Vertigo and Dizziness: Causes, Symptoms and Physiotherapy
Vertigo and Dizziness: Causes, Symptoms and Physiotherapy
Understand the difference between vertigo and dizziness, common symptom patterns, warning signs and when vestibular physiotherapy may help.
Vertigo and dizziness can feel like spinning, floating, light-headedness, unsteadiness or reduced walking confidence. These symptoms may arise from the inner ear and vestibular system, migraine, blood pressure changes, medication effects, neck-related factors or other medical conditions. Sometimes more than one factor contributes.
Vertigo usually describes a false sense of movement. Dizziness is a broader term and may feel like faintness, imbalance or simply feeling “off”. Understanding the timing, triggers and associated symptoms helps guide whether you may benefit from vestibular rehabilitation therapy, BPPV repositioning, neck assessment, medical review or a combined approach.
Vertigo
A false sensation that you or your surroundings are moving, spinning, tilting or swaying.
Dizziness
A broader feeling that may include light-headedness, faintness, imbalance, floating or feeling “off”.
Useful clues
Triggers such as rolling in bed, standing up, rapid head movement, visual motion or neck movement can help guide assessment.
Vertigo and Dizziness: What Is the Difference?
Vertigo
Vertigo is the sensation that you or your surroundings are moving, spinning, tilting or swaying when no matching movement is occurring. It commonly occurs with disorders affecting the vestibular system, which helps the brain interpret head movement and position.
Conditions commonly associated with vertigo include:
- BPPV, which often causes brief spinning when rolling in bed, looking up or bending forward.
- Ménière’s disease, which may involve vertigo, tinnitus, ear fullness and hearing changes.
- Vestibular migraine, which may cause dizziness or vertigo with light, sound, visual or motion sensitivity.
- Cervicogenic dizziness, where neck-related sensory input may contribute after other relevant vestibular, neurological and medical causes have been considered.
Dizziness
Dizziness is a broader term. It may include light-headedness, faintness, unsteadiness, imbalance, floating or a vague feeling that something is not right. It does not always involve spinning.
Possible contributors include vestibular disorders, migraine, blood pressure changes, dehydration, medication effects, fatigue, neck-related factors and other medical conditions. Some people experience more than one type of dizziness at the same time.
What Symptoms Can Occur With Vertigo or Dizziness?
The way your symptoms feel, how long they last and what brings them on can provide useful clues. However, symptoms alone do not confirm a diagnosis.
- Spinning or movement: you may feel as though you or the room is turning, tilting or swaying.
- Light-headedness: you may feel faint, woozy or as though you might pass out.
- Imbalance: walking may feel unsteady, particularly in the dark, on uneven ground or during head movement.
- Nausea: vestibular symptoms can cause nausea or motion sickness.
- Visual motion sensitivity: supermarkets, scrolling screens, traffic or busy environments may provoke symptoms.
- Hearing symptoms: tinnitus, ear fullness or hearing changes can accompany some inner-ear conditions.
- Headache or sensory sensitivity: light, sound or motion sensitivity may occur with vestibular migraine.
What Symptom Patterns May Provide Useful Clues?
Patterns can help guide further assessment, although several conditions can cause similar symptoms.
- Brief spinning when rolling in bed: commonly occurs with BPPV or another positional vestibular problem.
- Dizziness with hearing changes or ear fullness: may require medical assessment for an inner-ear disorder.
- Dizziness with migraine features: may occur with vestibular migraine, particularly when light, sound, visual motion or head movement also trigger symptoms.
- Dizziness with neck pain or stiffness: may involve neck-related factors, although other causes should also be considered.
- Light-headedness after standing: may relate to blood pressure, hydration, medication or another medical cause.
Why Do People Get Vertigo or Dizziness?
Vertigo can arise when the vestibular system or the brain’s processing of balance and movement information is disrupted. Dizziness has a broader range of possible causes and may involve vestibular, neurological, cardiovascular, medication-related or other medical factors.
Some people have one clear cause. Others have overlapping contributors. For example, BPPV may settle but leave temporary imbalance, while migraine sensitivity or persistent postural-perceptual dizziness (PPPD) can contribute to continuing symptoms.
How Are Vertigo and Dizziness Assessed?
A vestibular physiotherapy assessment starts with your symptom history. Your physiotherapist may ask when symptoms began, how long episodes last, which movements or positions trigger them, and whether you have hearing changes, headaches, falls, imbalance, medication changes or relevant medical conditions.
Assessment may include eye movement testing, head movement tolerance, walking and balance tasks, positional testing, balance reactions and neck movement when relevant. Tests are selected according to your presentation rather than applying every vestibular test to every person.
If your symptoms suggest BPPV, positional tests such as the Dix-Hallpike test may be appropriate. Other presentations may require vestibular rehabilitation assessment, balance testing, neck assessment or referral to a GP, ENT specialist, neurologist or another medical service.
How Can Physiotherapy Help Vertigo and Dizziness?
Physiotherapy may help when symptoms relate to the vestibular system, balance control, motion sensitivity, gaze stability, BPPV or relevant neck factors. Treatment should match the assessment findings rather than relying on one generic set of dizziness exercises.
Depending on your assessment, physiotherapy may include:
- canalith repositioning manoeuvres when positional testing identifies BPPV
- gaze stabilisation and graded head movement exercises for appropriate vestibular problems
- walking and balance retraining to improve steadiness and confidence
- graded exposure to movement or visually busy environments when motion sensitivity is present
- neck assessment and rehabilitation when neck symptoms appear relevant
- guidance about activity, falls risk and safe progression back to daily activities.
Vestibular rehabilitation therapy is tailored to the underlying problem, your current ability and the activities you want to return to.
When Should Dizziness or Vertigo Be Assessed Urgently?
Seek medical advice if dizziness is new, persistent, unexplained or worsening, even when none of these urgent warning signs are present.
Vertigo and Dizziness FAQs
What is the difference between vertigo and dizziness?
Vertigo is a false sense of spinning or movement. Dizziness is a broader term that may include light-headedness, faintness, imbalance, floating or feeling “off”. The distinction can help guide assessment because the possible causes and management options differ.
Can physiotherapy help vertigo and dizziness?
Physiotherapy may help when dizziness relates to the vestibular system, balance control, motion sensitivity, gaze stability, BPPV or relevant neck factors. Treatment may include vestibular rehabilitation, balance retraining or repositioning manoeuvres depending on the assessment findings.
How is BPPV treated?
BPPV is commonly managed with canalith repositioning manoeuvres. These aim to move displaced calcium carbonate particles within the inner ear to a position where they no longer trigger vertigo. The appropriate manoeuvre depends on the affected canal and positional test findings.
When is dizziness a red flag?
Seek urgent medical care if sudden dizziness occurs with chest pain, fainting, severe new headache, new weakness or numbness, facial droop, speech problems, sudden vision changes, double vision, sudden hearing loss or sudden difficulty walking.
Why does vertigo happen when you turn over in bed?
Brief vertigo triggered by rolling in bed commonly occurs with BPPV. Changes in head position can move displaced calcium carbonate particles within the inner ear and briefly create abnormal movement signals. This may cause spinning, nausea or short-lived unsteadiness.
What should you do if vertigo or dizziness keeps coming back?
If vertigo or dizziness keeps returning, arrange an assessment. Recurring symptoms may require vestibular testing, balance assessment, BPPV repositioning, vestibular rehabilitation, neck assessment or medical review depending on the pattern.
What to Do Next
If vertigo or dizziness is affecting daily activities, driving confidence, work, sport or walking steadiness, an assessment can help identify likely contributors and guide the next step.
A vestibular physiotherapy assessment may be useful when symptoms keep returning, appear related to movement or balance, or you are unsure what is causing them. Your physiotherapist can determine whether vestibular rehabilitation, BPPV repositioning, balance retraining, neck rehabilitation or medical referral is appropriate.
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References
- Hall CD, Herdman SJ, Whitney SL, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther. 2022;46(2):118-177. doi:10.1097/NPT.0000000000000382.
- Lempert T, Olesen J, Furman J, et al. Vestibular migraine: Diagnostic criteria (Update): Literature update 2021. J Vestib Res. 2022;32(1):1-6. doi:10.3233/VES-201644.
- Alfarghal M, Kamil ES, Hamdan M, et al. Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: A systematic review and meta-analysis. Front Neurol. 2023;14:1288150. doi:10.3389/fneur.2023.1288150.
- Rezaeian A, Abtahi H, Moradi M, Farajzadegan Z. The effect of vestibular rehabilitation in Meniere’s disease: a systematic review and meta-analysis of clinical trials. Eur Arch Otorhinolaryngol. 2023;280(9):3967-3975. doi:10.1007/s00405-023-08066-x.
