Vertigo vs. Dizziness vs. Unsteadiness

Vertigo is a feeling of spinning when you are not actually moving. Dizziness occurs when you feel light headed, faint, woozy, or disoriented.  Unsteadiness is a feeling of imbalance or disequilibrium, especially when walking.  It is important to distinguish which sensation you are experiencing when you meet with your doctor because the diagnosis and treatment vastly differ. 


Vertigo results from inner ear problems.  Some of the most common causes are Benign Positional Paroxysmal Vertigo (BPPV) and Meniere's Disease.

Benign Positional Paroxysmal Vertigo (BPPV)

What it is -  Calcium Carbonite Crystals (otoconia) become dislodged from their home in the utricle and migrate into a nearby 3 semicircular canals in the inner ear where they do not belong. 

Symptoms – When you turn your head, the otoconia artificially stimulate nerve endings in the inner ear that send signals to the brain that you are moving.  When these signals do not match the feedback from muscles, joints, and the eyes, the net effect is a false sense of spinning for less than a minute.   This commonly occurs when rolling onto your side in bed or with quick head movements.

Diagnosis – When the head is moved in a position that stimulates the otoconia, the signaling mismatch causes a pattern of movement with the eyes called nystagmus.  This can be visualized while performing a Dix Hallpike Maneuver, which is demonstrates which canal is involved. 

Treatment – Fortunately, the majority of cases can be resolved mechanically.  For greatest accuracy, the gold standard of vertigo assessment, Videonystagmography (VNG), is used to assess the direction of nystagmus to determine which of the semicircular canals is involved.  Once the doctor determines where the otoconia are residing, a repositioning maneuver, like the Epley Maneuver, is performed to facilitate mechanical movement of the crystals back to their home.  Positioning maneuvers are over 90% successful at resolving symptoms in 1-3 treatments (1).

Our approach – Following the repositioning maneuver with the aid of VNG, we perform brain rehabilitation to improve feedback between the relays involved in the sensory mismatch between the eyes, muscles and joints, and the inner ear to improve your symptoms as quickly as possible.

Self Treatment - It is ill advised to perform the Epley Maneuver on yourself.  Many do not find relief because they performed the wrong maneuver or it was not BPPV. 

1. Parnes LS, et al. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 169(7):681-693.

Meniere’s Disease aka Idiopathic Endolymphatic Hydrops

Cause – Believed to be caused by an abnormality in the volume of fluid in the inner ear.

Symptoms – Episodes of vertigo, intermittent hearing loss, tinnitus or ringing in the ear, and sensation of fullness in the ear that last 20 minutes up to 4 hours.

Diagnosis – Your doctor will diagnose based on your history of symptoms. Follow up diagnostic tests include hearing and balance functions. 

Treatment – A low salt diet, diuretic, anti-vertigo medication, intratympanic injections, air pressure pulse generators, and rarely, surgery.

Our approach – In addition to managing with your primary care physician, brain rehabilitation and exploring causes of autoimmunity have proven effective for many patients suffering from Meniere’s Disease who are looking for long term solutions.       

Central Vertigo

What it is - Vertigo caused by disease or injury to the brain, including:

  • Head Injuries 
  • Infections or Encephelopathy
  • Multiple Sclerosis
  • Migraines
  • Brain Tumors
  • Stroke or Transient Ischemic Attacks

Symptoms - Episodes come on without warning and last longer than peripheral causes of vertigo described above.  Symptoms can also be more intense.

Diagnosis - Because the causes vastly range, it is important to have a thorough neurological evaluation performed. 

Our approach - Those who suffer from central vertigo are excellent candidates for neurological and vestibular rehabilitation

Dizziness & Unsteadiness

Dizziness comes in many forms and can be described as:

  • Nausea
  • Light headed
  • Spatial disorientation
  • Body disassociation
  • Blurry vision
  • Photophobia (sensitivity to light)
  • Phonophobia (sensitivity to sound)
  • Sensation of movement (tilting, bobbing, floating, swaying)
  • Increased fall risk
  • Unsteadiness
  • Disequilibrium
  • Imbalance

Triggered by:

  • Moving your head
  • Overstimulation from the environment (grocery store, malls, action movies)
  • Driving
  • Riding in a car
  • Motion sickness
  • Migraines
  • Imbalance/gait ataxia (unsteadiness when walking)
  • Orthostatic changes (changing from lying position to standing)

Causes - Dehydration, decreased blood pressure (hypotension), anemia, heart muscle disease, hyperventilation are some of the apparent reasons for dizziness and should be ruled out. However, many forms of dizziness are caused by poor integration of neurological pathways of the brain.  

The body maintains balance with sensory information from three systems:

  • vision
  • proprioception (joints and muscles tell us where we are in space)
  • vestibular system (inner ear sensing motion, equilibrium and spatial awareness)

Our approach: A thorough neurological examination, computerized posturography, and videonystagmography are performed to objectively distinguish which brain relays are working inefficiently.  After narrowing in the areas of weakness, customized neurological and vestibular rehabilitation is prescribed to provide appropriate feedback to the brain.  


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