What Triggers the Onset of Vertigo?

Key Pointers at a Glance:

Vertigo is more than just dizziness. It’s a false sensation of spinning or movement.
The most common cause is Benign Paroxysmal Positional Vertigo (BPPV), often triggered by head movements.
Inner ear infections, migraines, Meniere’s disease, or even dehydration can cause sudden onset of vertigo.
Stress, anxiety, and fatigue can worsen balance symptoms or bring on your first episode.
If vertigo keeps returning, is accompanied by hearing symptoms, or affects daily life, it’s time to see an ENT doctor.

That sudden feeling that the room is spinning —even when you’re sitting still— can be startling and disorienting. If you’ve ever experienced vertigo, you’ll know it’s not just “feeling dizzy.” It’s a very specific kind of imbalance that can affect your sense of stability, movement, and confidence in daily life. But what exactly triggers the onset of vertigo? And why do some people feel it when they roll over in bed, while others get it after a long day at work? Let’s explore some of the common causes of vertigo and what might bring on that first episode.

Vertigo: A Quick Overview

Vertigo is a sensation of spinning or movement that isn’t actually happening. It’s often described as:

Feeling like you or the room is rotating
Losing your balance or needing to grab onto something
Nausea or visual disturbances accompany the spinning sensation

Vertigo is often associated with inner ear problems, as the inner ear plays a crucial role in helping your brain process motion and maintain balance.

Common Causes of Vertigo Onset

Several conditions and lifestyle factors can trigger vertigo. Sometimes, the first episode can seem to come out of nowhere but often, it’s linked to one of the following:

1. Benign Paroxysmal Positional Vertigo (BPPV)

This is one of the most common causes. BPPV occurs when tiny calcium crystals in the inner ear become dislodged and interfere with your balance sensors. It may be triggered by:

Rolling over in bed
Looking up or down quickly
Sudden head movements

People with BPPV often describe their first episode as happening while getting out of bed or tilting their head back to wash their hair.

2. Inner Ear Infections (Labyrinthitis or Vestibular Neuritis)

These are usually caused by viral infections. The inflammation affects the balance nerves in the inner ear, causing sudden vertigo, often with nausea and imbalance. The first signs may follow a recent cold or flu.

3. Meniere’s Disease

This condition causes repeated episodes of vertigo, along with hearing loss, tinnitus (ringing in the ear), and ear pressure. Episodes can be unpredictable, and the first one may last from 20 minutes to several hours.

4. Migraines

Vestibular migraines can cause vertigo even without a traditional headache. Some people first experience vertigo as a part of their migraine pattern, triggered by stress, sleep changes, or certain foods.

5. Dehydration or Low Blood Pressure

Standing up too quickly after sitting for a long time, skipping meals, or being dehydrated in hot weather can lead to light-headedness or vertigo-like symptoms. This is more likely when your blood pressure drops suddenly.

6. Stress and Anxiety

Chronic stress can trigger or worsen dizziness and imbalance. Some individuals may notice vertigo for the first time during emotionally intense periods or when feeling overwhelmed.

Vertigo Isn’t Always Caused by the Ear

It’s important to note that not all vertigo originates from the inner ear. In fact, research shows that only about one-third of giddiness or balance complaints are ear-related. The rest may involve other systems in the body and should not be overlooked.

Other possible causes include:

Stroke or Transient Ischaemic Attack (TIA)
Especially if symptoms come with sudden weakness, speech difficulty, or visual changes.
Heart Rhythm Disturbances or Low Blood Pressure
May cause dizziness or blackouts, particularly in older adults or those with cardiovascular risk factors.
Medication Side Effects
Sedatives, antihypertensives, or even some antibiotics can lead to balance issues, especially when combined.
Neurological Disorders
Conditions like multiple sclerosis or Parkinson’s disease may present with vertigo or unsteadiness.
Blood Sugar Fluctuations
People with diabetes may experience dizziness when sugar levels drop or spike.

Because of this, patients with vertigo may require a multi-disciplinary approach. Your ENT specialist may coordinate with other doctors such as a neurologist, cardiologist, or geriatrician, depending on your symptoms and health history.

When Do People Usually First Notice Vertigo?

Many people report that their first episode of vertigo happens during everyday activities like:

Turning over in bed
Getting up too fast
Tilting their head during exercise or yoga
After a period of illness (like a cold or sinus infection)
During periods of poor sleep or high stress

If the spinning sensation lasts for seconds to minutes and seems to follow certain movements, it may point to BPPV. If it comes with other symptoms like hearing changes or ringing in the ear, an ENT evaluation is usually advised.

When to See an ENT Specialist for Vertigo

While vertigo can sometimes go away on its own, it’s worth seeing a doctor if:

The episodes keep coming back
You feel off balance even when not dizzy
You experience hearing loss, ear fullness, or ringing
The vertigo lasts more than a few minutes at a time
You’re unsure whether it’s vertigo or something else

At Dr Lynne Lim Ear Nose Throat Head and Neck Surgery Centre, Dr Lynne Lim, a Senior Consultant Ear Nose Throat – Head & Neck Surgeon, works closely with patients to assess the underlying cause of vertigo. The clinic offers in-house vestibular tests, balance assessments, and repositioning manoeuvres for BPPV, along with care plans tailored to individual needs.

Book an appointment today if vertigo is disrupting your day even if it’s just started. Early evaluation can help you feel more stable, informed, and in control.