Vertigo: Causes, Treatments and the Role of Supplements

10 August 2024, by SANUSq Research team
13 min reading time

Older man lying on a sofa holding his head, with an inner-ear icon representing vertigo

Search for natural remedies for vertigo and you will find plenty of promises that a capsule or a herbal tea will make the spinning stop. The reality is more useful. Vertigo is a symptom, not a disease in itself, and once its cause is known there are often very effective ways to deal with it. Most of them, though, are not supplements.

Written by SANUSq Research Team | Medically reviewed by Dr Ajay Kumar, MD
Published: 10 August 2024 | Updated: 10 August 2024

Vertigo is a symptom, not a diagnosis

Vertigo is the feeling that the room is spinning, or that you are, when you are in fact still. It usually comes from the vestibular system, the balance organ in the inner ear. It differs from feeling light-headed, faint or simply unsteady, and that distinction is the first thing a doctor will try to pin down. Vertigo that is new, unusual or keeps coming back is worth discussing with your doctor.

Balance relies on the inner ear, whose fluid-filled canals detect head movement, on your eyes and on position sensors in muscles and joints. When one of them, most often the inner ear, sends a faulty signal, the brain receives conflicting reports, and that mismatch produces the sense that everything is moving.

The main causes of vertigo

The word covers very different conditions. The most common include:

Benign paroxysmal positional vertigo (BPPV) — the most frequent cause. Tiny calcium crystals in the inner ear come loose and drift into one of the canals, triggering short but intense spells of vertigo when you change the position of your head: lying down, turning over in bed or looking up.
Vestibular neuritis (or labyrinthitis) — inflammation of the balance nerve or inner ear, often after a viral infection. The vertigo can be severe and last for days, but it usually settles gradually as the brain adapts.
Ménière's disease — an inner-ear condition that combines attacks of vertigo with fluctuating hearing loss, tinnitus and a feeling of fullness in the ear.
Vestibular migraine — episodes of vertigo linked to migraine, sometimes with little or no headache.
Central causes — problems arising in the brain rather than the ear. These are less common, but some are serious and need prompt assessment.

Diagnostic criteria agreed by the Bárány Society and the International Headache Society, published by Lempert et al. (2012), define vestibular migraine by recurrent vestibular symptoms of moderate or severe intensity in someone with a history of migraine, a link in time between the vertigo and migraine features, and the exclusion of other causes. Episodes last between five minutes and 72 hours.

Low blood pressure on standing, some medicines, dehydration, anxiety or neck problems can cause similar dizziness, which is why self-diagnosis is unreliable.

When vertigo is an emergency

This is the most important section of this article. In a small number of cases, vertigo is a sign of a serious neurological problem such as a stroke. Call emergency services straight away (112 in Europe, 999 in the UK) if vertigo comes with any of the following:

Slurred speech or difficulty finding words
Weakness or numbness on one side of the body or face
Double vision or sudden loss of vision
A sudden, severe headache unlike any you have had before
Difficulty walking, loss of coordination or being unable to stand
Confusion, drowsiness or reduced consciousness

With these warning signs, every minute counts. This is never a situation for waiting to see, and never one where a supplement has any place.

How vertigo is diagnosed

Most of the work is done by listening and examining, not by scans. Your doctor will ask what the sensation feels like, how long it lasts, what triggers it and whether hearing loss, ringing in the ears or headache come with it. The Dix-Hallpike test, in which the head is turned and lowered while the doctor watches the eyes, helps confirm BPPV. Eye-movement checks known as HINTS help separate an inner-ear problem from a central cause in someone with continuous, severe vertigo.

A meta-analysis by Ooi et al. (2023) pooled 11 studies of the head impulse test and the HINTS examination and concluded that they appear to be moderately good at telling peripheral vertigo apart from stroke. Most tests were done by specialist neurologists, which may limit how well the results apply in emergency departments.

For typical BPPV without other worrying signs, scans are usually unnecessary.

Treatments that work

The right approach depends on the cause, which is why diagnosis comes first.

Repositioning manoeuvres for BPPV

For BPPV, the standard approach is not a medicine but a repositioning manoeuvre, most often the Epley manoeuvre: a short sequence of head and body positions that guides the loose crystals out of the canal. Relief is often quick.

A Cochrane review by Hilton and Pinder (2014), covering 11 randomised trials and 745 patients, found that complete resolution of vertigo occurred in 56% of people after the Epley manoeuvre, compared with 21% after a sham manoeuvre or no treatment. No serious adverse effects were reported, although some people felt nauseous during the manoeuvre. The authors also noted a high recurrence rate after treatment, of around 36%.

The American clinical practice guideline on BPPV by Bhattacharyya et al. (2017) strongly recommends treating posterior canal BPPV with a repositioning procedure, or referring to someone who can. It advises against routine use of vestibular suppressant medicines and against routine imaging when the diagnosis is clear.

The manoeuvre should first be done or taught by a doctor or physiotherapist once the diagnosis is confirmed; some people then learn to repeat it at home.

Vestibular rehabilitation

Vestibular rehabilitation is a programme of eye, head and balance exercises that helps the brain recalibrate, particularly after vestibular neuritis.

A Cochrane review by McDonnell and Hillier (2015), including 39 studies and 2,441 participants with one-sided inner-ear balance problems, found moderate to strong evidence that vestibular rehabilitation is safe and effective, reducing dizziness and improving day-to-day function. For BPPV specifically, repositioning manoeuvres worked better in the short term, while combining the two helped longer-term recovery.

"Anti-vertigo" medicines (vestibular suppressants) are meant for short periods only; taken for too long, they can slow the brain's natural adaptation.

Ménière's disease and vestibular migraine

Ménière's disease has its own measures, often a lower-salt diet, avoiding triggers and prescribed treatments. Vestibular migraine is usually managed like other migraine: identifying triggers, regular sleep and meals, and prescribed medicines where needed.

Natural remedies for vertigo: what the research shows

Let's be clear: no supplement "regulates the vestibular system" or makes vertigo disappear, whatever some adverts suggest. Supplements are not a substitute for a diagnosis. That said, a few have been studied, and the findings are worth knowing.

Vitamin D and recurrent BPPV

The most interesting link concerns vitamin D and vertigo, specifically recurrent BPPV. Vitamin D contributes to the normal absorption and use of calcium, and BPPV crystals are made of calcium carbonate.

In a large randomised trial, Jeong et al. (2020) followed 1,050 people whose BPPV had been successfully treated with repositioning manoeuvres. Those in the intervention group whose vitamin D level was below 20 ng/mL took vitamin D and calcium for a year. The intervention group had fewer recurrences (0.83 versus 1.10 per person-year), and the proportion with any recurrence was lower (37.8% versus 46.7%).

A systematic review and meta-analysis by Wood et al. (2024) found that people with BPPV tended to have lower vitamin D levels than those without it. The link between vitamin D levels and recurrence, however, remained uncertain, and the quality of the studies varied.

So the evidence points to one specific situation: people with recurrent BPPV who are low in vitamin D. That is a matter for your doctor, based on a blood test, not a general fix for dizziness. If you are wondering about vitamins for vertigo more broadly, this is the only one with meaningful trial evidence.

Ginkgo biloba

Ginkgo extract has been studied for vertigo for decades, often in small or low-quality trials.

In a 12-week double-blind trial, Sokolova et al. (2014) compared a standardised ginkgo extract with betahistine, a prescribed vertigo medicine, in 160 patients. Both groups improved similarly, with fewer side effects on ginkgo. There was no placebo group, so the trial cannot show how much of the improvement was due to either treatment.

Ginger

Ginger is a traditional remedy for nausea, but its research base is mainly motion sickness, not inner-ear vertigo.

In a small crossover study of 13 volunteers prone to motion sickness, Lien et al. (2003) found that taking ginger beforehand reduced the nausea induced by a rotating visual drum, delayed its onset and shortened recovery, compared with placebo.

A note on safety

Ginkgo and ginger may both affect blood clotting. If you take a blood thinner such as warfarin, a direct oral anticoagulant, aspirin or clopidogrel, or you are due to have surgery, talk to your doctor or pharmacist before taking either. The same applies if you are pregnant or breastfeeding.

The best "natural" approach is an accurate diagnosis, followed by the management suited to the cause.

What you can do day to day

While you wait for an appointment, a few measures reduce discomfort and the risk of falling:

Sit or lie down as soon as a spell begins.
Move your head slowly and get up gradually, especially first thing in the morning.
Make your home safer with good lighting, secured rugs and something sturdy to hold, particularly for older people.
Drink enough fluids and don't skip meals, as dehydration and low blood sugar can make dizziness worse.
Keep a short diary of triggers, duration and any other symptoms. It helps your doctor a great deal.

The bottom line

Vertigo is a symptom to understand. Most cases come from the inner ear and respond well to repositioning manoeuvres or vestibular rehabilitation once the cause is known. Supplements have no proven role in resolving it; the one notable finding concerns vitamin D in recurrent BPPV with low levels, under medical supervision.

Frequently asked questions

Can a supplement get rid of vertigo?

No supplement has been shown to stop vertigo. The approaches that work, such as repositioning manoeuvres and vestibular rehabilitation, depend on an accurate diagnosis.

What is the Epley manoeuvre?

A series of head and body positions that moves loose inner-ear crystals out of the canal in BPPV. It should first be performed or taught by a doctor or physiotherapist.

Does vitamin D help with vertigo?

Only in a specific situation. In people with recurrent BPPV and low vitamin D levels, a large trial found fewer recurrences with vitamin D and calcium. This should be decided with your doctor after a blood test; it is not a general answer to dizziness.

When should I worry about vertigo?

Call emergency services immediately if vertigo comes with slurred speech, weakness on one side, double vision, a sudden severe headache or difficulty walking. These can be signs of a stroke. New, persistent or recurring vertigo without these signs still deserves a medical opinion.

Does vertigo go away on its own?

Sometimes. Vestibular neuritis often settles over days to weeks, and BPPV can resolve by itself. But vertigo that persists, keeps returning or feels unusual should be checked so the cause can be found.

Can stress cause vertigo?

Anxiety and stress can cause dizziness or a sense of imbalance, which is different from true spinning vertigo. If no inner-ear cause is found, this is worth exploring with a professional.

References

Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. Journal of Vestibular Research. 2012;22(4):167–172. PMID 23142830
Ooi S, Phillips G, Tang T, et al. Meta-analysis of the use of head impulse test and head impulse test with direction changing nystagmus and test of skew deviation in the diagnosis of peripheral vertigo and stroke. Cerebrovascular Diseases. 2023;52(2):184–193. PMID 36088909
Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. 2014;2014(12):CD003162. PMID 25485940
Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery. 2017;156(3 Suppl):S1–S47. PMID 28248609
McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews. 2015;1(1):CD005397. PMID 25581507
Jeong SH, Kim JS, Kim HJ, et al. Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: a randomized trial. Neurology. 2020;95(9):e1117–e1125. PMID 32759193
Wood H, Kluk K, BinKhamis G. Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis. BMJ Open. 2024;14(4):e077986. PMID 38653514
Sokolova L, Hoerr R, Mishchenko T. Treatment of vertigo: a randomized, double-blind trial comparing efficacy and safety of Ginkgo biloba extract EGb 761 and betahistine. International Journal of Otolaryngology. 2014;2014:682439. PMID 25057270
Lien HC, Sun WM, Chen YH, et al. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. American Journal of Physiology – Gastrointestinal and Liver Physiology. 2003;284(3):G481–G489. PMID 12576305

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