Vertigo and dizziness: common causes, exercises that help, and when it’s a stroke
Vertigo, the feeling that you or the room is spinning, is frightening but usually comes from a harmless inner ear problem. The most common cause can often be fixed in minutes with a head manoeuvre. Occasionally, though, sudden vertigo is a sign of a stroke. Here is how to tell the difference, what helps, and when to get urgent help.
Key points
- Vertigo is a spinning sensation. Dizziness can also mean feeling light-headed, faint or unsteady, which often has different causes.
- The most common cause is BPPV: brief spinning, usually under a minute, when you roll over in bed, look up or bend down.
- The Epley manoeuvre fixes BPPV in about 7 or 8 in 10 people after one to three treatments. Anti-dizziness tablets aren’t recommended for BPPV.
- Medicines such as cinnarizine and betahistine are available from pharmacists in Malaysia, but should only be used for a few days, as they can slow recovery and cause drowsiness.
- Call 999 for vertigo with double vision, slurred speech, weakness, numbness, sudden hearing loss or inability to walk. It may be a stroke.
Vertigo or dizziness?
- Vertigo: a false sense that you or your surroundings are spinning or moving. It usually comes from the inner ear, and sometimes from the brain.
- Light-headedness: feeling faint or about to pass out, often from low blood pressure, dehydration, low blood sugar or anaemia.
- Imbalance: feeling unsteady on your feet, common in older people.
Telling your doctor what it feels like, how long it lasts, and what brings it on is the most useful information for working out the cause. About 1 in 13 people have vertigo from an inner ear or balance problem at some point in their lives, more often women and older adults.
Why does vertigo happen? (Sebab vertigo)
| Cause | Typical pattern |
|---|---|
| BPPV (benign paroxysmal positional vertigo) | Brief spinning, usually under 1 minute, triggered by rolling over in bed, looking up or bending down. Caused by tiny crystals in the inner ear moving out of place. Hearing is normal. Most common in people in their 50s to 70s, and after head injury. |
| Vestibular neuritis and labyrinthitis | Sudden, severe vertigo lasting days, often after a cold or flu, with nausea and vomiting. Labyrinthitis also affects hearing or causes ringing. Balance usually recovers over 2 to 6 weeks. |
| Ménière’s disease | Attacks of vertigo, usually lasting 20 minutes to several hours, with hearing loss, ringing (tinnitus) and a feeling of pressure in one ear |
| Vestibular migraine | Vertigo lasting minutes to days, often with migraine headaches or sensitivity to light. More common in women. |
| Low blood pressure on standing | Light-headedness when getting up quickly, from dehydration, some blood pressure medicines, diabetes or older age |
| Other causes | Low blood sugar in diabetes, anaemia, anxiety, heat exhaustion, and new medicines |
In older adults, medicines are a common cause of dizziness. Bring a list of your medicines to your doctor.
Exercises for vertigo at home
The Epley manoeuvre is a series of head and body positions that move the loose crystals back to where they belong. It is the recommended treatment for the most common type of BPPV:
- About 7 or 8 in 10 people improve after one to three treatments.
- It works far better than older home exercises (Brandt-Daroff exercises).
- You don’t need to sleep upright or restrict head movements afterwards.
The manoeuvre depends on which ear is affected, so it is best to have a doctor or physiotherapist confirm the diagnosis and do it the first time. They can then teach you how to repeat it at home if the vertigo comes back.
Vestibular rehabilitation is a programme of balance and eye-head exercises, guided by a physiotherapist. It helps the brain adapt after vestibular neuritis, and for lasting unsteadiness. Keeping gently active and walking early, rather than staying in bed, also speeds recovery.
Medicines for vertigo, including cinnarizine
Anti-dizziness medicines, called vestibular suppressants, can ease severe symptoms for a short time:
- Cinnarizine, dimenhydrinate and promethazine (antihistamines) and betahistine can be supplied by a pharmacist in Malaysia without a prescription. Prochlorperazine, for severe nausea and vertigo, needs a prescription.
- Use them only for a few days. In vestibular neuritis, taking them for longer than about 3 days can slow the brain’s natural recovery.
- They aren’t recommended for BPPV. They don’t fix the cause, and they increase the risk of falls.
- Side effects: cinnarizine commonly causes drowsiness, so don’t drive or drink alcohol. Rarely, especially in older people with long-term use, it can cause stiff, slow or jerky movements. Betahistine, used mainly for Ménière’s disease, usually doesn’t cause drowsiness.
Check with a doctor or pharmacist before using these medicines if you are older, pregnant, or have Parkinson’s disease, glaucoma, or liver or kidney disease.
When dizziness is a stroke
A stroke in the back of the brain can cause sudden vertigo, and sometimes looks just like an inner ear infection. In one study, vertigo was the first symptom in nearly half of people with this type of stroke. A normal CT scan doesn’t rule it out.
Call 999 if vertigo or dizziness comes with
- Double vision or loss of vision
- Slurred speech or difficulty speaking
- Weakness, numbness or tingling in the face, arm or leg
- Clumsiness, or being unable to stand or walk
- Sudden hearing loss in one ear
Remember BE FAST: Balance, Eyes, Face, Arm, Speech, Time to call 999.
The risk is higher in people over 50, and those with high blood pressure, diabetes, high cholesterol, an irregular heartbeat (atrial fibrillation), a previous mini-stroke, or who smoke. See our stroke and heart attack guide.
Staying safe, and when to see a doctor
- Sit or lie down as soon as you feel dizzy. Lying still in a quiet, dark room helps during an attack.
- Get up slowly, sitting on the edge of the bed for a minute first.
- Don’t drive, climb ladders or use machinery while dizzy.
- Older people should take extra care to prevent falls. About 1 in 3 adults over 65 falls each year.
See a doctor if vertigo keeps coming back or doesn’t settle, if you aren’t improving after a few days of an inner ear infection, or if dizziness started after a new medicine. Get urgent help for vertigo with a severe headache, vomiting that won’t stop, fever, or sudden hearing loss.
Where to see a doctor about vertigo
A GP can work out the likely cause of vertigo, perform the Epley manoeuvre for BPPV, check your blood pressure and medicines, and refer you to an ENT specialist or physiotherapist if needed. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states.
Browse the clinic directoryFrequently asked questions
What causes vertigo? (Sebab vertigo)
The most common cause is BPPV, when tiny crystals in the inner ear move out of place. Others include inner ear infections (vestibular neuritis and labyrinthitis), Ménière’s disease and vestibular migraine. Rarely, it is a stroke.
What exercise can I do for vertigo at home?
For BPPV, the Epley manoeuvre is the most effective treatment. Have a doctor or physiotherapist confirm which ear is affected and do it the first time, then they can teach you to repeat it at home.
Is cinnarizine good for vertigo?
Cinnarizine can ease severe vertigo and nausea for a few days, and a pharmacist can supply it in Malaysia. It causes drowsiness, isn’t recommended for BPPV, and long-term use can slow recovery and, rarely, cause movement problems in older people.
How long does vertigo last?
BPPV attacks last under a minute but can recur for weeks until treated. Vestibular neuritis causes severe vertigo for a few days, with balance recovering over 2 to 6 weeks. Ménière’s attacks last 20 minutes to several hours.
How do I know if dizziness is a stroke?
Call 999 if dizziness comes with double vision, slurred speech, weakness or numbness, clumsiness, being unable to walk, or sudden hearing loss. Use BE FAST: Balance, Eyes, Face, Arm, Speech, Time.
Why do I feel dizzy when I stand up?
Usually because blood pressure drops briefly when you stand, especially if you are dehydrated, older, diabetic or on blood pressure medicines. Get up slowly, drink enough fluids, and see a doctor if it keeps happening.
Sources
- Bhattacharyya et al. — Clinical practice guideline: benign paroxysmal positional vertigo, update (AAO-HNS, 2017)
- Muncie et al. — Dizziness: approach to evaluation and management (American Family Physician, 2017)
- NHS — Vertigo
- NHS — Dizziness
- NHS — Labyrinthitis and vestibular neuritis (Aug 2026)
- NHS — Ménière’s disease (Sep 2026)
- NHS — Low blood pressure
- NHS — Cinnarizine (Aug 2026)
- NHS — Betahistine (Sep 2026)
- Ministry of Health — Poisons List, First Schedule, Poisons Act 1952
- NHS — Stroke: causes
