Do You Have True MS Vertigo or Is It BPPV?

MS is sometimes, but not always, the culprit for vertigo in MS patients.

Woman looking upset or in pain. Credit: Courtney Keating

Vertigo is a brutal symptom of multiple sclerosis, the true awfulness known only to those who have experienced it firsthand. Think back to when you were a child and spun around and around, then stopped. That’s pretty much the sensation—only now you're an adult, you're not at the playground, and you can't make it stop. It may also mimic the sensation of "the spins" from overindulging in alcohol. It is an acute, uncomfortable feeling of unsteadiness or disequilibrium, making those of us who are already a little unsteady on our feet feel even more nervous.

Vertigo as a Symptom of Multiple Sclerosis

Vertigo is a fairly common symptom of multiple sclerosis (MS), occurring in about 20 percent of people with MS at some point. Fortunately, it's not a permanent symptom for most people, and may not even indicate a new lesion or inflammation, as vertigo can have non-MS causes. However, it may be from new brain lesions or old lesions that are getting bigger. 

What Does MS Vertigo Feel Like?

Vertigo, caused by MS and otherwise, is a sensation of spinning, whether it feels like you are spinning or your surroundings are rotating. It can feel like:

  • The ground is suddenly rushing upwards
  • The room (or surroundings) is moving continuously
  • The room only seems to rotate part of the way, return to normal, and rotate part way again

It can be a very powerful feeling of movement and can cause nausea or vomiting. At its worst, it can cause difficulty standing or walking and even lead to falls.

 It rarely persists for a long time, but can take weeks or months to go away, which it usually does gradually. Some people, however, experience it chronically. 

What Causes Vertigo?

Vertigo can be caused by MS lesions in the cerebellum. It can also be a result of damage to the nerves that control the vestibular functions of the ear (acoustic cranial nerve, CN VIII) in the brain stem.

However, it appears that a very common cause in people with MS is something called benign paroxysmal positioning vertigo (BPPV), rather than demyelination. This means that just because you have MS doesn't necessarily mean that the vertigo is a direct result of the MS disease process.

What is BPPV?

BPPV feels like severe vertigo that occurs upon movement of the head, especially when rolling over in bed, getting out of bed or tipping the head back to look up. It feels like you (or your surroundings) are spinning or tilting when you are not. It usually lasts just a couple of minutes.

BPPV is caused by debris that has collected in a specific part (semicircular canals) of the inner ear, which is part of the vestibular system. The debris, called otoconia or canaliths, are actually small calcium carbonate crystals that we all have. They are usually attached to the tiny hairs in your inner ear that detect movement, but can become dislodged and float around. When a person with BPPV moves his or her head, these crystals shift and stimulate these tiny hairs, sending false signals to the brain.

The vertigo happens because of the confusion caused by these signals and other systems controlling proprioception. Since many people with MS already have difficulty with proprioception, this may make them feel BPPV even more acutely.

What Else Can Be the Culprit for Your Vertigo?

Vertigo can also be made worse by some of the drugs prescribed for MS symptoms, such as tricyclic antidepressants (such as Elavil) for neuropathic pain or Baclofen for spasticity. Blood pressure issues, low blood sugar, or cardiovascular disease may also be the cause for your vertigo -- so seeing your primary care physician for a complete check-up is a good idea. 

Lastly, vertigo can be caused by infections, such as the flu.

Coping with Vertigo

If you have MS and are experiencing vertigo, it's a good idea to see an otolaryngologist, a fancy name for an ear, nose and throat specialist (ENT). Really ideally, if you live in a place with access to such a specialist, you would be seen by an otoneurologist or a neurotologist (specialists in both matters of the inner ear and neurology) for any cases of MS-related vertigo. 

This is important because some causes of vertigo (such as BPPV) can be treated without medications (painless maneuvers as in the case of BPPV) and you can prevent unnecessary MRI scans and drugs with side effects like fatigue. If your vertigo is from MS, vestibular rehabilitation may be useful.


Carol Turkington and Kay D. Hooper. The A to Z of Multiple Sclerosis. New York: Checkmark Books. 2005.

Randall T. Schapiro. Managing the Symptoms of Multiple Sclerosis (5th Ed.). New York: Demos Publishing. 2007.

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