Dizziness is one word covering several very different problems, and the treatment for one does nothing for another. That is why people spend months on the wrong approach.
Here is how they are told apart.
BPPV, benign paroxysmal positional vertigo
What it feels like. Short, intense spinning, usually lasting under a minute, triggered by a change in head position. Rolling over in bed, lying down, looking up at a high shelf, or bending forward. Between episodes you feel largely normal, though often vaguely unsteady.
What is happening. Tiny calcium crystals that normally sit in one part of the inner ear have moved into a semicircular canal where they do not belong. When you move your head, they move, and the canal sends a signal saying you are spinning when you are not.
What fixes it. A corrective manoeuvre. A specific sequence of head and body positions that moves the crystals back where they belong. It commonly works in one or two sessions.
This is the most important thing in this article. BPPV is extremely common, it is frequently mistaken for something else, and it is one of the few causes of vertigo that can be genuinely corrected quickly. People live with it for months or years, sometimes on medication that only masks it, when the actual treatment takes minutes.
Which manoeuvre depends on which canal the crystals are in, and that is established by specific assessment. Doing the wrong manoeuvre does not help and can move crystals into a different canal.
Our physiotherapists teach BPPV corrective manoeuvres to other physiotherapists as an accredited course.
Vestibular neuritis and labyrinthitis
What it feels like. Sudden, severe, constant vertigo lasting days rather than seconds, often with nausea and vomiting. Usually a single episode, frequently after a viral illness. Labyrinthitis includes hearing changes, neuritis does not.
What fixes it. The acute episode settles on its own over days. What often does not settle on its own is the unsteadiness afterwards, because the brain has to compensate for the reduced signal from that ear.
Vestibular rehabilitation exercises drive that compensation. And the instinct to rest and avoid moving the head actually slows recovery, because the compensation is triggered by movement.
Meniere’s disease
What it feels like. Episodes of vertigo lasting twenty minutes to several hours, with hearing loss, tinnitus and a sense of fullness in the ear, typically all on the same side.
What fixes it. Medical management sits with an ENT specialist and often involves dietary changes and medication. Physiotherapy addresses the balance deficits that build up between episodes, which are often what actually limits people day to day.
Persistent postural perceptual dizziness
What it feels like. Ongoing unsteadiness and dizziness lasting months, worse when standing or walking, and noticeably worse in visually busy environments like supermarkets or shopping centres. It usually starts after another vestibular event that has since resolved.
What fixes it. Graded vestibular rehabilitation and visual desensitisation. It is a real, recognised and treatable condition, and it is frequently dismissed because scans and hearing tests come back normal.
Cervicogenic dizziness
Dizziness arising from the neck, often after whiplash or with significant neck pain. Treated by addressing the neck alongside vestibular work.
When dizziness is an emergency
Go to hospital for sudden vertigo with any of: severe headache, double vision, difficulty speaking, weakness or numbness on one side, difficulty walking that is disproportionate to the dizziness, or a severe unrelenting headache. Those can indicate a stroke affecting the balance centres.
Why to see someone with vestibular training
These conditions are separated by specific assessment, including eye movement testing and positional testing, and the treatment for each is different. A general physiotherapist may not have that training.
Our team includes accredited vestibular physiotherapists, which is a specific accreditation rather than a description of an interest.
Call 08 8331 2700.
