Doctor explains: Why vertigo strikes when getting out of bed and when it could be dangerous

Dizziness and balance-related complaints are among the most common neurological symptoms reported in outpatient clinics globally, with studies suggesting that nearly one in three adults’ experiences vertigo at least once in their lifetime.

Medical experts say that while most cases are linked to benign inner ear conditions, a smaller proportion may signal underlying neurological disorders such as stroke or vestibular dysfunction, making accurate differentiation critical for timely treatment.

Firstpost talked to Dr. Tushar Raut, Consultant, Neurology, Kokilaben Dhirubhai Ambani Hospital (Mumbai), to understand the causes, warning signs and treatment approaches for vertigo, and how patients can distinguish it from general dizziness.

What exactly is vertigo, and how is it different from general dizziness?

 Dr. Tushar: Vertigo is a specific type of dizziness in which a person feels as if they or their surroundings are spinning or moving, even when they are perfectly still. It is usually related to a disturbance in the balance system of the inner ear or the brain.

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General dizziness, on the other hand, is a broader term. It may include sensations such as light-headedness, faintness, imbalance, or feeling unsteady. While dizziness can arise from many causes such as dehydration, low blood pressure, or anxiety, vertigo typically points to a problem in the vestibular system, which controls balance and spatial orientation.

What are the most common causes of vertigo you see in patients?

Dr. Tushar: The most common cause of vertigo is Benign Paroxysmal Positional Vertigo (BPPV), which occurs when tiny calcium crystals in the inner ear get displaced and interfere with balance signals.

Other causes include vestibular neuritis, an inflammation of the inner ear nerve usually following a viral infection; Ménière’s disease, which involves fluid imbalance in the inner ear and may also cause hearing loss and tinnitus; and migraine-associated vertigo.

Less commonly, vertigo can arise from neurological conditions such as stroke, multiple sclerosis, or tumours affecting the balance pathways.

Why do many people experience vertigo while getting up from bed or turning their head?

Dr. Tushar: This typically happens in BPPV, where displaced calcium crystals inside the inner ear move with certain head positions. When a person suddenly sits up, lies down, or turns their head, these crystals stimulate the balance sensors in an abnormal way.

As a result, the brain receives conflicting signals about body position, creating a brief spinning sensation that usually lasts a few seconds to a minute. Although it can feel alarming, this type of vertigo is usually benign and treatable.

Are scans like MRI or CT required in all vertigo cases?

Dr. Tushar: No, scans are not required in most cases of vertigo. Many patients can be diagnosed through a detailed medical history and simple bedside tests that assess eye movements and balance.

Imaging such as MRI or CT scans is usually recommended only when doctors suspect a central nervous system cause for example, if the patient has neurological symptoms like weakness, double vision, severe headache, or difficulty speaking. In such cases, scans help rule out conditions like stroke or structural brain abnormalities.

How effective are exercises or repositioning manoeuvres compared to medicines?

Dr. Tushar: In conditions such as BPPV, repositioning manoeuvres like the Epley manoeuvre are often more effective than medications. These exercises help guide the displaced crystals in the inner ear back to their correct position, addressing the root cause of vertigo.

Vestibular rehabilitation exercises can also help the brain adapt to balance disturbances and reduce symptoms over time. Medications may provide temporary relief from nausea or severe spinning sensations, but they usually do not correct the underlying problem.

When should vertigo be treated as a medical emergency?

Dr. Tushar: Vertigo should be treated as a medical emergency if it occurs suddenly and is accompanied by warning signs such as severe headache, weakness in the arms or legs, difficulty speaking, double vision, loss of consciousness, or trouble walking.

These symptoms may indicate a stroke or another serious neurological condition and require immediate medical evaluation. Persistent vertigo with new hearing loss or severe vomiting should also be assessed urgently.

Is vertigo curable, or does it usually need long-term management?

Dr. Tushar: Many forms of vertigo, particularly BPPV are highly treatable and often resolve completely with appropriate repositioning manoeuvres. Some patients may experience occasional recurrences, but these can usually be managed effectively with repeat treatment.

However, certain conditions such as Ménière’s disease or vestibular migraine may require long-term management, including lifestyle modifications, medications, and vestibular rehabilitation. With proper diagnosis and treatment, most patients are able to control symptoms and maintain a normal quality of life.