Vertigo and Dizziness: Causes, Symptoms, and Treatment

Vertigo and Dizziness: A Complete Guide to Causes and Physiotherapy Treatments

Vertigo and dizziness affect approximately 35% of adults over 40. These symptoms can significantly disrupt your daily life. The good news is that most cases are benign and very treatable. Vestibular physiotherapy achieves success rates of 80 to 95% for several conditions, including benign paroxysmal positional vertigo (BPPV).

You might feel like the room is spinning around you when you lie down. Or you might feel unsteady when walking in a crowd or grocery shopping. These sensations can be frightening and frustrating. Rest assured: most of the time, it's not a serious problem. Understanding where your symptoms come from is the first step towards relief.

What are Vertigo and Dizziness?

Vertigo is a sensation of spinning, as if you are turning or the world is turning around you. Dizziness, on the other hand, is more of a floating sensation, imbalance, or lightheadedness without any spinning motion. These are two different symptoms that can have distinct causes.

True vertigo gives the impression that everything is moving while you are still. It is often intense and can be accompanied by nausea. Dizziness is generally less intense but equally bothersome. It can make you feel unsteady or as if you are about to fall.

These symptoms often originate from the vestibular system in your inner ear. This system acts like an internal gyroscope. It tells your brain about your head's position and your movements. When it's disturbed, the signals it sends no longer match what your eyes see. This is what creates the sensation of vertigo.

What is the Difference Between Vertigo and Dizziness?

Vertigo creates a sensation of spinning or rotational movement that isn't actually happening. Dizziness, on the other hand, gives a feeling of instability, floating, or lightheadedness without any spinning. Vertigo is generally more intense and specific, while dizziness is more vague.

The main differences concern the sensation itself, intensity, presence of nausea, typical cause, and triggers. Vertigo involves a sensation of rotation or spinning, often intense, frequently accompanied by nausea, usually caused by an inner ear problem, and triggered by head movements. Dizziness involves a sensation of floating or instability, with variable and often milder intensity, less frequently accompanied by nausea, and can have various causes such as tension, pressure, or neck issues, with variable triggers.

Both can coexist in the same person. Sometimes, an intense episode of vertigo gives way to persistent dizziness. This is normal and part of the recovery process.

What are the Causes of Vertigo?

The causes of vertigo are mainly related to the inner ear and the vestibular system. The most frequent causes include BPPV with its displaced crystals, vestibular neuritis caused by nerve inflammation, Meniere's disease, and vestibular migraine. The neck can also cause dizziness when it sends confused signals to the brain.

Benign paroxysmal positional vertigo (BPPV)

BPPV is the most common cause of vertigo. It accounts for 20 to 30% of all vertigo cases seen in clinics. It occurs when small calcium crystals, called otoliths, become displaced within the canals of the inner ear.

These crystals normally float in one part of the inner ear. But sometimes, they migrate into the semicircular canals where they don't belong. When you move your head, they create a fluid movement that tricks your brain. The result: intense episodes of spinning vertigo.

Typical signs of BPPV include vertigo triggered by certain head movements, short episodes lasting 30 seconds to 2 minutes, symptoms provoked by lying down, getting up, or turning over in bed, and the fact that looking upwards can trigger an episode.

The good news is that BPPV responds remarkably well to treatment. The Epley maneuver, performed by a trained physiotherapist, is successful in 80 to 92% of cases, often after just one session.

Vestibular Neuritis and Labyrinthitis

Vestibular neuritis is an inflammation of the vestibular nerve, often caused by a viral infection. It leads to a severe episode of vertigo that can last for several days. Labyrinthitis is similar but also affects hearing.

These conditions often start suddenly. You might wake up one morning with intense vertigo that doesn't go away. Nausea and vomiting are common. While very unpleasant, most people recover well within a few weeks.

Vestibular physiotherapy helps your brain compensate during recovery. The exercises allow you to regain your balance more quickly.

Meniere's Disease

Meniere's disease is an inner ear disorder that causes episodes of vertigo, fluctuating hearing loss, tinnitus (ringing or buzzing in the ears), and a feeling of fullness in the ear. These episodes can last from 20 minutes to several hours.

This condition affects about 0.2% of the population and is more common between the ages of 40 and 60. The exact cause is unknown, but it involves a buildup of fluid in the inner ear.

Treatment includes dietary changes such as reducing salt, medications, and vestibular physiotherapy to improve balance between episodes.

Vestibular Migraine

Vestibular migraine combines migraine symptoms with vertigo. It is the second most common cause of recurrent vertigo. Episodes can include headaches (though not always), sensitivity to light and sound, nausea, and vertigo that lasts from a few minutes to several hours.

If you have a history of migraines and experience episodes of vertigo, vestibular migraine could be the cause. Treatment often combines migraine management with vestibular physiotherapy. To learn more about migraines, consult our guide on headaches.

Cervicogenic dizziness

Cervicogenic dizziness comes from problems in the neck. Your neck contains position receptors that tell your brain where your head is. When these receptors are disturbed, they send confused signals that create a feeling of imbalance.

This type of dizziness is common after whiplash. Between 40 and 85% of people who have experienced neck trauma report dizziness. Physiotherapy for neck pain that treats both the neck and the vestibular system together yields the best results.

What are the symptoms of vertigo and dizziness?

Symptoms vary depending on the cause. The most common include a sensation of spinning or swaying, instability when walking, nausea and vomiting, difficulty focusing your gaze during movement, and fatigue and anxiety related to the episodes.

Impact on Quality of Life

Vertigo and dizziness can truly affect your daily life. Many people develop anxiety about their symptoms, avoiding certain activities for fear of having an episode. This reaction is normal.

Some people are afraid to drive, go to large stores, or walk alone. These fears are understandable, and with the right treatment, you can regain your confidence and resume your normal activities.

How is vertigo diagnosed?

Diagnosis primarily relies on your symptom history and specific clinical tests. Your healthcare professional will ask you about the nature of your episodes, their triggers, their duration, and any associated symptoms. Tests like the Dix-Hallpike test help identify the cause.

Questions Your Professional Will Ask

To fully understand your condition, expect questions about exactly what you feel (whether it's spinning, swaying, or floating), when it started, how long it lasts, what triggers the symptoms, if you experience nausea or vomiting, if you have hearing problems or ringing in your ears, if you've had a head or neck injury, and if you have a history of migraines.

Tests Performed for Vertigo

The Dix-Hallpike test evaluates posterior canal BPPV by having you lie down quickly with your head turned. The roll test evaluates horizontal canal BPPV by turning your head from side to side. The head impulse test assesses vestibular nerve function through rapid head movements. Balance tests evaluate overall vestibular function by having you stand with your eyes closed and walk heel-to-toe.

These tests may cause temporary dizziness. This is normal and necessary to identify the cause. Your physical therapist will guide you safely through the process.

When is imaging necessary?

Imaging like a CT scan or MRI is not necessary in most cases of vertigo. It is reserved for situations with red flags or when clinical tests are inconclusive. If your healthcare professional requests imaging, it is generally to rule out rare causes.

What are the treatment options?

Treatment depends on the identified cause. For BPPV, repositioning maneuvers are very effective. For other vestibular conditions, vestibular physiotherapy, which includes habituation, gaze stabilization, and balance exercises, is the first-line treatment.

BPPV Treatment

BPPV is treated with repositioning maneuvers performed by a trained physiotherapist. The Epley maneuver is the most well-known. It guides displaced crystals out of the problematic canal by positioning you in a series of specific postures.

The maneuver takes 5 to 10 minutes. You might experience vertigo during the procedure, but this is temporary. The results are often dramatic: 80% to 92% of patients find relief after one or two sessions.

Treatment for Other Vestibular Conditions

For vestibular neuritis, Meniere's disease, and other vestibular disorders, treatment often combines several approaches. Medications like anti-vertigo and anti-nausea drugs are used to control acute symptoms, but they provide temporary relief without addressing the underlying cause.

Vestibular physiotherapy uses specific exercises that help your brain compensate. Success rates reach 75% to 85% with a well-followed program. Lifestyle changes, such as reducing salt, caffeine, and alcohol, can help with Meniere's disease.

Treatment for Cervicogenic Dizziness

When the neck is the cause, treatment combines cervical physiotherapy and vestibular rehabilitation. Techniques include joint mobilizations and manipulations of the cervical joints, releasing tight neck muscles, gaze stabilization exercises, and balance training.

Studies show that approximately 75% of patients improve with this combined approach.

How Can Vestibular Physiotherapy Help?

Vestibular physiotherapy is a specialized rehabilitation that treats vertigo, dizziness, and balance disorders. It uses targeted exercises to help your brain compensate for inner ear problems and regain normal function.

How Does Vestibular Rehabilitation Work?

Vestibular rehabilitation relies on three main mechanisms. Adaptation allows your brain to learn how to better use the remaining vestibular signals. It's like adjusting the volume on a radio to compensate for a faulty speaker.

Habituation makes your nervous system less sensitive to movements that cause dizziness. By gradually exposing yourself, your brain adapts and reacts less strongly.

Substitution allows your brain to learn to use other senses, such as vision and proprioception, to compensate for vestibular deficits.

What Exercises Are Used?

Gaze stabilization exercises involve fixing your eyes on a target while moving your head from side to side or up and down. These exercises train your brain to maintain stable vision during movement.

Habituation exercises gradually expose you to movements that trigger your symptoms. Over time, your nervous system adapts.

Balance training includes progressive exercises that challenge your balance system. You start by standing with your feet together, then on one leg. Eyes open, then closed. On a stable surface, then an unstable one.

What results can I expect?

The results of vestibular physiotherapy are generally excellent. For BPPV, the success rate is 80% to 92%, with relief ranging from immediate to a few days. For vestibular neuritis, the success rate is 75% to 85% over 4 to 8 weeks. For cervicogenic dizziness, the success rate is approximately 75% over 4 to 12 weeks. For post-concussion dizziness, results vary over 6 to 12 weeks.

The consistency of home exercises strongly influences the results. Aim for 10 to 20 minutes per day. Doing a little each day is better than overdoing it once a week.

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

Consult a professional if your dizziness persists for more than a week, affects your daily activities, or is accompanied by concerning symptoms. Most causes of vertigo are benign, but some symptoms require urgent evaluation.

Good Reasons to Consult

You should seek medical advice if you experience vertigo that lasts more than a few days, dizziness that affects your work or daily activities, a feeling of imbalance when walking, dizziness after a head or neck injury, or recurrent vertigo with no known cause.

When to seek urgent care?

The following red flags require immediate medical evaluation. These symptoms are rare, occurring in less than 5% of cases, but are important to be aware of. A sudden, severe headache could indicate a vascular problem. Double vision or vision loss is a neurological sign that needs evaluation. Difficulty speaking or understanding suggests a possible stroke. Weakness on one side of the body is a sign of a possible stroke. Facial numbness is an urgent neurological sign. Loss of consciousness requires immediate evaluation. Vertigo accompanied by a high fever suggests a possible infection.

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

Who to see for vertigo?

In Quebec, you can consult a physiotherapist who can assess and treat most causes of vertigo, without a prescription. Your family doctor can perform a general check-up and rule out medical causes. An ENT specialist treats complex ear problems or Meniere's disease. A neurologist is involved if a neurological cause is suspected.

A physiotherapist trained in vestibular rehabilitation is often an excellent starting point. They can assess if your vertigo originates from the inner ear and begin treatment quickly.

Frequently asked questions about vertigo and dizziness

Is vertigo dangerous?

In the vast majority of cases, no. Serious causes of vertigo account for less than 5% of cases. Vertigo is unpleasant and can affect your quality of life, but it rarely indicates a dangerous condition. The red flags mentioned above help identify the rare cases that require attention.

How long does vertigo last?

It depends on the cause. BPPV (Benign Paroxysmal Positional Vertigo) causes episodes lasting from a few seconds to 2 minutes. Vestibular neuritis can last several days to weeks. Meniere's disease causes episodes lasting from 20 minutes to several hours. With the right treatment, most people improve significantly within a few weeks.

Can vertigo go away on its own?

Sometimes, yes. BPPV resolves spontaneously in 50% of people within a few weeks. However, treatment greatly speeds up recovery and prevents weeks of discomfort. For other causes, active treatment generally yields better results than waiting.

Will exercises make my vertigo worse?

Initially, vestibular exercises might trigger some symptoms. This is normal and even desired. Exercises need to stimulate your vestibular system to be effective. The discomfort should remain tolerable and fade within 15 to 20 minutes after the exercise.

Should I avoid movements that trigger my vertigo?

No, quite the opposite. Avoiding movements often prolongs the problem. Your brain needs to be exposed to movements to adapt. Vestibular physiotherapy teaches you how to gradually and controllably expose yourself to triggers.

Can stress cause vertigo?

Stress generally does not directly cause vertigo. However, it can worsen existing vestibular symptoms and delay recovery. Managing your stress can help your treatment be more effective.

Do I need a medical referral to see a physiotherapist?

In Quebec, no. You can directly consult a physiotherapist for physiotherapy without a prescription. This is a good starting point if you are experiencing vertigo or dizziness. If your condition requires a medical evaluation, your physiotherapist will refer you.

Conditions associated with vertigo

Vertigo and dizziness often coexist with other conditions. Headaches, especially migraines, are frequently associated. Neck problems, anxiety, and the aftermath of a concussion can also accompany or worsen vestibular symptoms.

Getting help for your symptoms

If you are suffering from persistent vertigo or dizziness, you don't have to endure it in silence. Our physiotherapists trained in vestibular rehabilitation can assess your condition and offer a personalized treatment plan to help you regain your balance.

The prognosis is generally excellent with the right treatment. Book an appointment today to start your journey towards relief.

Sources

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Hillier S, McDonnell M. Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane Review. Eur J Phys Rehabil Med. 2016;52(4):541-556.

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.