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What is head shaking vertigo?

Head shaking vertigo, also known as head shaking nystagmus, is a condition where vertigo and nystagmus (involuntary eye movements) are triggered by head movements. It is a type of vestibular dysfunction that can significantly impact a person’s balance and quality of life.

What causes head shaking vertigo?

Head shaking vertigo is most commonly caused by loose otoliths within the inner ear. The otolith organs (utricle and saccule) contain calcium carbonate crystals called otoconia that sense gravity and head movements. If some of these crystals become dislodged, they can migrate into one of the semicircular canals and cause vertigo and nystagmus when the head is moved in certain directions.

Less commonly, head shaking vertigo may be caused by:

  • Vestibular neuritis – inflammation of the vestibular nerve
  • Labyrinthitis – inflammation of the inner ear
  • Vestibular migraine
  • Meniere’s disease
  • Acoustic neuroma – benign tumor of the vestibular nerve

The specific medical cause can often be determined through a detailed medical history, physical examination, balance testing, and diagnostic imaging such as MRI.

What are the symptoms of head shaking vertigo?

The main symptoms of head shaking vertigo include:

  • Dizziness and vertigo – triggered by moving the head in certain directions. This is often described as a spinning sensation.
  • Nystagmus – involuntary eye movements that occur with the vertigo. The eyes may jerk rhythmically side to side, up and down, or rotationally.
  • Imbalance and unsteadiness – difficulty maintaining balance and coordination when symptoms are triggered.
  • Nausea – vertigo can stimulate the vomiting reflex, leading to nausea.
  • Headache – migraine or tension-type headaches may accompany vertigo.

Symptoms only occur with specific head positions and movements. Keeping the head very still typically relieves symptoms.

How is head shaking vertigo diagnosed?

Head shaking vertigo is diagnosed through:

  • Medical history – detailed questions about symptoms and onset.
  • Physical exam – balance, coordination, eye movements assessed.
  • Dix-Hallpike maneuver – checks for vertigo and nystagmus when moving head and body into certain positions.
  • Head shaking test – look for nystagmus triggered by head turns in each plane.
  • Videonystagmography (VNG) – records involuntary eye movements during balance tests.
  • MRI – helps rule out acoustic neuroma or other brain abnormalities.

The characteristics of nystagmus provoked during testing can help identify the likely cause and affected ear.

How is head shaking vertigo treated?

Treatment options for head shaking vertigo include:

  • Vestibular rehabilitation – exercises to promote central compensation and improve balance.
  • Medications – steroids, anti-nausea, and anti-vertigo drugs as needed.
  • Surgery – in rare cases, surgery may be done to plug the affected semicircular canal.
  • Head position maneuvers – techniques to reposition otoconia out of the semicircular canals.

The main goal is to promote central compensation so the brain adapts to the asymmetric vestibular input. With time and rehabilitation, symptoms often improve significantly or resolve entirely.

What is the prognosis for head shaking vertigo?

With proper treatment, the prognosis for head shaking vertigo is generally good. Symptoms often improve gradually over weeks to months. However, in some cases it can take 6 months or longer for the brain to fully compensate.

With central compensation, the severity and frequency of vertigo attacks lessen over time. Eventually the vertigo and instability may disappear entirely with head movements.

A minority of patients do not adequately compensate and may have some residual dizziness or imbalance. But with ongoing rehabilitation and compensation training, most people are able to return to normal activities and improve their quality of life.

Can head shaking vertigo be prevented?

There are no definitive ways to prevent head shaking vertigo, since the most common cause is loose otoconia that move abnormally in the inner ear. However, prompt treatment of inner ear disorders may help prevent progression and secondary complications.

Some measures that may help lower the risk of head shaking vertigo include:

  • Treating infections quickly to prevent spreading to the inner ear.
  • Avoiding excessive head trauma that could dislodge otoconia.
  • Getting immediate medical attention for new vertigo symptoms.
  • Managing other vestibular disorders to stabilize the inner ear.
  • Practicing good head positioning during vertigo attacks.

While these steps may help, head shaking vertigo can still occur unpredictably. Seeking prompt diagnosis and treatment is key to managing the condition.


Head shaking vertigo is a disabling form of dizziness caused by loose particles in the inner ear. It triggers vertigo and nystagmus with certain head positions. While challenging, this condition often improves with vestibular rehabilitation and compensation training. With time, the brain can adapt to the asymmetric signals from the inner ear and symptoms gradually subside. Continued research on new treatments provides hope for better management of this troublesome vestibular disorder.

Cause Symptoms Diagnosis Treatment
Loose otoliths in semicircular canals Vertigo and nystagmus triggered by head movements in specific planes Medical history, physical exam, VNG, MRI Vestibular rehabilitation, medications, surgery, head maneuvers

Key Points

  • Head shaking vertigo is caused by loose particles in the semicircular canals.
  • It produces vertigo and nystagmus with certain head positions.
  • It’s diagnosed through medical history, exam, and tests like VNG.
  • Treatments include vestibular rehab, medications, surgery, and head maneuvers.
  • With time and adaptation, symptoms often gradually improve.

Frequently Asked Questions

What are the first signs of head shaking vertigo?

The first signs are typically vertigo and nystagmus provoked by moving the head in specific directions. This may be accompanied by nausea, imbalance, and occasionally headache. Symptoms only occur with certain head positions.

Is head shaking vertigo permanent?

For most people, head shaking vertigo improves over time with central compensation, so it is not necessarily permanent. With treatment like vestibular therapy, the brain can adapt to the asymmetric signals from the inner ear. This allows symptoms to gradually resolve or become manageable in many cases.

Can anxiety cause head shaking vertigo?

Anxiety doesn’t directly cause true head shaking vertigo, but it can make symptoms like dizziness and lightheadedness worse. Anxiety could potentially contribute to visual vertigo where symptoms are triggered by visual stimuli. But involuntary nystagmus due to inner ear problems would not be caused by anxiety.

Can you drive with head shaking vertigo?

It is usually not recommended to drive during active periods of head shaking vertigo, since the vertigo and loss of balance can impair driving ability and lead to accidents. As symptoms improve with treatment, driving may become possible by making adaptations like using mirrors more to reduce head turning.

Can vestibular neuritis cause head shaking vertigo?

Yes, vestibular neuritis (inflammation of the vestibular nerve) is one potential cause of head shaking vertigo. The asymmetric signaling from damage to the vestibular nerve can lead to abnormal nystagmus and vertigo with certain head positions. Vestibular neuritis should be evaluated by a doctor.


Head shaking vertigo can significantly impact quality of life. But the good news is that this condition often improves with time and treatment. By understanding the causes, symptoms, and treatment options available, individuals with head shaking vertigo can work with their healthcare providers to manage symptoms and regain balance and stability.