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Vertigo can be caused by multiple factors, including:

Peripheral Vertigo

• Head trauma - Trauma (injury) to the head accounts for approximately 17% of cases of peripheral vertigo.

• Peripheral vestibulopathy - Symptoms of vertigo, nystagmus, and postural imbalance are precipitated by vestibular neuritis (inflammation of the vestibular nerve usually caused by a viral infection), or bacterial labyrinthitis (inflammation of the labyrinth usually caused by a bacterial infection). Symptoms usually resolve between 1-6 weeks. Vestibular neuritis accounts for approximately 15% of cases of peripheral vertigo.

• Meniere's disease - This is an abnormality of the inner ear that is associated not only with vertigo, but also with tinnitus (ringing in the ears), hearing loss, and pain or pressure in the affected ear. It is related to a change in fluid volume within the labyrinth.

• Perilymphatic fistula - Symptoms of vertigo arise from abnormal contact between the space containing the perilymph (a fluid that fills the cochlea) and the middle ear. It is caused either by pressure changes in the cerebrospinal fluid or in the middle ear. It is associated with positional vertigo, imbalance, and nystagmus. The attacks are usually episodic, not chronic, and either heal spontaneously or may require surgery.

• Idiopathic - This describes the most common form of peripheral vertigo, benign paroxysmal positional vertigo, in which for unknown reasons, head movement triggers vertigo that may range in intensity from mild to severe.

• Medication - Certain medications may cause vertigo as a side effect, including: aspirin, some chemotherapeutic agents, such as cisplatin, diuretics such as furosemide (Lasix), sedatives such as phenobarbital, or antipsychotics such as chlorpromazine.

• Motion Sickness - A sensation of dizziness and nausea when traveling in a vehicle (e.g., car, plane, boat)

Central Vertigo

Causes of central vertigo may include:

• Acoustic neuroma - This is a benign tumor arising from cells in the auditory nerve (8th cranial nerve). The most common presenting symptom of acoustic neuroma is sudden or gradual sensorineural hearing loss, however, up to 40% of patients may also experience vertigo.

• Cerebellar infarction - A stroke in the back part of the brain (cerebellum) may cause central vertigo.

• Cerebellopontine angle tumors - These tumors develop on the vestibular portion of the eighth cranial nerve. They are associated with progressive hearing loss, tinnitus (ringing in the ears), and vertigo.

• Epileptic vertigo - Focal epileptic discharges in certain portions of the temporal lobe of the brain can cause vertigo.

• Basilar artery migraines - These may be associated with attacks of vertigo, nausea, vomiting, visual disturbances as well as other signs of brainstem dysfunction.

Psychogenic Vertigo

Psychological causes of vertigo may be associated with:

• Acrophobia - Fear of heights may precipitate vertigo

• Phobic postural vertigo - This is the most frequent form of psychogenic vertigo and is the third most common cause of vertigo in general. It is characterized by vertigo while standing as well as during motion. It may be precipitated by perceptual stimuli (e.g., staircases), or during social situations (e.g., attending a concert). Patients tend to avoid situations that precipitate the vertigo and thus minimize its occurrence.