Vertigo and dizziness

Dizziness and Lightheadedness: A Complete Guide to Understanding and Treating These Symptoms

Dizziness and lightheadedness are very common symptoms that can significantly impact quality of life. While they can be concerning, most cases are benign and respond very well to treatment. Vestibular physiotherapy achieves success rates of 80 to 95% for several conditions, including benign paroxysmal positional vertigo.

How to Differentiate Between Dizziness and Lightheadedness?

Dizziness and lightheadedness are two distinct symptoms that are often confused. Understanding the difference is important for identifying the cause of your symptoms.

Dizziness (vertigo) is a sensation where you feel like you are spinning within your environment (known as internal vertigo), or when the environment around you seems to be spinning (external vertigo). A classic example of dizziness is feeling like the walls around you are rotating while you are standing still.

Lightheadedness is a more general term that describes a feeling of spatial discomfort, a sense of not feeling well in your surroundings. The description can vary greatly from person to person. Typical sensations of lightheadedness include feeling disoriented, light-headed, floating on a cloud, or unstable as if intoxicated.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is the most common type of vertigo. It is a form of dizziness triggered by head movements. This condition is caused by the displacement of tiny crystals, called otoconia, in the inner ear, where our balance system is located.

During head movements, these small crystals and other tiny debris shift, causing an overstimulation of the balance system. This abnormal stimulation creates the sensation of vertigo, which can be very intense but is fortunately short-lived.

What are the Symptoms of BPPV?

The vertigo is usually very intense but short-lived, generally lasting less than a minute. It is triggered by sudden changes in head position. Typical triggering situations include getting into or out of bed, bending forward or standing up, looking upwards, or turning over in bed.

Vertigo can be accompanied by other symptoms such as nausea or vomiting, loss of balance, and various complaints that differ from person to person. Often, affected individuals completely avoid positions or movements that have triggered vertigo to prevent further episodes. However, this avoidance strategy can prolong the problem.

What are the Causes of BPPV?

In 10 to 30% of cases, BPPV develops following trauma such as a concussion or any other head or neck injury. In 5 to 25% of cases, BPPV can be a consequence of migraines, labyrinthitis, neuronitis, or Meniere's disease. In 60 to 80% of cases, BPPV is idiopathic, meaning its cause is unknown.

Some interesting facts about BPPV: there are three semicircular canals in the inner ear. Between 60 and 90% of BPPV cases are due to involvement of the posterior canal, 5 to 20% involve the horizontal canal, and 1 to 10% involve the anterior canal. One or more canals can be affected simultaneously, and the signs and symptoms will differ depending on the affected canal. Trauma increases the risk of multiple canal involvement. Women are three times more likely than men to experience BPPV.

How is BPPV diagnosed?

A physiotherapist diagnoses BPPV based on the patient's symptom history and a clinical examination. Specific maneuvers that provoke vertigo are used to identify the affected canal. An assessment of the oculomotor system, which examines eye coordination, and a neck assessment are also included in the clinical examination.

What are the Treatments for BPPV?

Once BPPV is diagnosed, maneuvers performed in the clinic with a physiotherapist help reposition the crystals to their normal place. The Epley maneuver is the most well-known and has a success rate of 80 to 92%. A series of specific exercises to do at home completes the treatment and helps resolve the problem, often in just one to two sessions.

While waiting to see a physiotherapist, simply avoid positions that trigger vertigo if you find your symptoms too strong and unpleasant. However, completely avoiding these positions long-term can prolong the problem.

What is Cervicogenic Lightheadedness?

Cervicogenic dizziness is a type of dizziness caused by an issue related to the neck. The neck contains many receptors that inform the brain about the head's position in space. When these receptors are disrupted, they can send confusing signals that create a sensation of dizziness.

What are the symptoms of cervicogenic dizziness?

The sensation of dizziness is similar whether it originates from the neck or another source. Descriptions vary from person to person and may include feeling disoriented, light-headed, floating on a cloud, or unstable.

In the specific case of cervicogenic dizziness, other signs and symptoms are often present. Neck pain or stiffness usually accompanies the dizziness. Headaches are frequently associated. Reduced neck mobility can be observed. Dizziness often appears after prolonged neck postures, such as when working on a computer, driving, or reading.

What are the causes of cervicogenic dizziness?

The precise cause is still not well understood by research. One explanation is a poor perception of the neck's position in space by our brain, which is called poor neck proprioception.

Neck pain and headaches are also thought to be factors associated with dizziness. This type of dizziness can therefore occur after an episode of neck pain or after whiplash from a car accident, for example.

How is cervicogenic dizziness diagnosed?

Your physiotherapist will diagnose cervicogenic dizziness based on your symptom history and a complete clinical examination. The clinical examination includes identifying neck positions and postures that trigger dizziness, assessing neck mobility, and performing specific tests.

A deficit in the oculomotor system (eye coordination) or the vestibular system can also contribute to cervicogenic dizziness. An evaluation of these two systems is therefore also included to determine the cause.

There is no single, definitive test for diagnosis. Medically, it is often a diagnosis of exclusion, meaning all other possible causes have been ruled out before concluding a cervical origin.

What are the treatments for cervicogenic dizziness?

Your physiotherapist will assess several elements to create a personalized treatment plan. The assessment includes your joint mobility, nerve gliding, postural habits, movement quality, strength and stability, the oculomotor system, and the vestibular system.

Based on the assessment results, the physiotherapist will use joint mobilizations and manipulations to treat your neck and nerves, reduce pain, and improve movement. Specific exercises to do at home will target the root cause of the problem.

If the oculomotor or vestibular system is involved, your physiotherapist will also include treatment for these two systems in your rehabilitation program. Physiotherapy for neck pain offers comprehensive approaches for these conditions.

What are the warning symptoms that require urgent medical attention?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at an emergency room or from a doctor. These red flags are rare but important to recognize. Consult immediately if you experience loss of consciousness, dizziness with physical exertion, vertigo with severe headaches, hearing loss, significant balance problems such as falling as soon as you stand up, or projectile vomiting.

These symptoms do not necessarily mean a serious problem, but they warrant a rapid medical evaluation to rule out serious causes.

When to consult a physiotherapist for vertigo or dizziness?

You should consult a physiotherapist if you experience symptoms as described previously, or if your doctor has already ruled out any other cause for your vertigo or dizziness. Physiotherapy offers very effective treatments for these conditions.

For BPPV treatment, you should consult a physiotherapist with expertise and adequate training in vestibular physiotherapy. This specialization allows for proper evaluation and treatment of various vestibular conditions.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires seeing a doctor, the physiotherapist will be able to inform you and guide you appropriately.

Other causes of vertigo and dizziness

Besides BPPV and cervicogenic dizziness, several other conditions can cause vertigo or dizziness. Vestibular conditions include vestibular neuritis, labyrinthitis, and Meniere's disease. Heart problems such as orthostatic hypotension or arrhythmias can also cause dizziness.

Psychiatric problems, particularly anxiety disorders and conversion disorders, can manifest as dizziness. Other rarer causes include brain tumors, multiple sclerosis, vestibular migraines, encephalopathy, Arnold-Chiari malformation, and drug or alcohol intoxication.

Central positional vertigo is very similar to BPPV, but rarer. Neurological symptoms such as headaches, significant weakness, and gait instability are often reported with this type of vertigo.

What is the link between anxiety and vestibular problems?

Dizziness and lightheadedness are symptoms that often worry those who experience them. The sensation is unpleasant and can create a feeling of losing control. This worry can lead people to experience significant anxiety and become hyper-vigilant, constantly monitoring every symptom they feel.

In this state of hyper-vigilance, all bodily signals can become a potential threat for an anxious person. In some cases, anxiety can even become more problematic than the vestibular issue itself. The good news is that vestibular physiotherapy helps break this cycle by reducing physical symptoms and restoring confidence in movement.

Conditions Associated with Dizziness and Lightheadedness

Dizziness and lightheadedness can coexist with other conditions. Concussion is frequently associated with vestibular symptoms. Concussion physiotherapy often addresses the vestibular component of these injuries.

Neck pain and dizziness are often linked, particularly after a neck injury. Headaches, especially migraines, can be accompanied by vestibular dizziness.

Getting Help for Your Dizziness or Lightheadedness

If you are experiencing dizziness or lightheadedness that affects your quality of life, our physiotherapists trained in vestibular rehabilitation can help you. A comprehensive assessment will identify the cause of your symptoms and help create a personalized treatment plan.

The prognosis is generally excellent for most vestibular conditions treated with physiotherapy. Book an appointment today to start your journey toward relief.

Sources

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Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology Head Neck Surg. 2008;139(5 Suppl):S47-81.

Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Archives of Physiotherapy. 2017;7(1):12.

Brandt T. Vertigo: its multisensory syndromes. Springer Science & Business Media; 2013.