Viral vertigo is one of the most common causes of vertigo, after idiopathic BPPV. Any active virus in the body can cause vertigo, if it affects the inner ear.

If hearing is not affected, then viral vertigo is called vestibular neuritis.

When hearing is affected, then viral vertigo is called vestibular labyrinthitis.

Causes of Viral Vertigo

Herpes

Herpes can cause viral vertigo directly if the herpes virus affects the inner ear. The herpes virus is one of the most common causes of viral vertigo from vestibular neuritis.

Vestibular neuritis is theorized to be a virus or inflammation attacking the inner ear. The herpes virus is particularly notorious for causing vertigo.

If one side of your face is tingling or if you had the cold sore on one side, it’s usually that ear that’s affected. However, either ear could be affected anytime there’s an active virus in the body.

Other viruses can cause this type of viral vertigo, but herpes is one of the most common. More possible causes of viral vertigo include the Epstein-Barr virus and long COVID. Viral vertigo can also occur after a sinus infection, ear infection, stomach bug, or upper respiratory infection if the culprit was a virus.

Herpes Outbreak on the Face or Neck can Cause a New Onset of BPPV

A herpes outbreak anywhere on the head or neck can also precede a new onset of BPPV.

Therefore, someone with a cold sore or fever blister on their face or neck may suffer from BPPV in addition to vestibular neuritis.

In some cases, people have post-viral BPPV causing vertigo, without vestibular neuritis.

For example, I just had a patient come back to the office this week after having been clear of vertigo for quite some time. She had a new cold sore near her nose on the right side and tingling on her right cheek.

Upon BPPV testing, it turned out she had right posterior canal BPPV. I treated the BPPV with maneuvers and it resolved completely on the same day.

She had no lingering vertigo, so we were able to conclude that she had experienced post-viral BPPV but no vestibular neuritis.

Vestibular neuritis usually takes longer to gradually resolve over time. Whereas, BPPV can resolve with treatment maneuvers right away or with a few sessions of treatment.

Viral activity in the body can trigger a new onset of BPPV, even in the absence of vestibular neuritis. If the patient gets BPPV as a result of viral activity, then BPPV treatment maneuvers can help relieve this secondary effect of viral vertigo.

Sinus Infections

Sinus infections can contribute to dizziness as a stand-alone cause, and sinus infections can co-occur with a new onset of BPPV.

Consult with your doctor if you have sinus congestion, sinus infection, or chronic sinusitis. Addressing the sinus issues may be helpful to prevent chronic or recurrent vertigo.

Your doctor may recommend medication or nasal spray. The doctor may order special tests like a CT scan of your sinuses. Occasionally, a sinus surgery is even recommended to correct a deviated septum.

What Treatments Might Help Viral Vertigo?

If the virus itself is directly causing the vertigo as in vestibular neuritis, then the patient will not get any relief with BPPV treatment maneuvers. 

If you get partial relief with BPPV maneuvers but not complete relief, then you may be having viral vertigo from vestibular neuritis, in addition to a potential new onset of BPPV. 

If vestibular neuritis and BPPV are suspected due to viral vertigo, the treatment should focus on

  1. Resolving any BPPV with maneuvers, and
  2. Supporting your immune system and implementing antiviral measures to fight the virus, which may include the use of prescription medications and/or supplements.

For example, you could get a prescription for an antiviral medication from your primary care provider, urgent care, or emergency room.

I personally keep an antiviral prescription on hand for use as needed.

Talk to your doctor about which supplements might help you with viral vertigo.

Can Natural Supplements or Dietary Changes Help?

To support the immune system in fighting the virus, cutting out sugar and alcohol helps in general.

Specific to the herpes virus, some of my patients with chronic recurrent herpes-related viral vertigo have decided to increase lysine in their diet or take a lysine supplement. They also cut out all foods high in arginine like coconut oil.

Increasing lysine intake and cutting down arginine intake seems to help fight the herpes virus, thereby reducing viral vertigo.

Some of my patients have found lysine supplements at a natural pharmacy, which can help the immune system fight the herpes virus. I personally keep a lysine supplement on hand for use as needed, along with antiviral medications.

Here are some common foods that contain more lysine, which may lower the number of herpes outbreaks causing viral vertigo for some people:

  • Cheese, especially parmesan
  • Eggs
  • Quinoa
  • Shrimp
  • Tofu
  • Tuna

These foods are high in arginine, which can potentially trigger the herpes virus causing viral vertigo for some people:

  • Chocolate
  • Rice
  • Wheat and wheat products
  • Certain nuts such as almonds, peanuts and walnuts
  • Coconut products such as coconut oil

If you suspect you might have viral vertigo related to herpes outbreaks on your face or neck, talk to your doctor about which supplements, dietary changes, or medications might help. Talk to your doctor about your vertigo treatment plan.

Disclaimer

This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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