Vertigo and Dizziness

Start by naming what you are feeling

Dizziness is a symptom, not a diagnosis, and the word covers several quite different experiences. Sorting out which one you have does most of the diagnostic work, so it is worth being precise.

True vertigo is a false sense of movement. The room spins, or you feel like you are turning when you are still. It is usually inner ear in origin.

Unsteadiness is feeling off balance without spinning, as though the floor is not quite reliable. This is the pattern more often linked to the neck.

Lightheadedness is the feeling of being about to faint. This one is more often cardiovascular or medication-related and generally belongs with your physician first.

Visual disorientation is discomfort in busy visual environments, such as supermarket aisles or traffic. It is common after concussion.

We work with the first two, and with the visual component where it follows a head injury. The third we refer.

Two patterns worth knowing

Positional vertigo (BPPV). The most common cause of true vertigo. Small calcium crystals that normally sit in one part of the inner ear become displaced into a semicircular canal, where they make the canal respond to gravity as though it were movement. The signature is unmistakable once you know it: short, intense spinning lasting well under a minute, triggered by rolling over in bed, lying down, sitting up or tipping the head back. Between episodes you feel normal.

Cervicogenic dizziness. The upper neck is full of position sensors, and their input feeds the same balance system as the inner ear and the eyes. When the neck is injured or stiff, that input can disagree with the other two, and the brain’s attempt to reconcile the conflict produces unsteadiness. It is typically vaguer than BPPV, lasts longer, comes on with neck movement or sustained positions, and usually travels with neck pain or headache. It shows up most often after whiplash or a concussion.

The local mechanisms behind it are easy to list: ski and snowboard falls at Silver Star, mountain bike crashes, hockey, and motor vehicle collisions.

How we assess and treat it

The assessment is largely about separating those patterns and ruling out the ones that are not ours to treat.

We take a careful history of timing, triggers and duration, which is often more informative than any single test. We use positional testing to check for BPPV and identify which canal is involved, examine the neck for the joints and muscles that reproduce your symptoms, and screen eye movement control and balance. We also screen for the features that point to something medical, and refer when they are present.

Treatment depends entirely on what we find:

• BPPV is treated with repositioning manoeuvres to guide the crystals out of the affected canal. Correctly identified, it often resolves quickly.
• Cervicogenic dizziness is treated by addressing the neck: chiropractic care for the joints involved, massage therapy for the muscular component, and retraining of neck position sense through exercise rehabilitation.
• Post-concussion dizziness is usually a combination, and it runs through our concussion care pathway, which addresses the cervical, vestibular and visual contributors together rather than one at a time.

Red flags that need a doctor, not us

Dizziness has a wider range of serious causes than most musculoskeletal complaints, so this list matters more than usual. Seek emergency care if dizziness comes with:

• Sudden severe headache, unlike any you have had before
• Double vision, difficulty speaking or slurred speech
• Weakness or numbness on one side of the face or body
• Difficulty walking or a marked loss of coordination
• New hearing loss or ringing in one ear alongside vertigo
• Chest pain, palpitations or fainting
• Vertigo that is constant and unrelenting rather than coming in episodes
• Dizziness after a head injury with worsening symptoms or repeated vomiting

Dizziness can be a presenting sign of stroke, and the combination of sudden dizziness with any of the neurological symptoms above needs emergency assessment immediately. If you are unsure, treat it as urgent.

Also see your physician first where dizziness started with a new medication, where you have fainted, or where it comes with significant unexplained weight loss.

When to book

Book when positional vertigo is recurring, when unsteadiness is persisting alongside neck pain or after a concussion, or when dizziness is limiting driving or work. Bring the detail of what triggers it and how long an episode lasts. Those two facts narrow the diagnosis more than anything else you can tell us.