Can Stress Really Cause Vertigo? Here's What To Know, According To Experts
You know the feeling: You're sitting completely still, yet somehow your mind manages to trick you into feeling as if you're spinning or moving up and down, as if you were on an amusement-park ride. Those are some of the telltale signs of vertigo, a condition that affects up to 15 to 20% of the adult population, reports the Handbook of Clinical Neurology1.
"Patients often blame themselves or feel like they're losing it when dealing with vertigo," says Joey Remenyi, MClinAud—vestibular audiologist, neuroplasticity therapist, and author of Rock Steady: Healing Vertigo or Tinnitus with Neuroplasticity. "Those dizzy sensations are truly inside of you. They are neural messages created by your brain and body and can change daily. You may need support to recalibrate those neural networks so you can feel like yourself again, but it absolutely is possible."
And because stress and vertigo are inextricably linked, according to Remenyi, managing stress properly can help. Here, expert-approved strategies to combat vertigo brought on by stress.
What is vertigo?
Vertigo is any sensation of movement or disorientation when you're still, explains Remenyi. "It can manifest as disequilibrium, dizziness, nausea, unsteadiness, or as simply feeling not quite right." The feeling of vertigo can last anywhere between a few hours and a few days.
So, how does it happen? Mohamed Elrakhawy, M.D., resident physician in the Department of Otolaryngology-Head and Neck Surgery at the University at Buffalo, explains that there are five organs in each inner ear responsible for determining the body's orientation.
- Three semicircular canals, positioned at approximately right angles to one another, are fluid-filled gyroscopes that signal head rotations to the brain (like nodding up and down, shaking side to side, and tilting left and right). They are responsible for rotational acceleration.
- Two otolith organs (both utricle and saccule) act as small pendulums that swing to indicate linear accelerations of the head. Small crystals called otoconia lie on a gelatinous membrane, which shift to cause sensations of linear acceleration, whether vertical or horizontal.
Alyssa Kirby Horowitz, N.D., who frequently uses naturopathic remedies to treat patients' vertigo, says the brain uses a variety of strategies to determine our body's orientation. She likens the mechanism to a bubble-filled level used in home renovations.
The relationship between stress and vertigo.
Remenyi says vertigo results from error messages being sent between the ears, eyes, limbs, and brain—so any lifestyle factor that leads to fatigue or overwhelm can trigger vertigo.
Here's something to think about: Like an endless loop or vicious cycle, stress influences vertigo as much as vertigo influences stress, according to Remenyi. "Vertigo symptoms can make patients feel anxious, stressed, self-critical, or stuck in rigid thinking, and all of those feelings are valid."
In addition, Horowitz says that when we're stressed, our hormone cortisol increases, which in turn affects our vestibular system, the part of the brain that controls balance and makes us feel off-kilter, as if we're on a boat while grounded.
It may seem as though the relationship between stress and vertigo is clear-cut, but Elrakhawy explains why it's a little more nuanced than experts previously thought. He says the stress response is complex, in that it involves various organs and chemical mediators that are secreted at various times depending on the body's current state.
He cites a few studies that looked into the relationship between the vestibular system and stress, specifically various stress hormones such as cortisol:
- One small study with 10 healthy volunteers investigated the stress response after vestibular stimulation2 and found that cortisol levels were elevated above resting levels during simulation.
- Another study published in the Journal of Vestibular Research found that there were elevated cortisol levels3 in dizzy patients with a diagnosed cause of vertigo, compared to those with idiopathic dizziness.
- Lastly, a study analyzing cortisol levels4 in patients with Ménière's disease (which involves fluctuating hearing loss, tinnitus, and vertigo attacks), found that patients diagnosed with the disease had much higher cortisol levels in the blood—but researchers determined it was a result of the chronic disease on the stress response rather than the cause itself.
"So it's tough to make a definitive statement on cortisol and the vestibular system, other than to suggest they are related, with future studies needed to show a precise connection," Elrakhawy says.
How to prevent vertigo brought on by stress.
Managing stress is no easy feat, says Elrakhawy, as we all have a baseline level of daily stress that we try to limit. However, there are some strategic measures that can help:
Adopt general health-supporting practices.
Measures you can take include eating a healthy, balanced diet, getting adequate sleep at night, and making sure to exercise and participate in physical activity. "Having good social support and a good network to rely on can help with coping with acute and chronic stressors," he says. "Treatment and management of anxiety, depression, and panic disorders is also important."
Brainstorm ways to reduce daily stressors.
Remenyi recommends seeking ways to minimize the triggers. For example, you might be able to regulate your sleeping patterns, have that difficult conversation with your partner or boss, or check off long-overdue items from your to-do list.
Try therapeutic techniques.
Horowitz recommends breathing exercises, meditation, walking in nature, taking a bath, talk therapy, journaling, Emotional Freedom Technique, or the home Epley's Maneuver, which requires you move your head in different positions to realign the inner ear sensors. In addition, try avoiding prolonged head tilting, such as when you're speaking on the phone, or rapid alternating head movements (including while driving).
Seek targeted nutritional support.
Supplements like ginkgo, antioxidants, and omega-3s can be helpful since they increase blood flow to the brain5, says Horowitz. Vitamin D can be a helpful option, as well. She also recommends opting for whole foods and steering clear of anything that can further contribute to inflammation, like fried or highly processed foods, alcohol, or caffeine. Because your inner ear maintains a strong balance of sodium, potassium, and chloride, she says it's important to keep your sodium intake low and ensure proper hydration.
Check in with yourself.
If you've taken general measures to no avail, it might be time to opt for Remenyi's route, which is to be gentle, without berating yourself for experiencing these issues. She recommends you first "do nothing and change nothing. Simply notice [your stress] and offer yourself the same level of compassion that you might offer a friend in your situation."
Once you've worked on your physical, psychological, and spiritual health, Remenyi recommends, "Really drop in and celebrate the choices you're making to nurture and care for yourself," she says. "Make the process of change rewarding rather than punitive or rigid. Learn to enjoy your body rather than fear the next vertigo attack by making more of these little changes each week."
What to do during a vertigo attack.
Elrakhawy recognizes how scary of a situation it can be, especially if it's your first time experiencing it. Here's how he advises handling a vertigo attack:
- The first thing to do is to sit down right away on a chair or bed so that you're safe from falling.
- Being in a quiet, dark room can help reduce the spinning feeling.
- Move carefully and slowly; especially paying attention to slow head movements is important.
From there, "a follow up with a doctor to evaluate the cause of the attack is critical, to try to avoid a similar event in the future or to mitigate it," says Elrakhawy.
Other causes of vertigo.
Say you've done the legwork on reducing daily stressors from your life, and you're still experiencing vertigo attacks. It might be worth investigating other root causes of vertigo under the guidance of your primary health care provider, like genetics, hormones, low blood sugar, dehydration, gut dysfunction, viral infections, inflammatory disorders, physical trauma, and irregular breathing patterns.
Elrakhawy says among the long list of possible culprits, some of the most common ones include:
- Vestibular neuronitis (labyrinthitis), which is usually a single acute episode caused by a viral infection. "It's associated with recent flu symptoms and can last for days," he says.
- Vascular disease, such as transient ischemic attack affecting the posterior circulation, as a nonrecurring episode.
- Benign paroxysmal positional vertigo, which is the most common type and usually lasts less than one minute. "It's caused by head tilting in a specific pattern that leads to abnormal stimulation by the crystals in the vestibular system," he says.
- Ménière's disease, which is a chronic condition with a triad episodic vertigo that lasts minutes to hours. You may experience fluctuating hearing loss and tinnitus. "It is thought to be due to distention of the fluid-filled space within the vestibular organs," says Elrakhawy.
- Migraine-associated, which, may be correlated with or caused by vertigo, according to Elrakhawy.
"One of the many systems it impacts is our breathing," says Horowitz. She explains that stress or anxiety alters our breathing patterns, which allows more carbon dioxide and less oxygen in. This, in turn, constricts our blood vessels, reducing the amount of blood that travels to each region of our body, thereby impairing its overall function.
What can be quite frustrating is that the explanation behind vertigo is sometimes idiopathic in that its cause of origin is unknown or unexplainable by science, says Remenyi. "While highly uncertain and upsetting for folks who receive this diagnosis, it can be an invitation to surrender and search more deeply for the inner strength to overcome chronic vertigo symptoms, using the wisdom of the body and not leaning too heavily on diagnosis, cures, or external fixes."
Your experience with vertigo might be frustrating, but there is hope. Vertigo is not a disease but rather a sensory experience that our brain receives through neural patterns and inputs, says Remenyi. "By using neuroplasticity to change our brain pathways and to develop new desired neural patterns that we choose, we can completely overcome vertigo symptoms and build a new sense of normal," she says. Considering vertigo is a symptom rather than a disease, Elrakhawy says you should see a medical professional promptly at its onset, in order to rule out any potential life-threatening causes.
Marissa Miller is a certified personal trainer from the American Council on Exercise and holds a certificate in plant-based nutrition from the T. Colin Campbell Center for Nutrition Studies at Cornell. She has over 10 years of experience editing and reporting on all things health, nutrition, beauty, fitness, style and home for publications including The New York Times, The Washington Post, The Wall Street Journal, Vogue, and many more.
Her first novel PRETTY WEIRD: Overcoming Impostor Syndrome and Other Oddly Empowering Lessons was published by Skyhorse Publishing and distributed by Simon & Schuster in May 2021.