comes from the brain rather than the inner ear

Vertigo is more than just feeling dizzy. The NHS describes it as feeling like you or everything around you is spinning, enough to affect your balance. NHS inform adds that it can be barely noticeable or so severe that it is difficult to keep your balance and do everyday tasks, and that attacks can last from a few seconds to much longer.

Balance depends on the inner ear, the nerve that carries its signals, and parts of the brain that interpret them. The NHS says inner ear problems are the most common causes of vertigo, and NHS inform notes that it can also be caused by problems in certain parts of the brain. Doctors often use the word central for vertigo that arises from the brain, to distinguish it from peripheral vertigo that arises from the inner ear or its nerve.

The distinction matters because the common inner ear causes tend to settle on their own or respond to simple treatment, while a brain cause may need urgent assessment. The NHS and NHS inform both set out a short list of warning signs that should not be waited out.

NHS inform lists the conditions that more commonly cause vertigo, such as benign paroxysmal positional vertigo (BPPV), migraine, labyrinthitis or vestibular neuronitis, persistent postural-perceptual dizziness and Ménière's disease. It then says that, less commonly, vertigo can be caused by conditions affecting parts of the brain, and names three examples.

The advice from the NHS is graded by urgency. A GP appointment is appropriate for vertigo that will not go away or keeps coming back. NHS inform adds that you should speak to your GP practice if the vertigo comes on suddenly or is affecting your daily life.

• Call 999 or go to A&E if you have vertigo and double vision or loss of vision, hearing loss, trouble speaking or slurred speech, or weakness, numbness or tingling in your arms or legs (NHS and NHS inform).

• Call 999 if you think you are having a stroke. The NHS describes the main signs as face weakness, arm weakness and speech problems, and says time matters: the F-A-S-T check ends with time to call 999.

• Ask for an urgent GP appointment or call NHS 111 if you have vertigo with a severe headache, feel or are being sick, or have a very high temperature or feel hot, cold or shivery (NHS).

• Do not drive to A&E yourself. The NHS says to ask someone to drive you or call 999, and to bring any medicines you take.

The NHS says a GP will ask about your symptoms to try to find out what could be causing them. A simple test that involves moving quickly from sitting to lying down might be done to check your balance, and it may bring on symptoms. NHS inform says the GP can carry out an examination to help determine some types of vertigo and may refer you for further tests.

If a brain cause is suspected, assessment is likely to take place in hospital, because the signs are those of a possible stroke or another condition affecting the nervous system. The NHS says stroke needs urgent medical help in hospital because it can be life-threatening. The sources used for this page do not describe the specific scans or bedside tests used, so your clinical team is the best source on what is needed in your case.

Symptoms that come and go can still matter. The NHS says symptoms of a stroke can sometimes stop after a short time, so you might think you are fine, but you should still get medical help straight away.

There is no single treatment for central vertigo because it is a symptom. The NHS says treatment for vertigo depends on the cause, and NHS inform says medicines such as prochlorperazine and some antihistamines may help in most cases, but should only be used for a short time (3 to 5 days), since longer use may slow recovery.

When the cause is in the brain, treatment is directed at that condition. For a stroke, the NHS says treatment depends on the type of stroke, and in the first 24 hours may include clot-busting medicine (thrombolysis), surgery to remove a clot (thrombectomy) or drain fluid, or a procedure to relieve pressure in the skull. The NHS recovery page describe rehabilitation that may include physiotherapy and exercises for movement, cognitive behavioural therapy for anxiety, depression and tiredness, and help with speech, swallowing and vision.

NHS inform says that if you still have vertigo or balance problems after 6 weeks you may be referred to a vestibular (balance) physiotherapist or an ENT consultant. Gentle movement is encouraged as soon as you are able, because it helps the balance systems reset.

Both NHS pages give practical self-help advice for an attack: lie still in a quiet, dark room, move your head slowly and carefully, sit down straight away when you feel dizzy, turn the lights on if you get up at night, use a walking stick if you are at risk of falling, get out of bed slowly and sit on the edge for a while, and try to relax because anxiety can make vertigo worse. The NHS also advises not bending over to pick things up and not stretching your neck.

NHS inform says to tell your employer if your job involves operating machinery or climbing ladders, and notes that you may have a higher chance of falling. It also cautions against avoiding all movement and never getting the correct diagnosis, because avoiding positions may feel easier in the short term but does not help the vertigo.

If you drive, you must tell the DVLA about your vertigo, the NHS says. Fear of heights, by contrast, is a separate matter: NHS inform says the correct medical term is acrophobia, and that the word vertigo is often used for it incorrectly.

Sudden vertigo with red-flag symptoms is an emergency and is managed through 999 and NHS emergency departments. Persistent or recurrent vertigo is usually assessed through a GP, who may refer you to ENT, neurology or a balance service. Some people also see a private ENT or neurology specialist for further tests. If you do, take any previous letters and scan reports with you, and tell your GP so the information is not duplicated.