Vertigo Symptoms: Type of Vertigo

Types of vertigo: Merry-go-round, boat, elevator or "cotton in your head"?

The type of vertigo you are suffering from give your doctors in important hint where to look for the causes. Therefore the first important question is: "Is your vertigo directional?" Types of vertigo to which patients attribute a direction often have a concrete cause, e.g. damage to the balance organ in the inner ear (peripheral and vestibular disorder).

Directional types of vertigo

Rotational vertigo

Rotational vertigo often comes with a spinning sensation, like the room is turning or tilting - similar to riding a merry-go-round. Such vertigo occurs e.g. with Menière's disease, with benign positional vertigo (benign paroxysmal positional vertigo [BPPV]) or failure of the vestibular system (neuropathia vestibularis).

As diverse as the causes of vertigo might be, the different types of vertigo/dizziness are just as varied. There’s dizziness with floating sensation (vertigo) with its sinking feeling of being in an elevator that is starting to move, and postural vertigo that results in a shaky uncertain stand and gait. But the so-called rotational vertigo is among the most common.

Typically, rotational vertigo attacks occur spontaneously, are unpredictable and can last from a few minutes up to several days. This vertigo type falls into two sub-types: the so-called rotational vertigo attack and the so-called persistent rotational vertigo.

Persistent vertigo

If vertigo symptoms persist over hours or even days, we talk about persistent vertigo. Typically, this goes along with a tendency to fall, nausea as well as vomiting and eye tremors, called nystagmus. The causes of this kind of vertigo are in most cases linked to a functional disorder of the balance system. For example, rotational vertigo is often the result of an inflamed balance nerve shutting down the balance system on one side. Usually the complaints subside after about one to two weeks.

In rare cases, damage to the central structures of the brain can also result in persistent rotational vertigo. Causes can be very diverse, ranging from blood circulatory problems, brain tumors to neurological failure in the brain.

Rotational vertigo attacks

Typically, attacks of rotational vertigo set in very suddenly and severely and can last from seconds up to several minutes. Those affected report experiencing nausea, a spinning sensation and a tendency to fall. The cause of such attacks of rotational vertigo can often be Manière's disease, but the so-called benign paroxysmal positional vertigo is also known for its sudden attacks that only last for a few seconds and disappear just as quickly.

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Postural vertigo

Postural vertigo manifests itself in an uncertain, shaky gait; you feel as if the room around you is staggering or you are – not unlike being on a boat on a stormy sea. This vertigo is typical of e.g. somatoform vertigo – for psychogenic or stress-induced vertigo.

Postural vertigo – similar to rotational vertigo and floating sensation (vertigo) – is another unpleasant way of experiencing vertigo. Here, the afflicted typically have the feeling that either the world around them is staggering or they are – similar to being on a ship on rough seas. Postural vertigo goes along with being unsteady on your feet and a tendency to fall.

Vertigo caused by emotional stress

Postural vertigo is normally induced by the so-called somatoform vertigo and that makes it a type of emotional vertigo. Triggers can be depression, anxiety or stress. Events such as large crowds or the fear of flying can bring about sudden vertigo attacks. Caused by stress or anxiety, somatoform vertigo that has no organic origin is a typical example of staggering vertigo. Normally, it is accompanied by nausea, shortness of breath, rapid heartbeat or sleeping disorders. Phobias and anxiety disorders often go along with shaking, while depression is often accompanied by headaches.

Postural vertigo attacks usually subside after a few seconds. In individual cases, however, they can become a constant companion. For those affected, it is important to learn how to manage staggering vertigo: In the long run, patients should consider psychotherapy.

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Floating sensation (vertigo)

Floating sensation (vertigo) on the other hand makes you feel like riding an elevator that starts moving: The bottom of the elevator cabin seems to either lift or drop and can give you a feeling of up and down dizziness. Floating sensation (vertigo) can also be indicative of somatoform causes.

In contrast to directional forms of vertigo, non-directional vertigo or lightheadedness makes those affected feel wobbly on their legs; they feel "woozy" or have visual problems (seeing double or black spots before their eyes). Many patients report "cotton in their head". Non-directional vertigo can point toward cardiovascular or metabolic diseases but also visual disorders as a possible cause.

Floating sensation (vertigo) – A permanent roller-coaster

People suffering from vertigo have a disorder of several of their senses. This results in balance problems and an unsteady posture or gait (loss of being in control of your body).

Apart from rotational and postural vertigo, floating sensation (vertigo) is considered to be one of the particularly unpleasant and annoying types of vertigo. Those suffering from it have the permanent sensation of riding on an elevator or rollercoaster. Floating sensation (vertigo) is felt as an unpleasant slumping or falling, an up and down dizziness.

Floating sensation (vertigo) belongs to the systematic types of dizziness/vertigo

Floating is defined as a systematic type of vertigo that has its origin in a disorder of the balance system, an area in the cerebellum or brain stem.

Typically, floating sensation (vertigo) attacks last from a few seconds up to several minutes and are often accompanied with drowsiness and severe discomfort. There might also be the symptom of an unsteady gait, which increases the danger of falling.

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When no causes can be identified

Apart from types of vertigo whose symptoms are indicative of certain disorders, there are also types of vertigo with causes that are either diverse or inconclusive. This is why the term multifactorial vertigo is used to encompass all these different types, i.e. vertigo that is influenced by several factors.

Schneider B et al. (2005): Treatment of vertigo with a homeopathic complex remedy compared with usual treatments: a metaanalysis of clinical trials. Arzneim-Forsch/Drug Res 55(1):23-29