Vertigo, and the dizziness that is not vertigo

Dizziness is one of the harder symptoms to sort out, because a single word covers several different experiences with different causes, and those causes are not treated the same way. Sorting out which one you have matters more than choosing a provider first.

This page describes the common causes, the signs that mean dizziness needs urgent medical attention rather than an appointment, what a chiropractic examination of the neck actually looks at, and which other providers treat the causes that are not ours.

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Dizziness and vertigo are not the same word for the same thing

People use "dizzy" for at least three different sensations, and the distinction is the first thing an examination tries to establish.

• Vertigo is a false sense of movement, usually of spinning, either of you or of the room. It points toward the inner ear or the balance pathways.
• Lightheadedness is the feeling of being about to faint. It points more often toward blood pressure, hydration, medication or heart rhythm.
• Unsteadiness is difficulty keeping your balance while walking or standing, without spinning and without feeling faint.

Vertigo can also be accompanied by nausea, ringing in one ear, hearing change, blurred vision or difficulty focusing, and fatigue. NIDCD explains balance symptoms and their possible causes.

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Common causes, and what each one is

• Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. Displaced particles in the inner ear can produce short bursts of spinning triggered by rolling over in bed, lying back, or looking up.
• Vestibular neuritis and labyrinthitis involve inflammation of the balance nerve or inner ear and may follow a viral illness. New, severe or persistent vertigo needs medical assessment; its cause cannot be identified from the symptom alone.
• Meniere's disease produces episodes of vertigo alongside hearing loss, a sense of fullness and ringing in one ear.
• Vestibular migraine produces vertigo as part of a migraine pattern, sometimes without the headache.
• Medication effects and blood pressure changes are a common cause, particularly of lightheadedness on standing. A medication review is worth raising with whoever prescribes them.
• Dizziness with neck pain is sometimes called cervicogenic dizziness. The Bárány Society's position paper finds insufficient evidence for the proposed neck-to-vertigo mechanism and does not offer clinical diagnostic criteria outside research. Ruling out some other causes does not prove a neck cause. Read the specialist position paper.
• Reduced blood flow to the back of the brain can also produce dizziness. This one is not a condition to bring to a chiropractic appointment. It belongs with a physician, and it is one of the presentations in which neck manipulation is not appropriate.

NIDCD's balance-disorder guide and the NHS vertigo guide describe inner-ear, medication and migraine-related causes.

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When dizziness needs urgent medical care, not an appointment

Dizziness that arrives suddenly and severely, especially alongside any of the following, can indicate a stroke affecting the back of the brain, and it is an emergency:

• A new severe headache or new severe neck pain
• Double vision, or loss of vision
• Slurred speech, or difficulty swallowing
• Weakness or numbness on one side of the face or body
• Severe imbalance, difficulty walking, or new unsteadiness on your feet
• Sudden hearing loss, or new deafness in one ear
• Fainting, or a sudden fall without warning

Call 911 or go to an emergency department for any of those. Dizziness that begins after a head or neck injury needs medical assessment rather than a chiropractic appointment, and urgently if any of the signs above are present with it. In either case, do not wait to see whether it passes.

For possible stroke symptoms, call 911 and use an ambulance rather than driving yourself. CDC lists stroke warning signs, and the NHS lists emergency symptoms accompanying vertigo.

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What a chiropractic examination of the neck looks at

A visit starts with a history and an examination. Describe what the dizziness feels like, what brings it on, how long an episode lasts, whether hearing has changed and which medicines you take. Neck movement, joint and muscle findings may help assess a coexisting neck complaint; dizziness may still require medical or vestibular assessment.

An examination of the neck cannot by itself establish the cause of dizziness. We will explain the findings and recommend another provider when the symptoms or uncertainty call for one.

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Safety, alternatives, and what else treats this

A realistic assessment of the risk. Neck manipulation can cause temporary soreness, headache or tiredness. Serious neurological events and neck-artery tears associated with stroke have also been reported. The relationship between manipulation and those events is uncertain, and there is no accurate estimate of their frequency. These limits belong in the discussion before treatment. Suspected vascular or neurological causes of dizziness need medical assessment. NCCIH explains spinal manipulation safety.

The alternatives, and what they are good for. Which one fits depends entirely on the cause:

• BPPV may be treated with canalith repositioning manoeuvres, a sequence of head and body positions performed by a trained provider to move displaced inner-ear particles. More than one treatment may be needed.
• Vestibular rehabilitation therapy uses a tailored exercise plan to improve balance and reduce dizziness. A therapist with vestibular training selects exercises and follow-up to fit the person's findings and needs.
• An ENT or audiology assessment is the route for hearing change, ringing in one ear, or suspected Meniere's disease. Its benefit is diagnostic reach we do not have: it can test hearing and inner ear function directly.
• Your physician can investigate medication effects, blood pressure, heart rhythm and neurological causes, then discuss treatment suited to the findings. Do not change a prescribed medicine without speaking with the prescriber.
• Migraine management is worth discussing when vertigo occurs as part of a migraine pattern. Assessment can guide migraine-specific care; relief is not guaranteed.

Any of these may be a better fit than chiropractic care, and several of them treat causes that chiropractic care does not. NIDCD describes specialist assessment, repositioning and vestibular rehabilitation.

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Preparing for an assessment of dizziness

Write down what "dizzy" feels like, how long an episode lasts, what you were doing when it started, and whether hearing changed or you fell. Bring your medication list. NIDCD's guide to balance disorders explains the questions and tests used to distinguish the possible causes.

You may hear the name Epley maneuver when BPPV is discussed. It is a sequence of positions intended to move displaced inner-ear particles, not a spinal adjustment. A clinician trained in diagnosing and treating BPPV can decide whether a repositioning procedure is appropriate. The NIDCD guide describes this distinction and the role of vestibular rehabilitation. Ask who should evaluate your symptoms before trying an exercise or maneuver yourself.

How we handle it here

We will take your history, examine you, and tell you what we find, including when what we find is not something we treat. If we are not able to help you with your problem or are unable to reduce your symptoms, we will make sure to give you a recommendation to another experienced provider. That is worth saying plainly on this page, because most of the causes listed above are not musculoskeletal and are not ours.

If you are dealing with dizziness in Clarksville TN and you want help working out where it belongs, call our team at Source Chiropractic.