Dizziness & Vertigo

Dizziness and vertigo are different sensations, though people often use the terms interchangeably.

Dizziness is a general term that includes:

• Lightheadedness (feeling faint)

• Unsteadiness (feeling off-balance)

• Wooziness (foggy or floating feeling)

• Disorientation (spatial confusion)

Vertigo is a specific type of dizziness:

• A false sensation that you or your environment is spinning or moving

• Often described as the room spinning

• Usually caused by inner ear or brain problems

• Often accompanied by nausea

How to identify what you're experiencing:

| Symptom | Likely Cause |
|---------|--------------|
| Room spinning | Vertigo (vestibular) |
| Lightheaded when standing | Blood pressure/circulation |
| Off-balance but no spinning | Balance dysfunction |
| Floating/detached feeling | Anxiety or vestibular |

Common causes by type:

• Vertigo: BPPV, vestibular neuritis, Meniere's disease, concussion

• Lightheadedness: Dehydration, low blood pressure, anemia, heart issues

• Unsteadiness: Vestibular damage, peripheral neuropathy, muscle weakness

Understanding the type of dizziness you have helps your doctor determine the cause and best treatment approach.

Post-concussion dizziness typically improves within 2-4 weeks, but can persist longer in some cases.

Typical timeline:

• Days 1-7: Dizziness is common and often most intense

• Weeks 2-4: Gradual improvement for most people

• Months 1-3: About 20-30% still have some dizziness

• Beyond 3 months: 5-10% have persistent symptoms

Factors that affect duration:

• Severity of the concussion

• Whether the vestibular system was directly affected

• History of previous concussions or vestibular problems

• Starting rehabilitation early vs. waiting

• Age (older adults often take longer)

Types of post-concussion dizziness:

• 1. Vestibular: Triggered by head movement, lying down, or looking up

• 2. Cervicogenic: Related to neck injury, often with neck pain

• 3. Visual: Triggered by busy visual environments or screens

• 4. Exertional: Occurs with physical activity

What helps:

• Vestibular rehabilitation exercises

• VOR (vestibular-ocular reflex) training

• Gradual return to activity

• Treating neck problems if present

• Managing triggers while building tolerance

If dizziness persists beyond 4 weeks, seek evaluation from a vestibular specialist or concussion clinic. Targeted rehabilitation can significantly speed recovery even months after the initial injury.

BPPV (Benign Paroxysmal Positional Vertigo) is the most common cause of vertigo, affecting about 2.4% of people at some point in their lives. It's highly treatable with simple repositioning maneuvers.

What causes BPPV:

• Tiny calcium crystals (otoconia) in your inner ear become dislodged

• When you move your head, these crystals move through the semicircular canals

• This sends false signals to your brain, causing brief but intense vertigo

Typical BPPV symptoms:

• Brief episodes of intense spinning (usually 30-60 seconds)

• Triggered by specific head movements:

- Rolling over in bed
- Looking up
- Bending over
- Tilting your head back

• May include nausea

• No hearing loss (if present, consider other diagnoses)

Treatment (repositioning maneuvers):

• 1. Epley Maneuver: Most effective for posterior canal BPPV (90% of cases)

- Success rate: 80-90% after 1-3 treatments

• 2. Semont Maneuver: Alternative to Epley

• 3. BBQ Roll: For horizontal canal BPPV

• 4. Brandt-Daroff Exercises: Home exercises for maintenance

What to expect:

• Most people improve after 1-3 treatments

• Some residual dizziness for 1-2 weeks is normal

• BPPV can recur (30-50% within 5 years)

• Learning home maneuvers helps manage recurrences

A trained vestibular therapist or ENT doctor can perform diagnostic tests to confirm which ear and canal is affected, ensuring the correct maneuver is used.

Yes, vestibular rehabilitation exercises have strong scientific evidence supporting their effectiveness for many types of dizziness.

What the research shows:

• 70-80% of patients improve significantly with vestibular rehabilitation

• Effective for post-concussion dizziness, vestibular neuritis, BPPV, and age-related balance problems

• Benefits are usually seen within 4-6 weeks

• More effective than medication for most vestibular disorders

How vestibular exercises work:

• 1. Adaptation: Train the brain to rely on the vestibular system again

• 2. Habituation: Reduce sensitivity to movements that trigger dizziness

• 3. Substitution: Teach the brain to use vision and proprioception to compensate

Types of vestibular exercises:

• VOR exercises: Improve gaze stability during head movement

• Gaze stabilization: Keep vision clear while moving

• Balance training: Progressive challenges to the balance system

• Habituation exercises: Repeated exposure to symptom-triggering movements

Expected timeline:

• Week 1-2: May initially feel worse (this is normal)

• Week 3-4: Begin noticing improvement

• Week 6-8: Significant improvement for most people

• Week 12+: Maximum benefit achieved

Important notes:

• Consistency matters—exercises must be done daily

• Some temporary increase in symptoms during exercises is expected and beneficial

• The exercises should be challenging but not overwhelming

• Progress is gradual but typically steady

Apps like VOR Eye Rehab can guide you through these exercises with proper progression and tracking.

Dizziness when lying down or rolling over is usually caused by BPPV (Benign Paroxysmal Positional Vertigo), which is highly treatable.

Most likely cause: BPPV

• Affects the inner ear

• Caused by displaced calcium crystals

• Spinning lasts 30-60 seconds then stops

• Triggered by specific positions

• Treatable with repositioning maneuvers (80-90% success rate)

Other possible causes:

• 1. Orthostatic hypotension: Blood pressure drops when changing position

- More lightheadedness than spinning
- Common in older adults or with certain medications

• 2. Central vertigo: Brain-related causes

- Symptoms last longer
- May have other neurological symptoms
- Requires medical evaluation

• 3. Cervicogenic dizziness: Neck-related

- Often accompanied by neck pain or stiffness
- Dizziness varies with neck position

When to see a doctor:

• First episode of positional vertigo

• Symptoms don't improve with repositioning maneuvers

• Accompanied by hearing loss, severe headache, or neurological symptoms

• Falls or injury risk

What you can do now:

• Avoid sleeping on the affected side

• Get up slowly from lying down

• Keep your head slightly elevated when sleeping

• Try the Epley maneuver (many instructional videos available)

Most positional vertigo resolves quickly with proper treatment. If it's BPPV, a single treatment session with a vestibular therapist often provides immediate relief.

Constant dizziness (as opposed to brief episodes) has several potential causes that require different treatments.

Common causes of persistent dizziness:

1. Vestibular dysfunction

• Damage to the inner ear or balance nerve

• Often from viral infections, concussion, or age-related changes

• Feels like being on a boat or unsteady ground

• Treatment: Vestibular rehabilitation

2. Persistent Postural-Perceptual Dizziness (PPPD)

• Chronic dizziness lasting 3+ months

• Worsens in busy visual environments

• Often develops after a vestibular event

• Treatment: Vestibular therapy + sometimes SSRIs

3. Vestibular migraine

• Dizziness associated with migraines (headache may not always be present)

• Affects about 1% of the population

• Treatment: Migraine prevention + vestibular rehabilitation

4. Anxiety-related dizziness

• Dizziness that worsens with stress

• Often accompanied by panic symptoms

• Can create a cycle: dizziness → anxiety → more dizziness

• Treatment: CBT + vestibular rehabilitation

5. Medication side effects

• Many medications cause dizziness

• Common culprits: blood pressure meds, antidepressants, anti-seizure drugs

Steps to take:

• 1. Keep a symptom diary (triggers, timing, severity)

• 2. See your primary care doctor for initial evaluation

• 3. Request referral to a vestibular specialist if needed

• 4. Get hearing tested

• 5. Start vestibular rehabilitation

Persistent dizziness is almost always treatable once the underlying cause is identified.