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 Viral Vertigo
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.
Waxing and Waning Viral Vertigo is Common Now due to Long COVID
Patients with frequently recurring viral vertigo may need treatment for immune system deficiency. Starting in 2020, waxing and waning viral vertigo has emerged as a more common problem due long COVID.
Waxing and waning viral vertigo is common in patients with the long haul COVID presentation, until the immune system deficiency is addressed with a COVID detox protocol.
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
- Resolving any BPPV with maneuvers, and
- 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 and educational 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.
Very helpful information!
Thank you!
I constantly have genitali herpes because I suffer from severe anxiety. I don’t always have the dizziness, but this morning I am really bad!! I’ve taken a gram of valtrex, but it’s done nothing yet. I’m getting ready to take a lysine.
Hi Linda,
I am sorry to hear this! You can check out the lysine products I recommend in the Vertigo Detective Store, section on Immune Support.
I hope you find the right combination of medications and supplements to feel better!
I have Stage 3A Kidney Disease. I’ve been at this stage for about 15 years. I’ve also taken Valtrex for about 15 years. Valtrex isn’t good for your kidneys, but I have no other alternative. I researched and read where Valtrex can cause neurological problems. I think that’s happening to me.
I just want to thank you for your website and your book! Such a lifesaver! I have had some occasional vertigo through the years. But this is something different it seems.
Last year had a viral infection that eventually went to my sinuses and ears. The doctor told me labyrinthitis.
Months have gone by but my head was still unbalanced, especially with walking.
From what I have read I think I had vestibular neuritis.
With the help of your resources, I located a vestibular PT and finally saw them.
I have been given head and eye exercises. I am also doing drills with just walking around moving my head. Now I am getting relief.
Having had vertigo in the past I was not moving my head, but now I am finally getting proper guidance after many months.
Thank you Dr. Bell!
Hi, may I kindly ask which antiviral medication works the best? Thank you so much for all your incredible information you share
Hi Lindsay,
The antiviral medication is usually a prescription drug so that typically depends on doctor preference and which country you are located in. You can talk to your doctor and ask for guidance for your individual case.
I talk some about viral vertigo and my clinical approach in my blog on COVID related dizziness here.
If you have a lingering virus, you may also benefit from immune support.
Best wishes!
Hi
I suffered vertigo only if I stay in my country, Philippines, but I don’t know why.
When I stay abroad, especially in Canada, I never had a single attack.
I went to several Doctors but never found one doctor to stop it.
It stopped for awhile but it always comes back almost every month despite of following my physician’s advice.
One time I had to stay on bed for almost a week taking anti-vertigo prescribed medicine.
I suffered this feeling for almost 25 yrs, on and off.
During the attacks, I could just lie one side on my left usually.I could not stand up alone, so I have to eat on my bed. I could not even go to the washroom alone because I feel as if the whole house is spinning.
I thank God for reading this article. Thank you so much.