Ask the Doctor: Brief vertigo

For about 3-4 years now, I will occasionally get VERY strong episodes of vertigo where it feels like I am being very strongly pulled in a weird direction. Sometimes it feels like my head is shaking back and forth. These episodes usually last anywhere from 20 seconds to sometimes 5-7 minutes. They NEVER happen when standing or moving. They only happen when lying down or sitting down, completely still. … I don’t have migraines, I DO sometimes get spinning sensations… I’m struggling to find conditions that cause vertigo that are not brought on by head movements. I used to get these episodes once every 3 or so weeks maybe, but over the past 3 months, I get them now daily, sometimes multiple times a day. The only good thing is that I can get myself out of any episode by moving, slightly aggressively. All I have to do is stand up and walk around and the sensation will subside until I sit or lay again completely still.

Read more: Ask the Doctor: Brief vertigo

Your description gives some important clues.  These are spontaneous, non-positional vertigo spells that last for minutes.  They are fairly mild because you don’t see the world spinning when they occur, although you mentioned some spinning sensations.  The pulling sensation you describe can be coming from the spinning sensors if the spinning is very brief.  With brief vertigo there will be a sense of tugging of the head along with a short rotation as if just starting to flip forward or back and toward one side. Very brief spells of vertigo don’t allow you to see the room spin because the sensation is not long enough to cause nystagmus (the rhythmic jerking of the eyes when vertigo is prolonged).  Brief vertigo spells can progress to longer spells over time and might eventually cause you to see the room spinning if the condition is progressive.  One condition that can cause these type of brief spells is superior semicircular canal dehiscence (SSCD). Sometimes a slight squealing sound can be heard if you turn your eyes strongly to the side in this condition, and loud noises, sneezing or coughing may set off a momentary feeling of tilting or spinning. 

Pulling sensations can also be due to gravity sensor malfunctions.  If the spells are brief and you are upright, you will see the floor appear to tilt momentarily.  This type of vertigo strongly affects balance, but since yours have been while sitting or lying down, that hasn’t affected you yet.  Gravity sensor vertigo can be brought on when lying down, but unlike BPPV it does not have a curving or spinning quality.  It feels like you are rocketing in a straight line, often backward or up- or downward, as if in an elevator.   

The most common cause of spontaneous vertigo lasting minutes is a form of migraine.  While you deny headaches, it is possible to have this kind of vertigo even with fairly mild headaches.  Headaches on one side of the head that are low grade can still be migraines.  Sometime migraine presents with flashing lights in the eyes or seeing a rippling zig-zag or rainbow-like illusion.  There is another important condition that causes  migraine-like vertigo, however: sleep apnea.  This is associated with snoring or pauses in breathing while asleep and frequent nighttime awakenings.  If you have these symptoms, you should inquire about having a sleep study.  The treatment, a CPAP machine, often resolves all the vertigo. 

Pay attention to your hearing. When an ear has a progressive disorder, hearing can often decline. Rubbing your fingers next to each ear can allow to notice small differences in hearing–both ears should normally hear the same intensity and sound quality. Any ringing in the ear is also an important clue. Ringing is often thought of as a high pitched sound, but low sounds like the roar of a vacuum cleaner can also indicate a disease. A formal hearing test is much more sensitive and should be done in anyone with vertigo.

Your best bet is to have a full inner ear workup by an otolaryngologist.  This should include a hearing test, videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP), and a sleep study if you have any of the sleep apnea symptoms above.  These tests will show if there is any permanent damage to hearing or balance or any evidence for SSCD.  If every test comes back perfectly normal, be prepared to re-test in 6 months as progressive inner ear disorders sometimes take time to develop signs of damage.