Vertigo and dizziness

Vertigo and Dizziness: How to Understand and Treat Them?

Vertigo and dizziness are understood based on their duration, triggers, and accompanying symptoms, and are then treated according to their probable cause. Vertigo causes a sensation of spinning. Dizziness, on the other hand, describes a lightheaded feeling, unsteadiness, or discomfort. Some causes respond well to physical therapy, while others require a medical evaluation.

How to Differentiate Between Dizziness and Lightheadedness?

Vertigo makes you feel as if you are spinning or that your surroundings are spinning, whereas dizziness is more of a sensation of lightheadedness, unsteadiness, or discomfort without any spinning. The duration, triggers, and other symptoms then help the healthcare professional identify possible causes.

Internal vertigo makes it feel as though your body is spinning. External vertigo makes it feel as though the room or objects are spinning around you, even though you are standing still.

Dizziness can feel like lightheadedness, disorientation, a sensation of floating, or a feeling of unsteadiness similar to that experienced after drinking alcohol. The description varies from person to person.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is an inner ear disorder that causes brief episodes of dizziness when the head changes position. Small calcium crystals move within a canal in the inner ear and temporarily disrupt the balance signal^[3]. BPPV is the most common vestibular disorder—that is, a disorder of the inner ear’s balance system^[1]. A population-based study estimates that 2.4% of adults experience it at some point in their lives^[2].

When the head moves, these crystals displace the fluid in a canal of the inner ear. The brain then receives a signal of movement that does not match the information from the eyes and the rest of the body. This mismatch causes intense, but usually brief, vertigo.

What are the Symptoms of BPPV?

VPPB usually causes intense dizziness that lasts less than a minute^[2]. Lying down, standing up, rolling over in bed, bending over, or looking up can trigger an episode.

Dizziness may be accompanied by nausea, vomiting, or a loss of balance. Some people therefore avoid any movements that trigger these symptoms. Exercising temporary caution can reduce the risk of falling, but an assessment can help determine how to safely resume normal movements.

What are the Causes of BPPV?

BPPV can occur without a clear cause or following a trauma, such as a concussion or a head or neck injury. After a trauma, both ears or multiple canals may be affected more often than in cases of BPPV with no known cause^[1][4].

The inner ear contains three semicircular canals that detect head rotations. The posterior canal is affected in approximately 80 to 90 percent of BPPV cases, and the horizontal canal in approximately 5 to 30 percent^[1]. The affected canal determines the symptoms observed and the maneuver used. Multiple canals may be affected at the same time^[1]. In a series of 583 patients, 8% had BPPV involving multiple canals^[5].

How is BPPV diagnosed?

A physical therapist trained in vestibular rehabilitation diagnoses BPPV based on the patient’s symptom history and maneuvers that place the head in specific positions. The therapist then observes the symptoms and involuntary eye movements to determine which canal is likely affected. The therapist also assesses eye movements, balance, and neck function when necessary.

What are the Treatments for BPPV?

Treatment for BPPV involves a repositioning maneuver tailored to the affected canal. For the posterior canal, the Epley maneuver is more effective at resolving vertigo in the short term compared with a sham maneuver or no treatment^[6][3]. The number of sessions varies depending on the canal, the cause, and the response to treatment. A clinical review describes rapid and effective treatment in more than 90% of cases, without specifying a precise number of sessions^[7]. BPPV may recur after successful treatment. The same review reports a recurrence rate of 40 to 50% over an average period of five years^[7]. A recurrence therefore does not mean that the initial maneuver failed^[1].

While waiting for the evaluation, move more slowly when changing positions and ask for help if you feel like you might fall. Some episodes resolve on their own, but their duration varies. In a population-based study, the median duration was two weeks^[1][2]. However, you do not need to wait for the symptoms to resolve on their own before seeking an evaluation.

What is Cervicogenic Lightheadedness?

The term “cervicogenic dizziness” refers to the hypothesis that a problem in the neck causes dizziness. One proposed explanation involves signals from the neck that do not align properly with those from the eyes and the inner ear. This causal link remains uncertain^[8][14].

What are the symptoms of cervicogenic dizziness?

Dizziness associated with the neck can cause a feeling of disorientation, lightheadedness, floating, or unsteadiness. This sensation alone is not sufficient proof that the neck is the cause.

Neck pain or stiffness usually accompanies dizziness that is considered cervicogenic. Headaches or limited neck mobility may also be present.

What are the causes of cervicogenic dizziness?

The exact cause of cervicogenic dizziness remains unclear. One hypothesis suggests that the brain receives less accurate information about the position and movements of the neck.

Neck pain and headaches may accompany dizziness. These symptoms may occur during an episode of neck pain or following a neck sprain—sometimes called whiplash—resulting from a collision.

How is cervicogenic dizziness diagnosed?

The evaluation looks for possible causes of dizziness and any accompanying neck problems; however, it cannot, on its own, confirm that the neck is causing the dizziness. In particular, the physical therapist checks to see if certain neck movements trigger the symptoms and assesses range of motion, strength, and balance.

The physical therapist may also examine eye movement control and the inner ear’s balance system. These assessments help the physical therapist identify other possible causes or multiple factors occurring simultaneously.

There are currently no tests or recognized sets of criteria that confirm a cervical origin^[14]. Some publications suggest an approach based on history, physical examination, and the investigation of other causes^[9][8]. The healthcare provider therefore assesses whether another cause better explains the symptoms, without considering the exclusion of that cause as proof of a cervical origin.

What are the treatments for cervicogenic dizziness?

Treatment depends on the limitations identified during the evaluation. The physical therapist assesses, among other things, neck movement and strength, balance, movement quality, and, if necessary, eye control and the inner ear system.

Based on the results, the physical therapist may recommend joint mobilization and gradual exercises. A systematic review concludes that manual therapy can reduce dizziness, neck symptoms, and balance problems in some people. The evidence is of moderate quality for manual therapy alone and very weak when combined with exercises^[10]. Home exercises are designed to improve movement, strength, or balance, depending on the difficulties identified during the evaluation.

If the evaluation also identifies a problem with eye control or balance originating in the inner ear, the program may include exercises specifically designed for these functions. Physical therapy for neck pain can complement this program when neck pain accompanies dizziness.

What are the warning symptoms that require urgent medical attention?

Call 911 if you suddenly experience dizziness or lightheadedness along with facial drooping, weakness or numbness on one side of the body, sudden difficulty speaking, a sudden change in vision, a sudden and very severe headache, or a sudden inability to stand or walk^[12]. These signs may indicate a stroke. Also call 911 if a person loses consciousness during physical exertion, does not wake up within a minute, or if the episode is accompanied by chest pain, difficulty breathing, or an unusual heartbeat^[15][16].

If you experience sudden hearing loss, with or without vertigo, see a doctor the same day. Sudden hearing loss is also a medical emergency, even if it feels like a blocked ear^[13]. Loss of consciousness also warrants medical attention, even after a full recovery^[15]. Dizziness during physical exertion requires prompt medical evaluation^[16]. Severe or repeated vomiting accompanied by dizziness also requires prompt medical attention^[17].

When to consult a physiotherapist for vertigo or dizziness?

Consult a physical therapist trained in vestibular rehabilitation if you experience brief episodes of dizziness that recur with certain head movements, if your balance remains impaired, or if your symptoms limit your activities. If you notice any of the warning signs described above, seek appropriate medical help first.

If you suspect BPPV, choose a physical therapist who has training in vestibular physical therapy. This training enables the therapist to select the appropriate tests and maneuvers based on which canal may be affected.

You can see a physical therapist directly. The physical therapist will refer you to a doctor or the emergency room if your medical history or physical exam indicates that a medical evaluation is needed immediately.

What are some other causes of dizziness and lightheadedness?

Other causes of dizziness and lightheadedness include inner ear disorders, migraines, certain medications, a drop in blood pressure when standing up, and irregular heart rhythms. Vestibular neuritis is an inflammation of the nerve that transmits balance information from the ear to the brain. Labyrinthitis affects the inner ear and can also affect hearing. Ménière’s disease is an inner ear disorder that can involve episodes of vertigo, tinnitus, and hearing loss^[17].

Anxiety and persistent dizziness can also exacerbate each other. Less commonly, a neurological condition—such as a stroke, multiple sclerosis, or a brain tumor—can cause these symptoms. This variety explains why the evaluation takes into account the onset, duration, triggers, and associated signs.

Dizziness originating in the brain can sometimes resemble BPPV. Unusual eye movements, weakness, difficulty speaking, or significant unsteadiness when walking require a medical evaluation.

What is the link between anxiety and vestibular problems?

Anxiety and vestibular symptoms can reinforce each other. Anxiety can increase focus on physical sensations and lead to avoidance of movement, while unpredictable symptoms can fuel anxiety. A systematic review describes this link in people with persistent dizziness accompanied by anxiety^[11].

Constant attention to physical sensations can make every signal from the body seem more threatening. In people with persistent dizziness accompanied by anxiety, vestibular rehabilitation can reduce disability related to dizziness. The reported improvements are small to moderate, and the certainty of the evidence ranges from very low to moderate^[11].

What conditions are associated with vertigo and dizziness?

Concussions, neck pain, and migraines can be associated with dizziness and lightheadedness. A concussion, in particular, can disrupt balance and eye control. The evaluation determines which functions appear to contribute to the symptoms.

Neck pain may accompany dizziness, especially after a neck injury. A migraine may also be accompanied by vertigo, even without a headache at the same time.

How can you get help for your dizziness or lightheadedness?

You can get help by making an appointment with a physical therapist trained in vestibular rehabilitation, unless the warning signs described above require medical attention first. The physical therapist can assess your symptoms, check your neck, eye, and balance functions, and then propose a plan tailored to the results. The evaluation looks for probable causes and signs that require medical referral, though it does not guarantee that a single cause will be found.

The course of the condition depends on the cause, the duration of symptoms, and any associated problems. Make an appointment if your symptoms are limiting your activities or if you would like to have your balance evaluated.

Sources

The sources for this article include the following recommendations and studies.

• [1] von Brevern M, et al. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res. 2015.
• [2] von Brevern M, et al. Epidemiology of benign paroxysmal positional vertigo: a population-based study. J Neurol Neurosurg Psychiatry. 2007.
• [3] Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017.
• [4] Fu Y, Zhao Z. Meta-analysis of the therapeutic effects of traumatic BPPV and idiopathic BPPV. Front Neurol. 2026.
• [5] Soto-Varela A, et al. Benign paroxysmal positional vertigo affecting several canals simultaneously: a series of 46 patients. Eur Arch Otorhinolaryngol. 2013.
• [6] Hilton MP, Pinder DK. The Epley maneuver for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. 2014.
• [7] Guo Xiang-Dong. Benign paroxysmal positional vertigo. J Neurosci Rural Pract. 2011.
• [8] Knapstad MK, et al. Clinical characteristics of patients with cervicogenic dizziness: A systematic review. Health Sci Rep. 2019.
• [9] Reiley AS, et al. How to diagnose cervicogenic dizziness. Arch Physiother. 2017.
• [10] De Vestel C, et al. Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness. J Man Manip Ther. 2022.
• [11] Ferlito R, et al. Anxiety-Related Functional Dizziness: A Systematic Review of Recent Evidence on Vestibular, Cognitive Behavioral, and Integrative Therapies. Life (Basel). 2026.
• [12] Heart and Stroke Foundation of Canada. Signs of a stroke.
• [13] National Institute on Deafness and Other Communication Disorders. Sudden Deafness.
• [14] Seemungal BM, et al. The Bárány Society’s Position on “Cervical Dizziness.” J Vestib Res. 2022;32(6):487-499. doi:10.3233/VES-220202.
• [15] NHS. Fainting. Updated August 17, 2026. Loss of Consciousness and Signs of a Medical Emergency.
• [16] NHS South West London Integrated Care Board. Dizziness. Recommendations approved in March 2025. Assessment and Management of Dizziness.
• [17] NHS. Vertigo. Causes, symptoms, and reasons for seeking urgent medical care.