“Dizzy” is one of the least precise words in medicine. Patients use it for spinning, light-headedness, floating, unsteadiness, and the feeling that the room lags a half-second behind when they turn their head. Each of those points somewhere different, which is why the first job with any dizzy patient is not treatment, it is figuring out which dizziness this is.
The kinds we see most
BPPV (benign paroxysmal positional vertigo) is the most common cause of true spinning vertigo, and it has its own article on this site. Brief spins, under a minute, triggered by rolling over in bed, looking up, or bending down. It is mechanical, and it is fixable with repositioning manoeuvres.
Vestibular hypofunction follows damage to the inner-ear balance organ, often after a viral illness (vestibular neuritis or labyrinthitis). The spinning settles over days, but the person is left unsteady, worse in the dark or on uneven ground, with a smeary feeling when the head moves. The treatment is vestibular rehabilitation: graded exercises that retrain the balance system and teach the eyes and body to compensate. This is real physiotherapy work, and it is one of the areas where doing nothing and “waiting it out” often leaves people limited for months.
Cervicogenic dizziness is dizziness that tracks with neck pain and stiffness, common after whiplash. It is a diagnosis made carefully, after the other causes are ruled out, and it responds to treating the neck.
The non-vestibular kinds matter too: blood pressure drops on standing, medication effects, low blood sugar, anxiety, anaemia. A physio assessment should catch the pattern that says “this one needs your doctor first.”
What an assessment looks like
History does most of the work: what the sensation is, what triggers it, how long episodes last, what else comes with them (hearing changes? headache? palpitations?). Then positional testing for BPPV, eye-movement and head-movement tests, balance testing, and a neck screen. Blood pressure lying and standing, when the story suggests it.
Red flags: medical care first, urgently
- Dizziness with double vision, slurred speech, facial droop, or limb weakness
- New severe headache, or the worst headache of your life
- Inability to walk, repeated vomiting, or fainting
- Sudden hearing loss in one ear
- Chest pain or palpitations with the dizziness
Those can signal stroke or other serious causes, and they are 911 territory, not physio territory.
The encouraging part
The most common causes of dizziness, BPPV and vestibular hypofunction, are also among the most treatable problems we work with, provided they are identified correctly. If your world spins when you roll over, or you have not felt steady since a bad flu months ago, that is worth an assessment rather than another month of moving carefully.
References
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017;156(3 Suppl):S1–S47. doi:10.1177/0194599816689667
- Heart and Stroke Foundation of Canada. Canadian Stroke Best Practice Recommendations: for the warning signs of stroke and the urgency of assessment.
General information only, not medical advice. New or unexplained dizziness should be assessed in person, and the red flags above mean urgent medical care.