Vertigo and Dizziness: Causes, Symptoms, and Treatment

Vertigo and Dizziness: How to Describe Them, When to Seek Medical Attention, and What Treatments May Be Appropriate?

Vertigo creates a sensation of movement, and dizziness can cause a feeling of lightheadedness; a medical consultation is recommended if these symptoms persist, and certain maneuvers or exercises may help depending on the cause. Sudden weakness, difficulty speaking, or double vision accompanying these symptoms requires an immediate call to 911. Vestibular physical therapy focuses specifically on the inner ear’s balance system. It can treat benign paroxysmal positional vertigo (BPPV)—a condition in which certain changes in head position trigger brief episodes of vertigo—or provide support when a dysfunction of this system has been diagnosed. An evaluation determines the appropriate treatment and whether a medical consultation is needed.

You may feel as though the room is spinning around you when you lie down. Or you may feel unsteady when walking through a crowd or while grocery shopping. These sensations can be frightening and frustrating. It’s important to describe them accurately. Their onset, duration, triggers, and associated symptoms will guide the next steps.

What is vertigo, and how does it differ from dizziness?

Vertigo causes a sensation of movement, such as spinning or swaying, whereas lightheadedness can also refer to a feeling of lightness in the head or unsteadiness without any sensation of movement.¹ Describing these sensations helps in understanding your symptoms, but it is not enough to determine their cause.

Vertigo can make you feel as if you’re moving even though you’re standing still. It can also make it feel as if the room is moving around you. Vertigo, like other types of dizziness, can be intense, accompanied by nausea, or interfere with your daily activities.

These symptoms may originate in the vestibular system in your inner ear. This system acts like an internal gyroscope. It tells your brain the position of your head.² When a vestibular disorder occurs, information about movement and position may become less consistent. However, this explanation does not cover all causes of dizziness or lightheadedness.

What is the difference between vertigo and dizziness?

Vertigo refers to a sensation of spinning or movement. Dizziness can manifest as a lightheaded feeling, unsteadiness, or a sensation of floating. Describing the sensation accurately helps guide the evaluation, though it is not sufficient on its own to determine the cause.

A sensation of spinning or swaying is associated with vertigo. A light-headed feeling or a sense of unsteadiness can be described as dizziness. These terms alone do not allow for identification of the cause. The onset of symptoms, their duration, their triggers, and other signs guide the evaluation. Problems with the inner ear, the heart, or the nervous system, certain medications, and other health issues can cause these sensations.

Both can occur simultaneously in the same person. Sometimes, an episode of intense vertigo gives way to persistent dizziness. Persistent or changing symptoms warrant reevaluation, especially if new signs appear.

What causes dizziness?

Several conditions can cause dizziness, including BPPV, vestibular neuritis, Ménière’s disease, and vestibular migraine. The evaluation is used to distinguish among these possibilities. Neck pain may accompany dizziness, but this association does not prove that the neck is the cause.

Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear. It occurs when otoconia—small calcium carbonate crystals—displace from their usual location.

These crystals are normally held in place within a small structure in the inner ear. But sometimes, they migrate into the semicircular canals, where they shouldn't be. When you move your head, they cause fluid to shift, which tricks your brain.³ The result: intense episodes of rotational vertigo.

Typical signs of BPPV include dizziness triggered by certain head movements. The episodes are brief. Symptoms occur when lying down, getting up, or rolling over in bed. Looking up can also trigger an episode.

After a positional test consistent with posterior canal BPPV and identification of the affected side, a repositioning maneuver such as the Epley maneuver may be performed by a trained professional. A follow-up evaluation is recommended if symptoms persist in order to verify the canal, the side, and other possible causes.⁴

Vestibular Neuritis and Labyrinthitis

Vestibular neuritis is characterized by a sudden decline in vestibular function on one side. The exact cause is not always known.⁵ Hearing loss suggests a different diagnosis, which must be evaluated.

New, sudden, and persistent dizziness requires urgent medical evaluation. Call 911 if it is accompanied by double vision, weakness, sudden numbness, difficulty speaking, a sudden and unusual headache, or a new inability to walk. A disorder of the inner ear should not be assumed without an examination.

After a diagnosis of impaired balance function in one ear, vestibular rehabilitation can reduce dizziness and improve your ability to perform certain activities. The specialist will tailor the exercises and their progression to your specific situation.⁶

Meniere's Disease

Ménière's disease is a disorder of the inner ear that can cause episodes of vertigo, fluctuating hearing loss, ringing in the ears (known as tinnitus), or a sensation of pressure in the ear. The frequency and severity of episodes and symptoms vary. Sudden hearing loss requires immediate medical evaluation.

There is no single confirmed cause of Ménière's disease. An excess of fluid is often observed in the inner ear, but its exact role in the episodes remains unclear⁷. The prevalence of the condition alone cannot explain a person’s symptoms.

Your doctor or an otolaryngologist (ENT), a doctor who specializes in the ears, nose, and throat, will provide medical care for Ménière's disease. Dietary changes, such as reducing salt intake, are often recommended, but their effectiveness remains uncertain.⁸ Vestibular physical therapy can help if balance problems persist between attacks; it is not used to treat an acute Ménière’s attack.

Vestibular Migraine

Vestibular migraine may involve episodes of vertigo and other symptoms associated with migraine. The recurrence of episodes alone is not sufficient to establish this diagnosis. Episodes may include vertigo of varying duration, with or without a headache, as well as sensitivity to light or sound and nausea. These features alone are not sufficient to confirm the diagnosis.

A history of migraines and episodes of dizziness may lead a doctor to consider vestibular migraine as one of several possible causes. Treatment depends on an individualized medical evaluation. To learn more about migraines, see our guide on headaches.

Cervicogenic Dizziness

The term “cervicogenic dizziness” refers to a neck-related cause that remains difficult to confirm. The neck contains position receptors that transmit information to the brain. Their role in dizziness remains a hypothesis. No single test can confirm this cause, and ruling out other causes is not sufficient to prove it.^{9, 10}

Dizziness may occur after a whiplash injury—a sudden movement of the head and neck. There are several possible causes following this type of trauma. An evaluation helps determine the necessary care. Physical therapy for neck pain can address any identified neck issues, but an improvement in dizziness does not confirm that the dizziness is caused by a neck problem.¹⁰

What symptoms may accompany vertigo or dizziness?

The symptoms associated with vertigo and dizziness vary depending on the cause, but the most common include a sensation of spinning or rocking, unsteadiness when walking, nausea and vomiting, difficulty keeping one's gaze steady during movement, and fatigue and anxiety related to these episodes.

Impact on Quality of Life

Vertigo or dizziness can interfere with certain daily activities. Many people become anxious about their symptoms. They avoid certain activities for fear of having an episode. It’s normal to react this way.

Some people are afraid to drive, go to supermarkets, or walk alone. The plan can gradually focus on the activities that matter to them, depending on safety, symptoms, and the observed response.

How are dizziness or lightheadedness evaluated?

The evaluation of dizziness is based on your symptoms, a physical exam, and tests selected based on the possible causes. The healthcare professional will ask you about your episodes, their triggers, their duration, and any other symptoms. They will also check for signs that require urgent medical evaluation. When symptoms suggest BPPV and movement is safe, the Dix-Hallpike test can be used to check for involvement of the posterior canal of the inner ear.⁴

Questions Your Professional Will Ask

The healthcare professional will ask you how you’re feeling: whether you experience spinning, swaying, lightheadedness, or unsteadiness. They’ll ask when the symptoms began, how long they’ve lasted, and what triggers them. They’ll check for nausea, vomiting, changes in hearing, or ringing in the ears. They’ll also ask you about migraines, medications, and any head or neck injuries.

Tests That May Be Included in the Evaluation of Vertigo

The Dix-Hallpike test screens for BPPV in the posterior canal. The roll test, which involves turning the head while lying down, can screen for BPPV in the horizontal canal. The healthcare professional observes involuntary eye movements, known as nystagmus, to interpret the results and identify the affected canal and side.⁴

Some tests may briefly reproduce your symptoms. The physical therapist will adjust them based on your tolerance and stop if necessary.

When is imaging necessary?

For VPPB that meets the diagnostic criteria and has no inconsistent signs, the guideline does not recommend routine imaging. In other cases, the decision to perform imaging depends on the medical evaluation and associated signs.

What treatments are appropriate depending on the cause of vertigo or dizziness?

Repositioning maneuvers can treat BPPV, while specific exercises can help with certain inner-ear balance disorders. These exercises can improve gaze stability, balance, or tolerance to movement. Other causes require medical evaluation and different treatment.

BPPV Treatment

BPPV is treated with repositioning maneuvers performed by a trained physical therapist. The Epley maneuver is the best known. The maneuver is selected based on the canal and side identified by the tests, and then uses a series of positions to attempt to reduce positional vertigo.

A maneuver can reproduce vertigo and must be tailored to safety considerations and contraindications. If symptoms persist, the semicircular canal, the side, and other causes are reevaluated.

Treatment for Other Vestibular Conditions

For vestibular neuritis, Ménière's disease, and other vestibular disorders, treatment may combine various approaches. During the acute phase, the doctor may prescribe medications for dizziness or nausea, such as anti-dizziness and antiemetic drugs. These are intended to provide temporary relief without treating the underlying cause.¹¹

When a dysfunction of one ear's balance system is diagnosed, appropriate exercises can reduce dizziness and improve performance in certain activities.⁶ The response varies and does not depend solely on the regularity of the exercises. For Ménière’s disease, lifestyle changes—such as reducing salt, caffeine, and alcohol intake—are sometimes recommended as part of medical care, but the evidence supporting them remains limited.

Treatment for Cervicogenic Dizziness

When neck pain accompanies dizziness, the evaluation first identifies possible causes and warning signs. The treatment plan can then address any issues identified in the neck or with balance. It may include neck exercises, joint mobilization(movements performed by the physical therapist), or balance and eye-tracking exercises, as needed.

The healthcare professional monitors changes in your symptoms and activities, then adjusts your treatment. If the dizziness persists or changes, they will reassess the possible causes. The response to treatment alone is not enough to confirm that the dizziness originates in the neck.¹⁰

How can vestibular physical therapy help?

Vestibular physical therapy can reduce certain types of dizziness through repositioning maneuvers or improve eye movement and balance through exercises tailored to your diagnosis. The evaluation identifies the cause of your symptoms and determines whether urgent medical attention is needed. The treatment plan takes your activities and safety into account.

How Does Vestibular Rehabilitation Work?

Depending on the diagnosis, some exercises help you keep a clear focus on a target when you move your head. Others have you practice movements to improve your balance or your tolerance for movement.

Habituation exercises involve repeating certain movements that cause mild to moderate symptoms, as directed by your healthcare professional. They are designed to reduce your sensitivity to these movements. The choice of movements and their intensity depend on your diagnosis, your tolerance, and your safety.

Some exercises use visual or proprioceptive cues—that is, information from the muscles and joints—to support balance during a given task.

What Exercises Are Used?

Eye stabilization exercises involve focusing on a target while moving your head from side to side or up and down. A professional will recommend these exercises if they notice that you have difficulty keeping your gaze steady. They will adjust the duration, frequency, and speed of the movements to suit your situation.

For certain conditions, the professional helps you gradually resume the movements or activities that trigger your symptoms. They explain the necessary support and the limits you need to observe to prevent falls.

Balance training includes exercises that increase in difficulty based on your abilities. The professional selects the exercises based on your risk of falling. You perform them with the recommended support or supervision.

What results can I expect?

The effects of vestibular physical therapy depend on the diagnosis and the measured results. For BPPV, repositioning maneuvers can reduce vertigo. For a loss of function on one side of the inner ear’s balance system, rehabilitation can reduce certain types of dizziness and improve certain activities⁶. For dizziness associated with the neck, the response to treatment and the number of sessions vary. After a concussion, an evaluation determines which functions are affected before selecting exercises.

The at-home exercise program, if prescribed, specifies the exercises, frequency, necessary supports, and signs that indicate when to stop or contact a healthcare professional.

When to seek medical advice and what are the warning signs?

Seek medical attention if the dizziness persists or interferes with your daily activities, and call 911 if it is accompanied by sudden weakness, difficulty speaking, double vision, or a sudden, severe headache. These warning signs may indicate a medical emergency. Other signs that require immediate evaluation are described below.

Good Reasons to Consult

You should see a doctor if your dizziness persists, if it interferes with your work or daily activities, if you feel unsteady when walking, or if it occurs after an injury.

When to seek urgent care?

Call 911 if dizziness is accompanied by weakness on one side of the body, sudden numbness, difficulty speaking or understanding, a sudden change in vision, or a sudden, severe headache. A new inability to walk or sit up, chest pain, palpitations accompanied by dizziness, or loss of consciousness also require urgent medical attention. Do not drive yourself to the hospital. Sudden hearing loss or dizziness accompanied by a high fever requires immediate medical evaluation.

If in doubt, seek professional advice. It's always better to get it checked.

Who should I see for vertigo?

In Quebec, you can see a physical therapist without a prescription. They can help assess vertigo and treat certain causes that fall within their scope of practice. Your family doctor can perform a general evaluation and rule out medical causes. An ENT specialist treats complex ear problems or Ménière’s disease. A neurologist is consulted if a neurological cause is suspected.

If there are no warning signs, a physical therapist trained in vestibular rehabilitation can assess issues within their scope of practice and refer you as needed. New, sudden, and persistent dizziness or sudden hearing loss requires an urgent medical evaluation first. For the emergency signs described above, such as sudden weakness or difficulty speaking, call 911.

Frequently Asked Questions About Vertigo and Dizziness

Questions often focus on the potential severity of dizziness, its duration, how it progresses, the effect of exercise, and the role of stress.

When does dizziness require urgent evaluation?

Vertigo requires urgent medical evaluation if it occurs suddenly and is persistent, or if it is accompanied by sudden hearing loss. Call 911 if you experience sudden weakness, difficulty speaking, double vision, a sudden severe headache, or a new inability to walk. Other warning signs are described in the previous section.

How long can vertigo last?

The duration and course vary depending on the cause and cannot be predicted based on the symptom alone. Persistent symptoms, or symptoms that are new or different from the usual pattern, require reevaluation.

Can the VPPB operate on its own?

Yes, BPPV can resolve on its own without treatment. Once the diagnosis is confirmed, a period of observation with follow-up may be an option. Repositioning maneuvers can also treat it. If symptoms persist or change, a reevaluation is performed to determine whether the BPPV is still present or if there is another cause.

Can exercise help with my dizziness?

Some exercises may briefly trigger symptoms, depending on the instructions you’ve been given. Stop the exercise and contact your healthcare professional if the symptoms exceed the expected limits, persist unusually, or if you fall. If you experience sudden weakness, difficulty speaking, double vision, or any other sign of a medical emergency, call 911.

Should I avoid movements that trigger my dizziness?

Which movements to resume or avoid depends on the cause of the dizziness and the risk of falling. After the evaluation, certain movements may be gradually resumed with the recommended support. The healthcare professional will specify which movements should be temporarily avoided.

Can stress affect vertigo?

Stress can affect certain symptoms, but it does not determine their cause. New-onset dizziness or lightheadedness warrants the same evaluation, regardless of whether a person is going through a stressful period.

Do I need a doctor's referral to see a physical therapist?

In Quebec, no. You can see a physical therapist directly for physical therapy without a prescription. If there are no signs of an emergency, vestibular physical therapy may be an option for dizziness or lightheadedness that persists or limits your activities. If your condition requires a medical evaluation, your physical therapist will refer you.

What conditions can cause dizziness?

BPPV, vestibular neuritis, Ménière’s disease, and vestibular migraine can cause dizziness. Certain headaches, particularly migraines, may accompany these episodes. A concussion may also be followed by dizziness that requires evaluation. Neck pain may occur alongside these symptoms, though this does not prove that the neck is the cause.

How can you get help for your symptoms?

For persistent dizziness or lightheadedness without any signs of an emergency, a physical therapist trained in vestibular rehabilitation can assist with the evaluation and recommend a plan tailored to your diagnosis, safety, and the activities that matter to you.

For persistent symptoms without any signs of an emergency, make an appointment for an evaluation. If you experience any warning signs, follow the emergency guidelines described above. Sudden weakness, difficulty speaking, or double vision require an immediate call to 911.

Sources

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

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