Vertigo in the car: when it is not motion sickness

Car sickness makes you queasy and unsteady. Vertigo is different: the world turns, tilts or slides although you know it is not moving, and it usually comes in short violent bursts. If that is what happens in your car, standard car sickness advice will not do much, because the drive is probably not the cause.

Why this happens in the car

A car provokes true vertigo in two ways. It puts your head through position changes, reaching into the footwell, tipping a seat back, turning to check a blind spot, and one of the commonest causes of sudden vertigo, benign paroxysmal positional vertigo, is set off by exactly those movements. It also leaves you with nothing to do but notice how you feel. The patterns separate cleanly. Motion sickness builds over minutes and eases after you stop. Positional vertigo starts within seconds of a head movement, spins hard, and often fades in under a minute while the car keeps going.

What to do right now

1. 1

   If you are driving, pull over as soon as it is safe. Do not try to steer through a spinning episode.

2. 2

   Keep still and fix your eyes on one stationary object outside the car until it passes.

3. 3

   Note what your head was doing when it started and how long the spinning lasted. That detail is what a doctor needs.

4. 4

   Do not treat it as car sickness. Horizon watching and airflow help the queasy aftermath, not the spinning.

5. 5

   Wait until you are completely clear before driving on, and get a lift if it repeats.

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Preventing it next time

• Move your head slowly in the car, especially when reclining a seat or reaching down.
• Get a diagnosis rather than a workaround. Positional vertigo is common and there are simple repositioning manoeuvres a clinician can do.
• Ask your doctor whether any of your medicines can cause dizziness.
• Do not plan to drive during a run of episodes. Rules on driving with sudden disabling dizziness differ by country, so check yours and ask your doctor.

When to see a doctor

Spinning vertigo deserves a medical opinion the first time it happens, not the fifth. Seek urgent care if it comes with new deafness or ringing in one ear, a severe headache, double vision, slurred speech, weakness or numbness on one side, or trouble walking, or if it does not settle at all. Those combinations point away from a simple inner ear cause.

Common questions

Medically informational; not a substitute for a doctor's advice. Persistent or unusual symptoms deserve a clinical evaluation.