Medically reviewed by Dr. Sarim Mir, board-certified neurologist at Mir Neurology. Last reviewed: October 2026.
Call 911 if vertigo or dizziness is sudden and severe or comes with stroke-type symptoms — face drooping, arm weakness, slurred speech, double vision, a severe headache, numbness, trouble walking, or fainting. Sudden vertigo can occasionally be a stroke and needs emergency care.
Short answer: Most vertigo comes from the inner ear (called peripheral vertigo), not the brain. Less often, vertigo is neurological (central vertigo), caused by a problem in the brainstem or cerebellum — such as vestibular migraine, multiple sclerosis, or, rarely, a stroke. The pattern of symptoms, the eye movements, and whether there are other nervous-system signs help tell the two apart.
Dizziness vs. vertigo
“Dizziness” is a broad word. Vertigo specifically means a false sense that you or the room is spinning or moving. Other types of dizziness include lightheadedness (feeling faint) and imbalance (feeling unsteady on your feet). Telling your doctor exactly which one you feel helps narrow the cause quickly.
Central vs. peripheral vertigo: key differences
| Peripheral (inner ear) | Central (neurological) | |
|---|---|---|
| Where it starts | Inner ear or the balance (vestibular) nerve | Brainstem or cerebellum |
| How common | Most cases of vertigo | Less common |
| Spinning | Often intense, may come in episodes or with head movement | Often milder spinning but more unsteadiness |
| Walking | Usually able to walk, though unsteady | Often severe imbalance; may be unable to stand or walk |
| Hearing | Hearing loss, ringing, or ear fullness may occur | Hearing usually not affected |
| Other symptoms | Nausea; no other neurological symptoms | Double vision, slurred speech, weakness, numbness, severe headache, or poor coordination |
| Eye movements (nystagmus) | Usually horizontal, one direction, lessens when focusing on an object | May change direction or be vertical; doesn’t lessen with focusing |
| Common causes | BPPV, vestibular neuritis, labyrinthitis, Meniere’s disease | Vestibular migraine, stroke or TIA, multiple sclerosis, tumors (rare) |
Inner-ear (peripheral) causes of vertigo
- BPPV (benign paroxysmal positional vertigo): the most common cause of vertigo. Brief spinning (usually under a minute) when you roll over in bed, look up, or bend down. Often treated with a simple repositioning maneuver such as the Epley maneuver.
- Vestibular neuritis and labyrinthitis: inflammation of the balance nerve or inner ear, often after a virus. Causes constant vertigo for days; labyrinthitis also affects hearing.
- Meniere’s disease: episodes of vertigo lasting hours with hearing loss, ringing, and ear fullness.
Inner-ear vertigo can feel frightening, but it is usually not dangerous and often improves with treatment or vestibular therapy.
When is vertigo a neurological problem?
Vertigo is more likely to be neurological (central) when it comes with:
- Double vision or vision loss
- Slurred speech or trouble swallowing
- Weakness or numbness of the face, arm, or leg
- Severe imbalance or inability to walk
- A sudden, severe headache
- Risk factors for stroke, such as high blood pressure, diabetes, smoking, or atrial fibrillation
The most common neurological cause is vestibular migraine, which can cause vertigo episodes with or without a headache. A stroke or TIA in the back of the brain is less common but is an emergency. If you have stroke risk factors, read about how high blood pressure raises stroke risk and our stroke and TIA care.
How a neurologist tells inner-ear from neurological vertigo
A neurologist takes a careful history — what the dizziness feels like, what triggers it, and how long it lasts — and examines your eye movements, balance, coordination, and nerves. Common bedside tests include:
- Dix-Hallpike test: moving the head into specific positions to check for BPPV.
- HINTS exam (Head Impulse, Nystagmus, Test of Skew): a set of eye-movement tests that, in trained hands, helps separate inner-ear causes from stroke in people with sudden, constant vertigo.
- Gait and coordination testing, and in some cases MRI or balance testing.
Treatment depends on the cause
Inner-ear vertigo may respond to repositioning maneuvers, vestibular rehabilitation therapy, or short-term medication. Neurological vertigo is treated by addressing the cause — for example, migraine prevention for vestibular migraine. Learn about our vertigo and dizziness treatment. If your dizziness started with screen time or eye strain, see can eye fatigue cause dizziness.
See a neurologist for vertigo in Hagerstown or Cumberland
If vertigo keeps coming back, doesn’t improve, or comes with other symptoms, a neurology evaluation can find the cause. Book an appointment or call (301) 797-7600.
Frequently asked questions
Is vertigo neurological or an inner ear problem?
Most vertigo comes from the inner ear (peripheral vertigo). Less often it is neurological (central vertigo), caused by a problem in the brainstem or cerebellum such as vestibular migraine or, rarely, a stroke.
How do I know if my dizziness is neurological?
It is more likely neurological if it comes with double vision, slurred speech, weakness, numbness, a severe headache, or being unable to walk. These need urgent medical care.
Can a neurologist treat vertigo?
Yes. A neurologist can determine whether vertigo comes from the inner ear or the nervous system and guide treatment, including repositioning maneuvers, vestibular therapy, or migraine treatment.
What is the most common cause of vertigo?
BPPV (benign paroxysmal positional vertigo), an inner-ear condition that causes brief spinning with head movements.
When is vertigo an emergency?
When it is sudden and severe, or comes with face drooping, arm weakness, speech trouble, double vision, numbness, a severe headache, or trouble walking. Call 911.
Sources: MedlinePlus – Vertigo-associated disorders; NIDCD (NIH) – Balance Disorders; Johns Hopkins Medicine – Vertigo.
Need to talk to a neurologist about this?
Mir Neurology offers same-week appointments in Hagerstown & Cumberland, MD. No referral needed for most plans.
