Many people say they feel "dizzy"-but not all dizziness is the same. If you’ve ever felt like the room is spinning, even when you’re lying still, you’re not just dizzy. You’re experiencing vertigo. And if you’ve ever felt lightheaded, unsteady, or like you might faint, that’s dizziness. These aren’t interchangeable terms. They come from different parts of your body, need different tests, and require completely different treatments. Getting the label wrong can mean months-or years-of unnecessary medication, misdiagnosis, and frustration.
What Exactly Is Vertigo?
Vertigo isn’t just feeling off-balance. It’s the illusion that you or your surroundings are moving-usually spinning, tilting, or swaying. It’s not a disease. It’s a symptom. And it almost always points to a problem in your vestibular system: the part of your inner ear and brain that tells you where your head is in space.
When your inner ear’s semicircular canals or otolith organs get disrupted-by tiny calcium crystals breaking loose, inflammation, or fluid buildup-you send false signals to your brain. Your brain gets confused. Your eyes start jerking involuntarily (that’s called nystagmus). You feel like you’re on a merry-go-round, even though you’re not moving. This isn’t anxiety. It’s physics. Your sensory system is out of sync.
The most common cause? Benign Paroxysmal Positional Vertigo, or BPPV. It happens when calcium crystals (otoconia) that normally sit in the utricle of your inner ear break free and drift into the semicircular canals. When you move your head-rolling over in bed, looking up, bending down-those crystals shift and trigger the spinning sensation. BPPV affects about 2.4% of people every year, and half of those cases happen in adults over 50. It’s not dangerous, but it’s terrifying. And it’s treatable-in minutes.
What Exactly Is Dizziness?
Dizziness is the umbrella term for everything else. It’s the feeling of lightheadedness. Of being faint. Of walking on a boat that’s not moving. No spinning. No rotation. Just... off. It’s often tied to your heart, your blood, your metabolism, or your nerves.
When your blood pressure drops too fast when you stand up-orthostatic hypotension-you get dizzy. When your blood sugar crashes, you feel weak and shaky. When you’re anemic, your brain doesn’t get enough oxygen. When you’re dehydrated, your circulation falters. And yes, stress and anxiety can make you feel dizzy too. But here’s the catch: if you have true vertigo, anxiety doesn’t cause it. It just makes it worse.
Studies show that about 30% of dizziness cases in older adults aren’t caused by one thing-they’re caused by three or four things at once. Low blood pressure. Mild dehydration. Medication side effects. Age-related balance decline. That’s why so many people get told, "It’s just aging," or "It’s anxiety," when the real fix might be as simple as drinking more water or adjusting a pill.
Neurological Causes of Vertigo: When Your Brain Is the Problem
Not all vertigo comes from your inner ear. Sometimes, it comes from your brainstem, cerebellum, or thalamus. These are the areas that process balance signals. When something goes wrong here-like a stroke, multiple sclerosis, or a tumor-you get central vertigo.
Central vertigo is rare-only 5-10% of cases-but it’s serious. It often comes with other red flags: double vision, slurred speech, trouble walking, numbness on one side of your body, or sudden severe headache. If you have vertigo plus any of these, you need emergency care. A stroke can mimic BPPV, but the consequences are life-altering if missed.
Vestibular migraine is another neurological cause. It’s not the same as a regular migraine. You don’t always get a headache. But you do get spinning, nausea, light sensitivity, and sometimes ringing in the ears. It affects 1% of the population, but makes up 7-10% of all vertigo visits. And here’s the kicker: over 30% of these cases are misdiagnosed as sinus infections or anxiety. People are put on antibiotics or antidepressants for months before someone finally connects the dots.
Vestibular Causes: The Inner Ear’s Role in Balance
The inner ear is the MVP of balance. It’s filled with fluid and hair cells that detect movement. When it’s healthy, you can spin around and not get dizzy. When it’s damaged, even a slight turn can feel like a rollercoaster.
BPPV is the most common vestibular issue. Then comes vestibular neuritis-an inflammation of the nerve connecting your inner ear to your brain, often after a virus. It hits hard: intense spinning, nausea, vomiting. It can last days, but usually improves with rest and anti-nausea meds. Labyrinthitis is similar but includes hearing loss or ringing in the ear.
Ménière’s disease is rarer but more complex. It’s caused by excess fluid pressure in the inner ear. You get vertigo attacks lasting 20 minutes to hours, ringing in the ear, muffled hearing, and a feeling of fullness. Attacks come and go. Over time, hearing can get worse. It affects about 615,000 people in the U.S. alone. Treatment ranges from salt restriction to injections into the ear. It’s not curable, but it’s manageable.
How Doctors Tell Them Apart
There’s no single blood test for vertigo or dizziness. Diagnosis is all about history and physical exam. Here’s what matters:
- Timing: Does the spinning happen only when you move your head? That’s BPPV. Does it last hours or days without movement? That’s vestibular neuritis or Ménière’s.
- Eye movements: A doctor can check for nystagmus. If it’s horizontal and stops when you focus, it’s likely peripheral (inner ear). If it’s vertical, twisting, or doesn’t stop, it’s central (brain).
- Other symptoms: Hearing loss? Tinnitus? Headache? Numbness? Weakness? These point to neurological causes.
- Tests: Videonystagmography (VNG) tracks eye movements with infrared cameras. Head impulse testing checks if your inner ear responds correctly to quick head turns. These are quick, non-invasive, and accurate.
Only 1-2% of vertigo cases need an MRI. But if you have vertigo with new neurological symptoms, imaging isn’t optional-it’s urgent.
Treatment: What Actually Works
Here’s the truth: most vertigo doesn’t need drugs. It needs movement.
The Epley maneuver is the gold standard for BPPV. It’s a series of head positions that guide the loose crystals back to where they belong. Done right, it works in 80-90% of cases. Many people feel better after one visit. No pills. No surgery. Just physics.
Vestibular rehabilitation therapy (VRT) is the go-to for chronic dizziness and vestibular damage. It’s physical therapy for your balance system. Exercises start simple-standing still with eyes open, then closed. Then you move your head while standing. Then you walk while turning your head. It takes 6-8 weeks. It’s not fun. But 89% of people who stick with it see major improvement.
For vestibular migraine, triggers matter: caffeine, stress, skipped meals, poor sleep. Medications like beta-blockers or anti-seizure drugs can help, but lifestyle changes often do more. For Ménière’s, low-salt diets and diuretics help control fluid buildup. Transtympanic gentamicin injections can shut down the overactive inner ear-but they carry a risk of hearing loss, so they’re used only when other options fail.
And here’s the thing: antidepressants and anti-anxiety meds don’t fix vertigo. They might help if anxiety is making your symptoms worse, but they won’t cure the root cause. Too many people are stuck on these drugs for years while the real problem goes untreated.
Why Misdiagnosis Is So Common
Most primary care doctors aren’t trained in vestibular disorders. Only 12% say they feel "very confident" diagnosing vertigo. That’s why patients wait an average of 8.2 months for a correct diagnosis.
People with BPPV get diagnosed fastest-around 3 months-because the symptoms are obvious. But those with vestibular migraine? They’re often told they have sinusitis, tension headaches, or anxiety. One patient spent two years on antidepressants before a neurologist noticed the pattern: spinning episodes triggered by stress, light sensitivity, and no ear pain. She had vestibular migraine. The antidepressants did nothing. The right diagnosis changed everything.
Even worse: some patients with documented inner ear damage are told their dizziness is "all in their head." That’s not just inaccurate-it’s harmful. Vestibular damage is real. Conditions like PPPD (Persistent Postural-Perceptual Dizziness) can develop after a concussion or infection. It’s not anxiety. It’s your brain rewiring itself to over-rely on vision for balance. It needs specialized rehab, not a prescription for Xanax.
What You Can Do Right Now
If you’re dizzy or vertiginous:
- Write down when it happens. After you turn your head? After eating? After stress? This pattern is gold for your doctor.
- Don’t ignore red flags: double vision, slurred speech, numbness, sudden hearing loss, or trouble walking. Go to the ER.
- Ask for a referral to a vestibular specialist or neuro-otologist-not just an ENT. Not all ENTs are trained in balance disorders.
- Request a VNG test or head impulse test. These are standard tools. If your doctor doesn’t know them, ask why.
- Stop assuming it’s stress. If you’ve been told "it’s anxiety" and nothing’s improved, get a second opinion.
Vertigo and dizziness are not normal parts of aging. They’re signals. And when you listen to them the right way, the fix is often simpler than you think.
Can vertigo be caused by stress?
Stress doesn’t cause vertigo, but it can trigger it or make it worse. If you have vestibular migraine, stress is a known trigger. If you have BPPV, stress might make you more sensitive to head movements. But the root cause is physical-not psychological. Treating stress won’t fix the spinning. You need to treat the inner ear or brain issue.
Is dizziness always a sign of something serious?
No. Most dizziness comes from simple causes like dehydration, low blood sugar, or standing up too fast. But if it’s new, severe, or comes with other symptoms like chest pain, confusion, slurred speech, or weakness, it could be a stroke, heart problem, or neurological condition. When in doubt, get checked.
How long does vertigo last?
It depends on the cause. BPPV episodes last seconds to minutes and can resolve in days with the Epley maneuver. Vestibular neuritis usually lasts days to weeks. Ménière’s attacks can last hours and recur over years. Vestibular migraine attacks last minutes to hours. Chronic dizziness from PPPD can last months or years without proper rehab. Duration tells you the likely cause.
Can I treat vertigo at home?
For BPPV, yes-the Epley maneuver can be done at home after a doctor confirms the diagnosis. There are reliable videos and instructions. But don’t try it without knowing if it’s BPPV. Doing it for the wrong type of vertigo won’t help and could make it worse. For other causes, home treatment isn’t enough. You need diagnosis first.
What’s the difference between vertigo and lightheadedness?
Vertigo is the sensation that you or your surroundings are spinning or moving. Lightheadedness is feeling faint, woozy, or like you’re about to pass out. Vertigo is a balance system problem. Lightheadedness is often a circulation or blood sugar issue. One feels like you’re on a boat. The other feels like you’re about to collapse.
Do I need an MRI for vertigo?
Only if there are red flags: new neurological symptoms like weakness, numbness, double vision, slurred speech, or sudden hearing loss. Most vertigo cases-especially BPPV-are diagnosed with a physical exam and simple tests. MRIs are expensive and overused. They’re only needed in 1-2% of cases.
Why do some doctors say my dizziness is anxiety?
Because vestibular disorders are underdiagnosed. Many doctors aren’t trained to spot them. When they can’t find a clear cause, they default to anxiety. But anxiety doesn’t cause spinning. It can make existing dizziness feel worse. If you’ve been told that and nothing’s improved, ask for a vestibular specialist. You deserve a real diagnosis.
Can vertigo go away on its own?
Sometimes. Vestibular neuritis often improves over weeks as your brain adapts. BPPV can resolve on its own as the crystals dissolve or move. But waiting isn’t always wise. BPPV can be fixed in minutes with the Epley maneuver. Vestibular rehab can speed recovery. Don’t wait months hoping it’ll get better. Get it checked.
Vertigo and dizziness aren’t just inconveniences. They’re clues. And when you know how to read them, the path to feeling normal again becomes clear.
