What Causes Vertigo, and When Should You See a Physio?
The room isn't moving. Your inner ear has just convinced your brain that it is, and that mismatch is what vertigo actually is. Working out which of the many vertigo causes is behind it matters, because the fix for one is often useless for another.
This guide runs through the most common causes, how long each one tends to last, the signs that need urgent care and when it's worth seeing a physio rather than waiting it out.
What Is Vertigo, Exactly?
Vertigo is a false sense of movement, usually spinning, either of you or the room around you. It's different from general dizziness, which is a broader term covering lightheadedness, faintness or feeling unsteady on your feet.
Along with the spinning sensation, vertigo often comes with:
Nausea or vomiting
Sweating or looking pale
Loss of balance
Ringing in the ears or hearing changes
Rapid, uncontrolled eye movements
Symptoms can appear out of nowhere or be triggered by a specific movement, and they can last seconds or persist for days depending on the cause.
The Most Common Vertigo Causes
Most vertigo traces back to one of a handful of conditions. Here are the ones physios and GPs see most often.
BPPV Is the Most Common Cause of Vertigo
Benign paroxysmal positional vertigo, BPPV for short, happens when tiny calcium crystals in your inner ear shift out of place. Every time you move your head, they send confused signals to your brain about which way is up.
BPPV is the single most common cause of vertigo, and it most often appears spontaneously in people aged 50 to 70, though a head injury can bring it on at any age. Episodes are brief and set off by specific movements: rolling over in bed, tipping your head back or bending down to tie a shoe.
Vestibular Neuritis and Labyrinthitis Cause Sudden, Severe Vertigo
These two conditions involve inflammation of the nerve or structures inside your inner ear, usually following a viral infection. Unlike BPPV, the vertigo isn't triggered by movement. It arrives suddenly, often overnight, and stays constant for hours or days rather than coming and going in short bursts.
Labyrinthitis can also affect hearing, while vestibular neuritis usually doesn't.
Meniere's Disease Causes Vertigo With Hearing Changes
Meniere's disease is a build-up of fluid pressure in the inner ear. It's less common than BPPV or neuritis, but it has a distinctive pattern: vertigo attacks that arrive alongside ringing in the ear, a feeling of fullness and hearing that comes and goes.
Vestibular Migraine Can Cause Vertigo Without a Headache
Migraine isn't just a headache condition. Vestibular migraine can cause vertigo, light sensitivity and motion sensitivity on its own, sometimes with no headache at all, which is exactly why it's so often missed or mistaken for an inner ear problem.
Head Injury and Concussion Are Common Vertigo Causes Too
A knock to the head can disturb the inner ear directly or disrupt how your eyes, inner ear and brain communicate to keep you balanced. Vertigo after a head injury can show up straight away or develop over the following days, and it's a common reason concussion recovery takes longer than expected.
Other Vertigo Causes Worth Knowing About
A shorter list of causes shows up less often but is still worth knowing about:
Certain medications, including some blood pressure and antibiotic prescriptions
A build-up of ear wax pressing on the eardrum
Low blood pressure, particularly on standing up quickly
Sinus infections or pressure changes affecting the inner ear
Anxiety, which can both trigger vertigo and make existing symptoms feel worse
Age-related decline in the balance system, common after 65
Less often, vertigo comes from a problem in the brain itself, including stroke, multiple sclerosis or a brain tumour. These are rarer than the inner ear causes above, but they're the reason sudden, severe vertigo always deserves a proper assessment.
How Long Does Vertigo Last?
Duration is one of the clearest clues to the cause.
BPPV: seconds to under a minute per episode, though it can keep recurring for weeks if left untreated.
Meniere's disease: 20 minutes to several hours per attack, usually with hearing changes.
Vestibular neuritis or labyrinthitis: hours to several days of constant vertigo, with milder unsteadiness that can linger for weeks while your brain adjusts.
Vestibular migraine: minutes to days, and highly variable from person to person.
If your vertigo doesn't fit any of these patterns, or it's dragging on without any improvement, that's worth raising with your GP or physio rather than assuming it will settle.
When Vertigo Is a Medical Emergency
Most vertigo is uncomfortable rather than dangerous. But according to healthdirect Australia, you should go to the nearest emergency department if vertigo comes with any of the following:
Problems with walking or coordination
Problems with your eyesight, eye movements or double vision
Loss of sensation or movement on one side of your body
Slurred speech or difficulty swallowing
A severe headache
Confusion
These can be signs of a stroke or another serious neurological problem, and they need to be assessed straight away rather than watched at home.
When Should You See a Physio for Vertigo?
Once anything serious has been ruled out, physiotherapy is often the most direct route back to feeling steady, and it starts with working out exactly which of the vertigo causes above is behind your symptoms.
A vestibular assessment can identify:
Whether BPPV is present, and which ear and canal are affected, so it can be treated with a specific repositioning technique
Whether your vestibular system needs retraining after neuritis, labyrinthitis or a head injury, using gaze stabilisation, habituation and balance exercises
Whether ongoing unsteadiness is being driven by muscle weakness, neck stiffness or confidence rather than the inner ear itself
BPPV in particular often responds well to a single repositioning session, though follow-up is sometimes needed. Vestibular rehabilitation for the other causes tends to take longer, since it relies on retraining your brain's balance system rather than a one-off fix.
You can read more on our vestibular disorders page, which sits under our broader neurological physiotherapy service.
Getting Support for Vertigo on the Gold Coast
Vertigo and balance problems are also a genuine falls risk, particularly for older adults and anyone managing a neurological condition alongside it. We see people at our Pimpama clinic or at home across the Gold Coast, Logan and Brisbane, whichever setting suits your symptoms and mobility better.
If vertigo is affecting your goals under an NDIS plan, vestibular physiotherapy may be able to be included as part of your funded supports. Eligibility depends on your individual plan, so it's worth asking us directly. You can find more detail on our NDIS physiotherapy funding page.
Get in touch with any questions, or book an assessment online when you're ready.
Frequently Asked Questions
What is the most common cause of vertigo?
Benign paroxysmal positional vertigo (BPPV) is the most common cause. It happens when calcium crystals in the inner ear move out of place, triggering brief vertigo with certain head movements.
How long does vertigo usually last?
It depends on the cause. BPPV episodes last seconds to under a minute, Meniere's attacks last minutes to hours and vestibular neuritis can cause constant vertigo for several days.
Can stress cause vertigo?
Stress doesn't usually cause vertigo on its own, but it can trigger or worsen episodes, particularly with vestibular migraine or during recovery from an inner ear condition.
Is vertigo dangerous?
Most vertigo isn't dangerous, though it can increase your risk of falling. Sudden vertigo with symptoms like slurred speech, double vision or weakness on one side needs urgent medical attention.
Does vertigo go away on its own?
Often, yes. Many cases of vestibular neuritis and some cases of BPPV improve without treatment, though getting the cause confirmed speeds up recovery and rules out anything more serious.
What's the difference between vertigo and dizziness?
Vertigo is a false sense of spinning or movement. Dizziness is a broader term that also covers lightheadedness, faintness and general unsteadiness.
Can a physio help with vertigo?
Yes. A vestibular physiotherapist can identify the cause, treat BPPV with repositioning techniques and guide vestibular rehabilitation exercises for other causes like neuritis or head injury.
Can ear wax or a head cold cause vertigo?
Yes, both can. A build-up of ear wax against the eardrum and sinus or middle ear congestion from a cold can each affect balance signals and bring on vertigo-like symptoms.
This information is general and is not a substitute for an individual assessment. Please book an appointment for advice tailored to you. If you or someone near you has sudden facial weakness, call 000.
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