What Causes Vertigo? 6 Common Reasons the Room Is Spinning
Vertigo affects 1 in 5 adults. Learn the most common causes — from BPPV and vestibular migraines to hormonal changes and old injuries — and what to do about each one.
If the room has ever suddenly started spinning — while rolling over in bed, standing up from a chair, or for seemingly no reason at all — you know how unsettling vertigo can be. It's disorienting, sometimes frightening, and it can make you feel like you've lost control of your own body.
But here's the important thing to understand: vertigo isn't a condition. It's a symptom. And that distinction matters, because the real question isn't just do I have vertigo — it's what's causing it.
Vertigo affects roughly 1 in 5 adults at some point in their lives, and it's two to three times more common in women than men [1]. The good news? Once you identify the underlying cause, most forms of vertigo are highly treatable. Let's walk through the most common reasons you might be experiencing that spinning sensation — from specific diagnoses to the more generalized dizziness that doesn't always fit a neat label.
1. BPPV — The Most Common Cause of Vertigo
Benign paroxysmal positional vertigo, or BPPV, is far and away the most frequent cause of vertigo. It accounts for 20–30% of all vertigo diagnoses in specialized dizziness clinics [2].
So what's actually happening? Inside your inner ear, tiny calcium carbonate crystals called otoconia help your brain sense gravity and movement. Sometimes these crystals become dislodged and drift into the semicircular canals — fluid-filled tubes that detect rotation. When that happens, your brain receives false signals that you're moving when you're not.
The result: brief but intense spinning episodes, usually lasting less than a minute, triggered by specific head movements. Rolling over in bed, tilting your head back, or bending forward are classic triggers. If your vertigo feels worse in the morning, BPPV is often the reason — the crystals settle overnight and shift when you first move.
The encouraging news is that BPPV has one of the highest treatment success rates in medicine. Repositioning maneuvers like the Epley maneuver resolve BPPV in 80–98% of cases, often in just one or two sessions [2][3]. Not sure if BPPV is what you're dealing with? Here are the five signs to look for. And yes — BPPV can be effectively cured.
2. Vestibular Migraines
Here's one that surprises a lot of people: migraines can cause vertigo — even without a headache.
Vestibular migraines affect roughly 3% of adults, and they account for about 10% of patients seen in dizziness clinics [4]. What makes them tricky to diagnose is that the majority of people who have them experience vertigo without any head pain. You might have episodes of spinning, dizziness, or imbalance that seem to come out of nowhere, and because there's no headache, neither you nor your doctor connects it to migraines.
The underlying mechanism involves overlapping pathways in the brain that process both pain and vestibular (balance) signals. When these pathways get triggered — by stress, poor sleep, dietary triggers, hormonal changes, or other factors — the result can be vertigo that lasts anywhere from five minutes to 72 hours.
If this sounds familiar, two things are worth exploring: understanding whether you can have a vestibular migraine without a headache (spoiler: absolutely), and identifying your personal triggers so you can start reducing episode frequency.
3. Vestibular Neuritis and Labyrinthitis
These two conditions are related but slightly different. Both involve inflammation of the inner ear, usually caused by a viral infection — and both can cause sudden, severe vertigo that lasts days to weeks.
Vestibular neuritis affects the vestibular nerve, which carries balance information from your inner ear to your brain. When this nerve becomes inflamed, the signals get disrupted, and your brain essentially receives conflicting information about where you are in space. The result is intense vertigo, nausea, and difficulty with balance. It's the third most common cause of peripheral vertigo [5].
Labyrinthitis involves inflammation of the entire labyrinth — the structure that houses both your balance and hearing organs. So in addition to vertigo, you may also experience hearing loss or ringing in the affected ear.
Both conditions often follow a cold, flu, or upper respiratory infection. The acute vertigo phase can be severe, but the brain is remarkably good at compensating over time. Vestibular rehabilitation therapy accelerates this process by helping retrain your brain to process balance signals correctly, even when one ear isn't sending reliable information.
4. Meniere's Disease
While less common than the conditions above, Meniere's disease is worth knowing about. It's caused by abnormal fluid buildup in the inner ear, though researchers still don't fully understand why it happens in some people.
The hallmark of Meniere's is a cluster of symptoms that tend to occur together: episodes of vertigo lasting 20 minutes to several hours, fluctuating hearing loss (usually in one ear), tinnitus (ringing or buzzing), and a sensation of fullness or pressure in the ear. Over time, hearing loss can become more permanent.
Meniere's is less common than BPPV or vestibular migraines, but it can be particularly disruptive because the episodes are unpredictable and can be severe. Management typically involves a combination of dietary changes (particularly sodium reduction), medication, and vestibular therapy. While there's no cure, most people can significantly reduce their episode frequency and severity with the right treatment plan.
5. Post-Concussion Vertigo
Head injuries can directly damage the vestibular system — and the resulting dizziness is more common than many people realize. Research shows that up to 80% of concussion patients experience some form of dizziness or balance disruption [6].
For some people, this resolves within a few weeks. But for others, the vestibular symptoms persist for months, especially if the vestibular component isn't specifically addressed during recovery. The standard advice of "rest and wait" doesn't always work when the inner ear or its neural connections have been affected.
Post-concussion vertigo can involve BPPV (the impact can dislodge those inner ear crystals), damage to the vestibular nerve, or central processing issues where the brain struggles to integrate balance information properly. The good news is that vestibular therapy specifically designed for post-concussion recovery can make a significant difference. If you're dealing with lingering dizziness after a head injury, here's what you need to know about concussion-related vertigo.
6. Anxiety and Stress-Related Dizziness
This one is complicated, because it goes both directions.
Yes, anxiety can cause dizziness. The fight-or-flight response affects blood flow, breathing patterns, and muscle tension — all of which can create lightheadedness, unsteadiness, or a floating sensation. Chronic stress keeps your nervous system on high alert, which can amplify any vestibular symptoms you're already experiencing.
But here's what often gets missed: many people who are told their dizziness is "just anxiety" actually have an underlying vestibular problem that's causing the anxiety. When your balance system isn't working properly, your brain perceives it as a threat. That triggers anxiety, which worsens the dizziness, which increases the anxiety — a vicious cycle.
The key is figuring out which came first. If you've been dismissed with an anxiety diagnosis but the dizziness came before the anxious feelings, it's worth digging deeper into whether something else is going on. Addressing the vestibular issue often reduces the anxiety significantly.
When Vertigo Doesn't Fit a Neat Diagnosis
The six causes above are the most common — but they're not the whole picture. Sometimes dizziness doesn't fit neatly into any one category, and that can be the most frustrating experience of all. You feel off, unsteady, or like something just isn't right, but standard tests come back "normal" and no one can give you a clear answer.
This is more common than you'd think, and it often involves one or more of these overlapping factors:
Visual and oculomotor dysfunction. Your eyes and your vestibular system work together to keep you balanced. When the eye-tracking system is weak — whether from an old injury, deconditioning, or neurological changes — it can cause dizziness in visually busy environments. Feeling dizzy in grocery stores, Target, or while scrolling is a classic sign that your visual-vestibular system needs attention.
Hormonal changes. Postpartum shifts, perimenopause, and even menstrual cycle fluctuations can disrupt the vestibular system in ways that don't show up on a standard test. Many women in their 30s and 40s develop vestibular symptoms that seem to come out of nowhere — and the connection between hormones and dizziness is often the missing piece.
Delayed effects from old injuries. That concussion from high school sports or a fender bender years ago? It may not have caused noticeable vestibular problems at the time, but the effects can show up 10 or 20 years later as your brain's ability to compensate gradually declines with age or stress.
The common thread in all of these is that they're real, they're treatable, and they require a specialist who knows where to look beyond the standard tests.
How to Figure Out What's Causing Your Vertigo
With so many possible causes — from specific diagnoses to more generalized vestibular dysfunction — it's clear that vertigo isn't a one-size-fits-all problem. And that's exactly why getting a proper evaluation matters.
A general practitioner can rule out serious concerns, but they may not have the specialized training to pinpoint a vestibular disorder. A vestibular specialist can perform targeted assessments — including positional testing, balance evaluations, and eye movement analysis — that identify the specific cause of your vertigo.
Why does this matter? Because different causes require different treatments. BPPV needs repositioning maneuvers. Vestibular migraines need trigger management. Post-concussion dizziness needs rehabilitation. Treating the wrong cause — or just masking symptoms with medication — delays real recovery. If you're ready to compare your options, here's a breakdown of vertigo treatment approaches and how they differ.
You Don't Have to Live With the Spinning
Here's what we want you to take away from this: most vertigo is treatable. Whether it's crystals in your inner ear, a migraine variant you didn't know existed, hormonal changes, lingering effects from an old concussion, or generalized dizziness that no one's been able to explain — there are answers, and there are effective treatments.
The first step is finding out what's actually causing your symptoms. Once you know that, the right treatment plan can get you back to feeling steady and confident again.
If you're in the Fishers or Indianapolis area and ready to find out what's behind your vertigo, Dizzy Free PT can help. Call us at (317) 804-1222 to schedule a consultation — no referral needed.
