Dear doctor, I've been suffering with vertigo sometimes followed by severe headaches. Do I need a brain scan?

Q: I am in my 50s and in the past year I have been suffering with vertigo sometimes followed by severe headaches. Should I be concerned about a brain tumour? Do I need a brain scan?

A: Vertigo is not uncommon in your age group. In the majority of situations, the cause of vertigo is not a brain tumour. In fact, brain tumour as a cause of vertigo is rare. The features of the vertigo and associated symptoms determine whether the cause is from the inner ear or the brain.

The commonest cause of vertigo associated with headaches is vestibular migraine, one of a number of types of migraine in which vertigo is the predominant feature. In some people, the vertigo is not accompanied by headaches. Adults with vestibular migraine may have had typical migraine headaches in the past.

Another common cause of vertigo in your age group is BPPV (benign paroxysmal positional vertigo) caused by chalk crystals in the inner ears dislodging and floating freely in one of the tubes in the inner ears. The vertigo in BPPV is brief, usually lasting less than a minute and triggered by a change in the position of the head such as looking up, lying flat, turning over in bed, head tilt and bending. A period of nausea may also follow the vertigo. A Dix-Hallpike test is performed to confirm the type of BPPV which is then treated by an appropriate particle re-positioning manoeuvre such as the Epley manoeuvre to move the crystals away from the tube.

There are several other causes of vertigo such as labyrinthitis, vestibular neuritis and the rare Ménière’s disease. If a vertigo attack is associated with vomiting, it is advisable to contact your doctor as you may require medications to control the vomiting or if you are dehydrated, be admitted to hospital for treatment.

If the vertigo is recurrent, you may consult your doctor who can decide if you need to be referred to a specialist. The specialist can provide a definitive diagnosis, offer the appropriate treatment and decide whether a brain scan is necessary. 

Find out more about Dr Victor Osei-Lah, Consultant Audiovestibular Physician practising at Spire Portsmouth Hospital.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.