Why the room spins, and what helps

Vertigo is the false sensation that you or your surroundings are spinning. It is not the same as light-headedness or feeling faint, and the distinction matters because the causes are different.

The most common cause is benign paroxysmal positional vertigo (BPPV): small calcium crystals that normally sit in one part of the inner ear become dislodged into the balance canals, where they disturb the signal your brain uses to sense head position.

What BPPV typically feels like

• Brief, intense spinning lasting seconds to under a minute
• Triggered by a change of head position — rolling over in bed, looking up, bending down
• Often worst on first waking, when you turn to one particular side
• Nausea during and a lingering unsteadiness afterwards
• Normal hearing — BPPV does not cause hearing loss

How it is assessed and treated

1. Positional testingThe Dix-Hallpike and supine roll tests move your head through specific positions to identify which canal the crystals have entered.
2. Canalith repositioningA sequence of guided head movements — the Epley, Semont or Gufoni manoeuvre — uses gravity to move the crystals back out of the canal.
3. Immediate retestThe same test is repeated to confirm the manoeuvre worked before you leave.
4. Habituation exercisesWhere dizziness persists or the vestibular system is underactive, graded exercises retrain your balance responses over several weeks.

When it is not BPPV

• Vertigo with hearing loss, ear fullness or tinnitus — needs ENT review
• Constant, unrelenting dizziness rather than brief positional episodes
• Vertigo with double vision, slurred speech, severe headache or limb weakness — seek emergency care
• Dizziness on standing up, which is more likely a blood-pressure issue