What are Dizziness and Vertigo?
Dizziness and Vertigo
Dizziness is a broad term for feeling lightheaded, woozy or unsteady. It can make you feel like you’re about to faint.
Vertigo is a false sense of motion. It can make you feel like you’re spinning or that the world is spinning around you. It can also feel like falling, tilting, swaying, being pulled in one or more directions, or being generally unstable.
Dizziness and vertigo often come with nausea. More severe cases can involve headache, sweating, a racing heart, ringing in the ears, eyes that won’t hold still, vomiting, and a feeling that you can’t sit up or stand without passing out.
Vertigo can range from a mild annoyance to a severely debilitating problem. Some people are bedridden by it, and it can make it nearly impossible to engage with the world (1).
Sudden dizziness or vertigo can sometimes be a sign of a stroke. Call 911 if dizziness comes with weakness or numbness, trouble speaking, double vision, facial drooping, a severe headache, trouble walking, chest pain or fainting.
What Causes Dizziness and Vertigo?
Dizziness and vertigo are often caused by a problem with the vestibular system. This includes the inner ear, the vestibular nerves, and the areas of the brainstem and brain that process balance information.
Dizziness and vertigo can also involve any of the brainstem, cerebellum and brain areas that receive input from the inner ear. When the signals from your inner ear don’t match the signals from your eyes or your muscles and joints, this sensory mismatch creates a false sense of motion (2).
What Are Some Common Types of Dizziness and Vertigo?
Benign paroxysmal positional vertigo (BPPV). BPPV is one of the most common causes of vertigo (3). The inner ear has two kinds of balance sensors: the otoliths, which sense head tilt relative to gravity and straight-line movement like up, down and side to side, and the semicircular canals, which sense head rotation. The otoliths rely on tiny calcium crystals called otoconia to work.
In BPPV, some of these crystals come loose and drift into one of the canals. The canals are fluid-filled tubes with hair cells that sense movement. When your head turns, the fluid lags behind for a moment, bending the hair cells and telling your brain which way your head is turning. In BPPV, when the affected canal is tipped into a vertical position, the loose crystals sink and drag the fluid with them, bending the hair cells even though your head isn’t turning. The canal sends the wrong signal to the brainstem, creating a sensory mismatch and vertigo.
BPPV is often treated effectively with the Epley maneuver and other canalith repositioning maneuvers, which move the head through a series of positions that guide the crystals back where they belong. More complicated cases involve more than one canal, and we have extensive experience treating these complex forms.
Ménière’s disease. Ménière’s disease involves fluid buildup in the inner ear (4). It can cause episodes of vertigo, ringing in the ears and a feeling of pressure or fullness in the ear, and it can lead to hearing loss over time.
Ménière’s disease involves more than the sensory mismatch it creates. Factors such as diet, salt intake and inflammation can affect the condition and are managed together with your physician. Neurological rehabilitation focuses on improving the vertigo, balance problems and other symptoms that come from the brain’s efforts to adapt.
Vestibular neuritis and labyrinthitis. These conditions usually follow a viral infection (5). The resulting inflammation can damage the balance sensors of the inner ear or the vestibular nerve.
Symptoms can be severe at first, with disabling spinning, nausea, vomiting, poor balance and unstable vision. This usually settles over a few days, and most people gradually regain function over the next one to two months. Some people, though, are left with lasting unsteadiness, dizziness when turning their head in certain directions, ongoing nausea and vision problems.
Early medical treatment, which may include medication prescribed by your physician, can be important. Neurological rehabilitation can then help the brain adapt and improve function.
Mal de débarquement syndrome (MdDS). MdDS causes a constant rocking feeling, as if you’re still on a boat (6). A leading theory is that it involves a mismatch between the inner ear’s two types of balance sensors, the otoliths and the semicircular canals, along with problems in the brain and brainstem systems that help them adapt together. We carefully measure how these systems are working and design your program based on that data, including methods from the Dai protocol, which has been studied for MdDS.
Vestibular migraine. Vestibular migraine is considered one of the most common causes of repeated, spontaneous vertigo attacks. Diagnosis requires a current or past history of migraine along with moderate to severe vestibular symptoms. Migraine involves changes in brain activity, brain chemistry and blood flow, and when these affect the brainstem and cerebellum, they can cause dizziness and vertigo, with or without headache (7).
Vestibular syncope. In some people, vertigo can trigger fainting. A 2022 study of 53 people with vestibular syncope found it was most often linked to Ménière’s disease and BPPV. Researchers believe a false sense of motion from the inner ear and brain can set off the reflexes that control blood pressure, causing a sudden drop and fainting (8). If you’ve fainted during a vertigo attack, tell your physician.
Central vestibular disorders. Dizziness and vertigo can come from problems in the inner ear itself (peripheral disorders), or from problems in the cerebellum, brainstem and brain systems that process balance information (central disorders) (9). These systems combine inner ear input with information from your eyes and from your muscles and joints to create a clear picture of where your body is and how it’s moving. Certain test findings can point to a central problem, such as changing patterns of involuntary eye movements called nystagmus, or trouble following a moving target with your eyes. Central disorders are generally considered harder to treat than peripheral ones, and they are a major focus of our work.
Brain and neck injuries. Vertigo and dizziness are among the most common symptoms after a traumatic brain injury. Neck injuries can also cause dizziness, called cervicogenic dizziness (10). The same forces that cause a concussion can also injure the inner ear and the muscles and joints of the neck, creating significant sensory mismatches. Many people have injuries to several of these systems at once, and caring for them well starts with carefully measuring how each system is working, which is one of the first steps in our NeuroRescue Program.
How Are Dizziness and Vertigo Usually Treated?
Dizziness and vertigo are often treated with medications, such as vestibular suppressants, anti-nausea medications or medications for anxiety, and sometimes antidepressants. These can help reduce symptoms, especially in the short term (11).
Many people are also referred to physical therapists for vestibular rehabilitation. Many programs use habituation, which helps the brain gradually get used to movements that trigger symptoms. This can be very helpful for many people (12).
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician and other providers, never in place of them. Please don’t change or stop any medication without talking with your prescriber.
How we approach dizziness and vertigo depends on the cause. In most cases, our goal is to improve the function of the inner ear reflexes and brain systems involved in the mismatch, and to help them work properly with your other systems. In other cases, our goal is to help your brain adapt to reflexes that can’t fully recover and learn to rely on other systems for balance, with the aim of reducing vertigo.
In every case, care starts with a thorough neurological exam and detailed testing. We measure how each system involved in your dizziness is working, including key eye reflexes, inner ear function and feedback from your muscles and joints.
We look not only at how each of these systems works on its own, but also at how well they work together under different balance conditions. This helps us identify which systems are contributing to the mismatch, how well they integrate, and the specific situations where that integration breaks down.
We then design a NeuroRescue Program specific to your pattern of function and fatigue, with the goal of helping you get back to engaging with the world with more confidence.
Depending on your needs and test results, your program may include canalith repositioning maneuvers for BPPV (13); exercises to retrain how your eyes and inner ear work together during head movement (14); eye exercises to improve visual stability (15); non-invasive electrical stimulation of the vestibular system through the skin (16); visual stimulation exercises (17), including visual stimulation combined with head movements (18); and exercises in a virtual reality environment (19). Transcranial magnetic stimulation (TMS) has also been studied for chronic dizziness (20). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you.
No two cases of dizziness and vertigo are alike, and the same is true for your NeuroRescue Program. The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure how each semicircular canal is working, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help the world feel steady again, so you can move, turn your head and go about your day with confidence.
Your Next Step
Living with dizziness and vertigo can be frightening and exhausting, especially when you’ve been searching for answers. You don’t have to keep figuring it out alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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