Kim Bell, DPT, PT's Blog

TL;DR – Causes of Vertigo by Age

The causes of vertigo vary by age group. Children often experience vertigo from concussions or migraines, adults from stress, lifestyle factors, or injury, and older adults commonly from BPPV and age-related changes. Identifying the root cause is essential for an effective treatment plan.

Many people think vertigo only affects older adults, but that’s not the case. The causes of vertigo by age vary widely, and I’ve treated patients from as young as 5 years old to over 100.

How Vertigo Affects Different Age Groups

The most common causes of vertigo vary by age group. In this blog, I will provide you with a brief snapshot of common causes of vertigo I find in each age group.

Common Causes in Children

Young patients: Often concussions, head injuries, gut issues, or infections trigger dizziness or vertigo in children.

Young patients are also subject to pediatric migraine disorder causing recurring dizzy spells and vertigo episodes.

To learn more about childhood vertigo, click here.

Common Causes in Adults

Middle-aged adults: Common causes and risk factors for dizziness and vertigo in middle-aged adults include hormonal changes, stress, lack of sleep, intake of certain foods (excessive caffeine, alcohol, sugar), tech neck from improper posture while using a phone or tablet, poor ergonomics on laptop or desktop computer, inflammation, dehydration, nutritional deficiency, unstable blood sugar, viral activity like herpes, long COVID, neck pain or stiffness, and trauma that caused a whiplash injury or head injury (concussion, TBI).

Stress management, proper posture, correct ergonomic set up, daily hydration, adequate sleep, and healthy nutrition can help reduce the risk of dizziness and vertigo for middle-aged adults.

Common Causes in Older Adults

Older adults: Natural degeneration of inner ear crystals due to normal aging often causes balance issues from BPPV in older adults. In this 30-minute webinar, I talk about why older adults with BPPV may not complain of spinning vertigo but can still feel off balance and fall.

Degeneration of the cervical spine with aging and even neurodegeneration of the brain can contribute to dizziness and vertigo in older adults.

Presbyastasis is a decline in all sensory systems with normal aging (vision, vestibular, proprioception, sensation in the feet, etc.) which can contribute to dizziness and imbalance in older adults.

Medical problems with blood pressure, cholesterol, kidney, heart, liver, lungs and blood sugar (diabetes) can also cause dizziness in older adults.

Can Medications Cause Vertigo at Any Age?

Medication side effects can cause dizziness in patients of any age and should always be considered for patients on medication regardless of age.

The Most Common Cause of Vertigo: BPPV

The most common vestibular cause of dizziness or vertigo is BPPV, or benign paroxysmal positional vertigo. Tiny crystals in the inner ear become dislodged, disrupting your sense of balance. Understanding the root cause is key, because once you know it, effective treatment is usually possible.

How BPPV Is Treated

Treatment for BPPV is called particle-repositioning maneuvers. These maneuvers must be done precisely to get a good outcome, so working with an experienced professional is key. When done correctly, these specific treatments can resolve dizziness, vertigo, nausea, imbalance, and motion sensitivity for patients with BPPV swiftly in many cases.

The Bottom Line: Vertigo Can Be Treated at Any Age

No matter your age, vertigo doesn’t have to control your life. If you live in the San Diego area,request an initial consultation. I’ll help identify the root cause and create a personalized treatment plan to help you get your life back.

Frequently Asked Questions About Vertigo by AgeDoes vertigo only affect older adults?

No. Vertigo can affect people of all ages, including children, adults, and older adults, depending on the underlying cause.

What causes vertigo in children?

Common causes include concussions, gut issues, infections, and pediatric migraine disorders.

What is the most common cause of vertigo in adults?

In adults, vertigo is often related to stress, lifestyle factors, migraines, or head and neck issues.

Why is vertigo more common in older adults?

Age-related changes in the inner ear, such as BPPV, and overall decline in sensory systems of balance with normal aging increase the risk.

Can vertigo be treated at any age?

Yes. Most causes of vertigo can be reduced if not completely resolved after the correct diagnosis is identified.

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The post Causes of Vertigo by Age: Children, Adults, and Older Adults appeared first on Vertigo Detective.

TL;DR

Vertigo may cause nausea for some patients because the inner ear sends incorrect motion signals to the brain. Immediate relief focuses on stabilizing the head, reducing visual motion, calming the nervous system, and staying hydrated. Medication can also be helpful for temporary relief. Long-term relief comes from diagnosing and treating the vestibular condition causing the vertigo.

Relief From Nausea When the Inner Ear Is Triggering Symptoms

Nausea is one of the most distressing symptoms of vertigo. When the inner ear balance system is disrupted, the brain receives conflicting motion signals, which can quickly activate the body’s nausea centers. This is why vertigo may cause queasiness, stomach upset, burping, salivating, or even vomiting.

Understanding how to get rid of it requires calming the vestibular system — not just the stomach.

If you’re wondering what to do for nausea caused by dizziness or vertigo, the following strategies and home remedies can help.

Why Vertigo Causes Nausea

The vestibular system (or inner ear) communicates with brain regions that control eye movement and balance. When the inner ear sends abnormal motion signals due to vestibular dysfunction, the brain interprets this error as a “movement mismatch” as compared to your visual system and proprioception. The sensory mismatch can cause nausea similar to motion sickness.

Common vertigo conditions that may trigger nausea include:

BPPVvestibular neuritis or labyrinthitisvestibular migraine episodesinner-ear inflammationuncompensated vestibular hypofunction

When the vestibular system is malfunctioning, nausea is a neurological response — not primarily a digestive one. Vertigo can cause nausea even when your stomach is working just fine.

Some patients have continuous nausea, while other patients have motion-activated nausea. This blog can help with both types of nausea.

Some vertigo patients do not experience nausea at all. Good for them!

Immediate Relief for Nausea From Vertigo

When vertigo-related nausea begins, the goal is to reduce vestibular stimulation quickly. The vestibular system is stimulated by head motion and visual input.

1. Stabilize the Head and Body

Sit upright with your head completely still. Sudden head movement intensifies vestibular mismatch and nausea.

Helpful positions:

Sitting upright in a chair with back supportSitting on the floor with your back against a wall if no chair is availableReclined (above 45 degrees) with head elevated on pillowsNote: Lying down may or may not help, depending on the root cause of the vertigo.2. Reduce Visual Motion

Visual input strongly influences vestibular nausea when you are triggered. Think about car sickness or the amusement park ride.

You can try eyes closed or softly focused, to see what helps you get some relief.

If you feel better with your eyes open, you can focus your gaze on a vertical line or stable point. Visual fixation on a stable target can help reduce any involuntary eye movement from vertigo, called nystagmus.

By focusing on a visual target, you may be able to get your eyes to slow down or stop jittering around as much. In turn, that may reduce your nausea from dizziness or vertigo.

If you are on a boat, look out at the horizon. If you are below deck, come up onto the deck so you can see the horizon.

To reduce symptoms, here are a few more visual strategies:

avoid scrolling or looking at electronic screens (phone, computer, TV)minimize moving environmentsdim lights if you feel sensitive to lightclose eyes briefly to see if that feels better than eyes openIf you watch TV, avoid watching drone footage, flying scenes, spinning camera work, etc.

Many patients notice nausea drops when visual load decreases, because visual input causes vestibular stimulation.

3. Cool and Calm the Nervous System

Vestibular nausea often improves when the autonomic nervous system settles. Cooling off to reduce nausea is a trick I learned from my clinical mentor years ago and it works!

Helpful strategies to reduce nausea by cooling and calming down include:

apply a cool compress on back of your neckcalm your breathingget some fresh airensure a quiet environmentcool down the temperature of the room by opening windows or turning on the air conditioner

It is ideal to cool off the room so much that you need to put on a sweatshirt and a blanket. That really helps reduce nausea from vertigo.

Cooling off and calming down can help the brain reduce nausea output.

How to Reduce Nausea During a Vertigo Episode

If symptoms persist, additional relief measures may help.

Natural Remedies to Reduce Nausea

Ginger and peppermint can reduce nausea. These may be taken as a hot tea or piece of candy. Many of my patients use ginger chews or peppermint candies to tolerate vertigo treatment.

Hydration

Small sips of water or electrolyte fluid can prevent worsening nausea from dehydration.

Light foods

If tolerated:

crackerstoastsimple carbohydrates

An empty stomach and low blood sugar often worsen vestibular nausea.

Medical options

Discuss with your healthcare provider:

anti-nausea medication (ondansetron and promethazine are the most common)vestibular suppressants (short-term relief)migraine treatment (if applicable)

Emergency room treatment may be necessary for patients with serial vomiting, to receive medication and hydrating fluids intravenously with an IV.

These self-care strategies and medical management options can provide relief from nausea.

Long-Term Relief From Nausea: Treat the Vertigo

If nausea repeatedly occurs with dizziness or vertigo, treating the root cause is essential.

Examples of how the treatment plan varies based on the root cause of vertigo:

BPPV → repositioning treatmentvestibular neuritis → inflammation management, possibly antiviral medicationhypofunction → vestibular rehabilitationvestibular migraine → migraine management

When vertigo improves, nausea typically resolves.

When to Get Help

Talk to your doctor. They may refer you to a GI specialist for a medical evaluation of the nausea.

Request a vestibular evaluation with a professional if you have:

nausea with head movement (motion-activated nausea)vertigo-related vomiting episodespersistent queasiness with imbalance, especially during walking or exercisenausea triggered by positional changesrecurrent vertigo episodes

These patterns often indicate a vestibular disorder.

How to Get Rid of Nausea From Vertigo Long-Term

Sustained relief comes from restoring vestibular health and stability.

Vestibular rehabilitation may include:

BPPV treatmentgaze stabilizationmotion tolerance trainingbalance retraining

As the brain recalibrates vestibular motion signals, nausea sensitivity often decreases.

The Bottom Line: Stopping Nausea From Vertigo

Vertigo-related nausea originates in the brain’s balance system, not just the stomach. The most effective approach combines:

head and visual stabilizationnervous system calminghydration supportmedical managementtreatment of the root causevestibular rehabilitation

With accurate diagnosis and targeted care, most patients can significantly reduce or eliminate their discomfort.

If you experience recurring nausea with dizziness or vertigo, you can request a vestibular consultation to identify and treat the underlying cause.

Frequently Asked Questions

Why does vertigo cause nausea?
Vertigo disrupts signals from the inner ear balance system. The brain receives conflicting motion information, which activates nausea pathways similar to motion sickness.

How long does it last?
Nausea may last minutes to several hours during an acute vertigo episode. In severe cases it can persist until the underlying vestibular trigger settles.

What helps vertigo nausea quickly?
Keeping the head still, reducing visual stimulation, cooling the body, hydrating, and resting in a quiet environment often reduce symptoms quickly.

Can medication help vertigo nausea?
Yes. Physicians may prescribe anti-nausea medications or short-term vestibular suppressants for severe symptoms.

Does treating vertigo stop the nausea?
Usually yes. When the vestibular condition causing vertigo is treated, nausea typically resolves as balance signals normalize.

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The post How to Get Rid of Nausea From Vertigo appeared first on Vertigo Detective.

TL;DR – How Long Does Vertigo Recovery Take?

Most vertigo conditions do not resolve in a single visit. Vertigo recovery time depends on the diagnosis, severity, and individual response to treatment. While some patients improve within one to three sessions (such as certain BPPV cases), many require four to eight visits, and complex vestibular disorders may take 12 to 20 sessions. Completing a structured vestibular treatment plan leads to better long-term outcomes.

Why Vertigo Recovery Is Rarely Instant

Many people come to vestibular therapy hoping for fast, immediate relief. While that does occasionally happen, most vertigo and balance conditions improve through a series of focused treatments over time working with a skilled professional. Most vertigo treatment plans also include home exercises to complete in between appointments.

Typical Recovery for Initial Episodes (4–8 Visits)

In my clinical experience, the average patient typically requires several visits during their initial episode of care, often ranging from four to eight appointments. More complex vestibular conditions may take longer, and that’s completely normal.

While it’s natural to want a quick fix, vertigo rarely resolves with a single session. Lasting improvement usually comes from proper diagnosis, targeted treatment, and allowing the nervous system time to adapt and heal.

Some patients do experience dramatic improvement in one or two visits, particularly in simpler cases. However, the majority of individuals require a progressive treatment plan tailored to their specific diagnosis.

BPPV Recovery Time (1–3 Sessions Per Affected Canal)

Even with BPPV — one of the most well-known causes of vertigo — treatment can take one to three sessions per affected canal. If multiple canals or both ears are involved, recovery may require several appointments to fully resolve symptoms.

Complex Vestibular Conditions (12–20 Visits)

For more complex vestibular disorders, full recovery may take anywhere from 12 to 20 physical therapy visits depending on the severity, duration of symptoms, and individual response to vestibular therapy.

This is why I encourage patients to choose a vestibular health care provider with specialized training, strong clinical experience, and a clear treatment plan, and then commit to completing that plan.

Why Progress Isn’t Always Linear

Progress isn’t always linear. Some days feel better than others during a vertigo treatment plan. Many patients experience a hangover feeling the day after an intensive vestibular physical therapy treatment session. But consistent, skilled vestibular care almost always leads to better long-term outcomes.

Many patients experiencing fluctuating symptoms throughout the course of a vertigo treatment plan are dealing with conditions such as vestibular neuritis, long COVID with waxing and waning viral activity, or vestibular migraine. Those conditions may require medical management as well as vestibular physical therapy.

The Importance of Proper Diagnosis to Guide Treatment

Another essential part of vestibular care is thorough screening and referrals for appropriate diagnostic testing. When certain clinical findings appear during a physical exam, further medical testing — such as advanced imaging — may be necessary to rule out serious conditions. This is a critical step in ensuring patient safety and guiding appropriate treatment.

Comprehensive vestibular care isn’t about quick fixes. It’s about identifying the true cause of dizziness, applying the right interventions, and supporting the body’s recovery process over time.

Final Thoughts on Vertigo Recovery Time

I understand how frustrating vertigo can be and how bad people want relief — that’s exactly why careful examination, proper diagnosis, and personalized care matter so much to me.

If you’re dealing with dizziness or balance problems, my advice is simple: work with a skilled vestibular health care provider you trust, follow the recommended treatment plan, and give your body the time it needs to heal.

The results are worth the commitment.

If you are navigating the health care system for relief of dizziness and vertigo, I wrote this book to help you skillfully advocate for yourself so you can get your life back.

Frequently Asked Questions About Vertigo Recovery

How long does vertigo recovery usually take?

Vertigo recovery time varies depending on the diagnosis. Simple cases such as certain BPPV episodes may improve within one to three sessions, while many patients require four to eight visits. More complex vestibular conditions may require 12 to 20 visits for full recovery.

Can vertigo go away after one treatment?

Some patients experience dramatic improvement after one or two sessions, particularly with straightforward BPPV. However, most vertigo conditions require multiple visits and a structured treatment plan.

Why does vestibular therapy take multiple sessions?

Vestibular therapy works by retraining the nervous system. This process requires repetition, gradual exposure, and time for the brain to adapt. Immediate improvement is possible, but sustained recovery typically occurs over several sessions over a period of weeks.

Is it normal for vertigo recovery to feel inconsistent?

Yes. Progress during vestibular rehabilitation is often not linear. There can be ups and downs during a vertigo treatment plan. Some days may feel better than others as the nervous system adapts.

What happens if I stop vestibular therapy too early?

Stopping therapy prematurely may lead to incomplete recovery, lingering symptoms, or recurrence. Completing the recommended treatment plan improves long-term outcomes.

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The post How Long Does Vertigo Recovery Take? Why Treatment Takes Time appeared first on Vertigo Detective.

TL;DR – BPPV in Bedbound Patients

BPPV in bedbound patients can cause intense vertigo, fear, nausea, and loss of mobility, especially during rolling or position changes in a hospital or electric bed. These symptoms are often mistaken for dementia, anxiety, or general decline. With proper vestibular health care, BPPV can be safely evaluated and treated in bed, often leading to dramatic improvements in comfort, independence, and quality of life.

Imagine this:

Every time a caregiver rolls an older adult from side to side to change a diaper, the room starts spinning. Panic sets in. The person screams in terror — not because they’re confused, but because the sensation is overwhelming.

I’ve seen this exact situation more than once.

When Vertigo in Bedbound Patients Is Mistaken for Dementia or Agitation

For families and caregivers, it can look like agitation, fear, or even progression of dementia. But in some cases, the real cause is untreated vertigo — specifically Benign Paroxysmal Positional Vertigo (BPPV) — occurring in someone who is completely bedbound.

And the good news? Even when someone cannot get out of bed, BPPV can still be evaluated and treated.

A True Story of Treating BPPV in a Hospital Bed

One family contacted me to treat their father in his senior living facility. He was living in a hospital bed, had advanced Alzheimer’s dementia, and was already on hospice care.

How Treating BPPV Restored Mobility and Ended Hospice Care

Every time his caregiver rolled him to change his diaper, he would scream in fear. The spinning sensation was intense and terrifying for him. He spent all day lying in bed.

After evaluating him right there in his hospital bed, I treated his BPPV — twice.

The results were remarkable.

His vertigo resolved.He was no longer bedbound.He came off hospice care.

While he still had Alzheimer’s dementia, he began walking up to 200 feet with a walker several times a day with his caregiver. He spent most of his days out of bed after his vertigo was resolved.

Treating his vertigo changed everything about his quality of life.

Another Case of BPPV Causing Severe Vertigo in a Bedbound Patient

In another case, I treated an older woman who had been stuck in bed for days because of vertigo. Every time she tried to sit up, she became violently nauseous and started vomiting — so she had no choice but to lie back down.

She was evaluated and treated in her own home using an electric bed.

After just one treatment, she was up out of bed and walking with her walker. Her family was amazed and grateful.

After two more treatments for BPPV, she got her life back and she didn’t need me anymore.

BPPV Caused by Prolonged Bed Rest in a Nursing Home Patient

In my third example, a friend of a friend was recovering in a nursing home after multiple fractures from a fall. He felt discouraged because he was very unsteady when trying to stand and could not return home until he could move safely on his own.

When I visited his bedside to pray for him, he mentioned that when nurses rolled him onto his left side to change his diaper, he experienced a brief spinning sensation that had started about two weeks earlier. He did not feel this when rolling to the right. Because prolonged bed rest is a risk factor for BPPV—and he had been bedbound for about three months—I suspected this could be the cause of his symptoms.

When his physical therapist visited, I shared my concerns. The therapist had been monitoring his blood pressure but wasn’t sure what else could be contributing. I explained that I had successfully treated bedbound patients with BPPV using Epley maneuvers. To my surprise, the PT treated him the very next day—right in his hospital bed.

He experienced significant relief. A few days later, he told me the spinning had gone from severe to mild. After a few more treatments, his BPPV resolved, his balance improved, and he was able to return home.

In hindsight, it was clear that untreated BPPV had been holding him back. I can’t help but wonder how many other bedbound patients in nursing homes have similar, overlooked symptoms.

Why Untreated BPPV Can Keep Older Adults Bedbound

For bedbound patients, vertigo can:

Prevent sitting upMake rolling for hygiene unbearableIncrease fall risk the moment they try to standBe mistaken for anxiety, dementia-related behaviors, or declineLead to unnecessary loss of mobility and independenceBe triggered by prolonged bed rest

When BPPV is the cause, treating it can dramatically change daily function, even in patients with complex medical conditions.

This is especially important for:

Older adults in hospital beds or electric bedsAssisted living or skilled nursing residentsHospice or palliative care patientsIndividuals who cannot tolerate traditional exam tablesYes, BPPV Can Be Treated in a Hospital or Electric Bed

Many people assume vertigo treatment requires:

A clinicA treatment tableGetting in and out of bed

That’s simply not true.

How Vestibular Health Care Providers Adapt Vestibular Testing and Treatment

With proper training, equipment, and assistance, BPPV testing and treatment can be safely and effectively performed in a hospital bed or electric bed — right where the patient is.

And when vertigo is the barrier keeping someone bedbound, treating it can unlock mobility, comfort, and dignity.

A Message for Families and Caregivers of Bedbound Patients

If someone you love:

Panics or screams when rolled in bedFeels intense spinning with position changesCan’t sit up without nausea or vomitingHas suddenly become bedbound

Vertigo may be playing a bigger role than you realize.

Even in medically complex cases, it is worth asking whether BPPV has been evaluated by a vestibular-trained physical therapist or other qualified professional.

For Clinicians: BPPV Examination and Treatment Protocol for Bedbound Patients

Setting: Hospital bed or electric bed with head elevation
Equipment: Infrared oculography video goggles strongly recommended, with laptop to record

Clinical Considerations for Safe and Effective Bedside TreatmentSit patient fully upright in bed with pillow supportPerform oculomotor exam in room light and with gogglesAssess for central, peripheral, or migraine-related nystagmus patternsDocument findings, as these may confound BPPV interpretationIf possible, perform a seated modified VBI screen with trunk flexion and head levelBPPV Test Series (Document All Findings)

For each position:

Symptom intensity (0–10)Symptom durationPresence and direction of nystagmus (via goggles) – make a separate video for each BPPV test so you can easily rewatch as neededTest Position Sequence:Supine – Start recording the eyes as you are reclining the head of the bed from upright to supineBed flat with one pillowRoll Test90° log roll to each sideHead supported on pillowReturn to supine between sidesRecord all positions and transitionsModified Dix-Hallpike (Supine)From supine, rotate head 45° to each sideStart with head on pillowTest both sidesNote intensity of symptoms consistent with Type 2 BPPVIf initial Dix-Hallpike testing is negativeRemove pillowRetest Dix-Hallpike with head resting directly on mattressFrom supine, rotate head 45° to each sideTest both sidesNote intensity of symptoms consistent with Type 2 BPPVConsider forward head posture common in bedbound patients when removing the pillow (Whitney et al.)Sufficient cervical extension may be achieved with the pillow removed.If the thoracic kyphosis is severe, the patient may still need a thin pillow to limit relative cervical extension to 20-30 degrees below horizontal for re-test

Rest Break

Sit patient back to upright with pillow supportReview and analyze nystagmus recordingsBPPV Treatment in a hospital bed or electric bed (Requires 2–3 Assistants)Posterior canal: Epley maneuver using bolsters/pillows is my first choice and assistance of 2-3 people. If the bed is pushed up against a wall, use a Semont maneuver.Horizontal canal: Gufoni maneuverAlways return patient to upright after each treatment for a 3-minute seated rest breakApply ice to the back of their neck for 15–20 minutes post-treatment while positioned upright.Final Thought for Clinicians

Treating BPPV in bedbound patients is not only possible — it can be life-changing. For some patients, resolving vertigo is the key that allows them to sit up, stand, walk, and re-engage with life. If you are a clinician who works with bedbound patients, I implore you to learn how to assess and treat BPPV.

Frequently Asked Questions About BPPV in Bedbound Patients

What is BPPV in bedbound patients?
BPPV in bedbound patients occurs when tiny calcium crystals in the inner ear become displaced, causing intense spinning sensations with rolling, sitting up, or position changes in bed. Prolonged bed rest increases the risk of developing BPPV.

Can BPPV cause fear or screaming in patients with dementia?
Yes. Severe vertigo from BPPV can cause panic, fear, and distress, even in patients with advanced dementia. These reactions are often misinterpreted as agitation or cognitive decline rather than a treatable vestibular condition.

Can BPPV be treated if someone cannot get out of bed?
Yes. With proper training and assistance, BPPV testing and treatment can be safely performed in a hospital bed or electric bed. Many bedbound patients experience significant improvement after treatment.

Why is BPPV often missed in bedbound or elderly patients?
BPPV is frequently missed because symptoms may be attributed to aging, anxiety, dementia, or general weakness. Imaging such as MRI or CT scans typically appears normal, which can delay diagnosis.

Who should evaluate vertigo in a bedbound patient?
A vestibular-trained physical therapist or healthcare provider with experience in positional vertigo should evaluate bedbound patients who experience spinning, nausea, or fear with position changes.
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The post BPPV in Bedbound Patients: When Vertigo Keeps Someone Trapped in Bed appeared first on Vertigo Detective.

Traditional BPPV typically causes spinning vertigo symptoms and robust nystagmus during BPPV testing. However, I see a lot of patients who have not gotten answers or relief with traditional vertigo health care.

BPPV without Spinning

In many so-called atypical vertigo cases that have failed to resolve with traditional vestibular health care, I frequently find mild intensity, widespread BPPV in multiple canals within both ears with corresponding weak nystagmus of short duration.

That means multiple canals in both ears appear to have BPPV crystals during testing, but the positional symptoms are mild such as transient dizziness, blurry vision, falling sensation, or nausea, not the typical intense spinning sensation characteristic of BPPV.

Weak, brief nystagmus is present during BPPV testing, but is not obvious, vigorous, or robust.

Typical BPPV vertigo produces a burst of robust positional nystagmus that correlates with the spinning feeling.

Since the classic robust burst of nystagmus and complaint of spinning during BPPV testing are not present in these cases, this type of atypical vertigo often goes undetected and unaddressed.

Atypical Vertigo Cases: What are Some Examples?

You may be wondering, “How can this happen?” I will share my observations for these atypical vertigo cases.

In some atypical vertigo cases, I have observed the presentation of mild, widespread BPPV in both ears may occur in patients who have been living with vertigo for years while trying to maintain an active lifestyle such as surfing, yoga, martial arts, volleyball, pickleball, and other sports or recreational activities.

I also find mild, widespread BPPV in patients who have experienced multiple onsets of vertigo over a multi-year period and thought the vertigo may have “gone away on its own” each time, so they have never sought professional help.

Effects of Mild, Widespread BPPV in Both Ears

For patients with mild, widespread BPPV in both ears, it appears as if someone took a leafblower to the inside of their inner ears spreading the BPPV particles all over the place throughout the vestibular labyrinth on each side. Essentially, it’s a pervasive mess that needs to be cleaned up methodically, similar to coming home from the beach and tracking sand through multiple rooms in your house.

Now you may understand why I advocate for consulting a vestibular professional instead of learning to live with vertigo.

I also sometimes explain to my patients that the ultimate effect of this condition on their neurological system is as if someone set up multiple radios all around them, playing different music continuously and simultaneously. In such atypical vertigo cases, the multiple conflicting errors in sensory input from the BPPV crystals spread throughout their vestibular system can overwhelm and stress their central nervous system, similar to listening to multiple songs at the same time.

Mild, widespread BPPV in multiple canals within both ears can cause significant daily distress and disability and may persist without a satisfactory diagnosis, even after consultation with traditional medical specialists.

This presentation of BPPV often co-occurs with significant fatigue, which is worse at the end of the day and gradually improves as the patient recovers.

Some of these patients require a higher than average number of visits to completely resolve the symptoms step by step. Patients who are willing and able to perform a home exercise program usually recover more quickly than patients who are unable or unwilling to do exercises as instructed at home.

With proper care, these patients can have a full recovery.

Even after the resolution of these atypical vertigo cases and successful relief of mild, widespread BPPV with particle repositioning maneuvers, some patients may still have lingering, residual dizziness for up to two weeks. That feeling usually dissipates as their brain recovers and recalibrates, especially with daily movement and good quality sleep.

Learn More About Other Atypical Types of BPPV

In addition to mild, widespread BPPV in multiple canals within both ears, there are other types of atypical vertigo cases which we did not discuss in this article.

For more information on another atypical presentation of BPPV called Type 2 BPPV, click here.

For a detailed discussion specifically on posterior canal BPPV variants, click here.

Click here for examples of atypical types of vertigo that present with symptoms worse on the unaffected side.

I hope this blog on atypical vertigo was helpful on your healing journey.

Updated January 16, 2026 by Dr. Kim Bell, PT, DPT

The post Atypical Vertigo Cases appeared first on Vertigo Detective.

Key Takeaways

Vertigo, dizziness, and disequilibrium are different, and I know how confusing it can be to explain to your doctor.

Vertigo: Sensation of spinning or motion when you are still.Dizziness: General lightheadedness or woozy feeling.Disequilibrium: Feeling off-balance or unstable.

Understanding the difference between vertigo, dizziness, and disequilibrium helps your doctor diagnose and treat symptoms accurately.

Vertigo, dizziness, and disequilibrium are different, and I know how confusing it can be to explain to your doctor. I wrote this blog to help you understand the difference between these terms. If after reading it, you’re still not sure exactly what you are experiencing, you can just use the word “dizziness,” which is what most patients call all three of these. My hope is that this blog will help you learn vocabulary words to communicate more effectively with your doctor.

Understanding the Difference Between Vertigo, Dizziness, and DisequilibriumVertigo: Causes, Symptoms, and How It Feels

Vertigo is the sensation that you are moving, even when you’re not. It might feel like spinning, tilting, or sliding. It can last anywhere from a few seconds to hours—or sometimes even days. For example, you could be sitting still upright in a chair and feel like you are doing a cartwheel to your right.

Vertigo can also describe a false perception of otherwise normal motion. For example, you could twirl around in a circle like an ice skater and feel like you are still moving even after you stop.

Whether you are completely still or in motion when you feel it, a false sensation of motion is referred to as “vertigo.” If you’ve never experienced vertigo before, consider yourself fortunate!

Dizziness: Lightheadedness, Wooziness, and Fainting Sensations

Dizziness is more general—lightheaded, woozy, or floaty. You feel like you might pass out. Many people lump vertigo and dizziness together, but the difference is important for treatment.

Disequilibrium: Balance Problems and Instability

This is when you feel off balance or “wonky,” like you could fall. It usually feels worse when you stand up. Some of my patients describe it as wobbly walking or feeling unstable.

Disequilibrium may occur on its own. It can also co-occur with dizziness or vertigo.

For example, people with neuropathy in their feet, or numbness in the feet, can have disequilibrium. They may also have dizziness when they stand up quickly but not usually experience vertigo.

What Causes Vertigo to Start Suddenly?When Vertigo Is Triggered by Position Changes

Positional vertigo is triggered by movement or certain positions, like rolling over in bed.

When Vertigo Happens Spontaneously

Spontaneous vertigo happens out of nowhere and can last longer. In severe cases, sometimes spontaneous vertigo requires urgent medical attention.

When Vertigo Comes and Goes in Episodes

Recurrent vertigo attacks may come and go in episodes with certain triggers. This usually indicates an underlying medical condition. Episodic vertigo can last for minutes, to hours, to days, depending on the root cause.

For example, people with migraines, Meniere’s disease, and even autoimmune conditions can have episodes of vertigo when their medical condition flares up. The key to preventing these episodic vertigo attacks is to manage the underlying medical condition.

How to Describe Vertigo Symptoms So Your Doctor Can Diagnose the Cause

Understanding the difference between vertigo, dizziness and disequilibrium is crucial. When you can describe your symptoms accurately, your healthcare provider can help you more effectively—and you’ll stop feeling as dismissed or confused.

Details That Help Differentiate Types of Vertigo

To report your symptoms to your doctor and assist with a correct vertigo diagnosis, be sure to report the circumstances of the vertigo onset, any possible trigger, and how long the symptoms last.

San Diego’s Vertigo Expert

If you’re in the Southern California area and struggle with understanding the difference between vertigo dizziness and disequilibrium, I’d love to help.

Schedule a consultation with me at my office in Vista, CA or request a home visit if you’re unable to travel.

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The post Difference Between Vertigo, Dizziness, and Disequilibrium: What You Need to Know appeared first on Vertigo Detective.

It’s very common for patients to be told that their dizziness or vertigo is caused by anxiety. In some cases, that may be partly true — but it’s not always the full story.

Why Anxiety Is Often Blamed for Vertigo (even When It’s Not the Real Cause)

Doctors sometimes diagnose anxiety when they can’t identify a clear physical cause for dizziness or vertigo. This happens because dizziness can be difficult to evaluate without specialized vestibular testing.

Many patients with dizziness have normal brain MRI and normal cervical spine Xray, along with normal bloodwork results. This can leave many doctors baffled about the cause of the vertigo. If they observe that the patient seems anxious, then they may say “Aha, your dizziness must be due to anxiety!”

However, unresolved dizziness and vertigo can cause anxiety, especially when the world feels like it’s spinning or your balance suddenly changes. Without answers about what is causing the dizziness or vertigo, many patients begin to fear the worst and start to feel anxious. That fear and uncertainty can naturally lead to anxious thoughts and sensations, which the doctor may pick up on and label as the cause of the dizziness.

Yet in many cases, anxiety is the RESULT of dizziness or vertigo — not necessarily the root cause. Either way, anxiety should be addressed if it is present, in order to guarantee the best possible outcome from a treatment plan.

Vertigo vs. Anxiety Dizziness: How to Tell the Difference

Anxiety-related dizziness usually feels like general lightheadedness, unsteadiness, or a sense of floating that worsens with stress or panic. Nausea is also a common symptom of anxiety. In extreme cases, anxiety attacks can even cause vomiting.

True vertigo, on the other hand, involves a spinning feeling or motion sensation that often points to a vestibular (inner ear) cause, a neck problem, or another episodic problem like vestibular migraine or Meniere’s.

Finding the Root Cause

If the underlying cause of dizziness isn’t found, symptoms (and the anxiety that comes with them) can persist.
Common causes like BPPV (Benign Paroxysmal Positional Vertigo) or neck-related dizziness are often missed when clinicians aren’t trained to test for them. Neither of these common causes of dizziness and vertigo show up on standardized, traditional medical testing.

Identifying and addressing the deepest root cause of dizziness and vertigo can often reduce anxiety naturally as the physical symptoms improve.

If you start feeling less dizzy because the root cause has been determined and addressed, then it makes sense that you would also feel less anxious, right?

Can Treating the Root Cause of Vertigo Reduce Anxiety?

Anxiety and vertigo are often connected and may occur together, but anxiety is not always the primary cause of dizziness and vertigo. A comprehensive evaluation by a vestibular physical therapist or other vestibular health care provider can help determine whether your dizziness stems from an inner ear, neck, or other underlying issue.

If you or someone you love is struggling with dizziness or vertigo, you can request a consultation with me today to start getting answers. I specialize in uncovering the root causes of dizziness and vertigo and creating personalized plans to help my patients find lasting relief and peace of mind.

Key Point: Anxiety needs to be addressed but may not always be the root cause of the dizziness.

TL;DR:

Anxiety can sometimes cause dizziness, but it’s not always the main cause of vertigo. True vertigo usually stems from inner ear, neck issues, or some other root cause. Anxiety-related dizziness feels more like lightheadedness, unsteadiness, and nausea. Identifying the root cause with a vestibular physical therapist or other vestibular health care provider can reduce both dizziness and anxiety naturally.

FAQ

Does anxiety cause vertigo?
Anxiety can cause dizziness, lightheadedness, or a sense of floating — but true spinning vertigo most often points to something else like an inner-ear (vestibular) or neck issue. Anxiety may contribute to dizziness lasting longer and feeling more severe, so a full evaluation is important.

How can I tell anxiety dizziness from true vertigo?
Anxiety-related dizziness usually feels like unsteadiness or lightheadedness that worsens with stress or panic. True vertigo causes a clear spinning or motion sensation, often triggered by head movement or position changes.

Can vertigo make my anxiety worse?
Yes. The unpredictability and intensity of vertigo can trigger fear and anxious thoughts, which in turn can amplify dizziness.

What should I do if I have dizziness or vertigo?
Get a comprehensive vestibular evaluation (including testing for BPPV and neck-related dizziness). Treating the underlying physical cause often reduces anxiety naturally. Request a consultation:

Request A Consultation

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The post Does Anxiety Cause Vertigo? Understanding the Link Between Anxiety and Dizziness appeared first on Vertigo Detective.

For many people living with dizziness or vertigo, getting a clear diagnosis feels like a never-ending journey. I know this struggle personally. It took me more than 25 years to discover the true causes of my own symptoms. Unfortunately, I’ve seen this story repeated in countless patients who come through my clinic.

So, why is it so hard to get answers?

Common Misdiagnoses and Patient “Bounce-Arounds”

Dizziness is one of the most common symptoms patients report in emergency rooms and doctor’s offices, but it’s also one of the most misunderstood. Many people are told it’s “just anxiety,” “just aging,” or are sent home with motion sickness pills that often don’t solve the underlying problem. Some patients bounce from one provider to the next without ever getting a full assessment for the root cause.

The Consequences of a Delayed Dizziness Diagnosis

The longer dizziness goes untreated or misdiagnosed, the greater the toll on a person’s quality of life. Missed work, strained relationships, fear of leaving home, even loss of independence — I’ve seen all of these consequences in patients who are desperate for answers.

How to Advocate for Yourself When Diagnoses Are Slow

If you feel stuck, persistence is key. Ask your provider about a referral to vestibular physical therapy or other vestibular health care providers. You can request a referral through insurance or pay out-of-pocket if you’re not getting answers. Keep a detailed diary of your symptoms, triggers, and patterns. These small steps can help guide your care team in the right direction.

A Hopeful Outlook: Finding Answers for Your Dizziness

The journey to a diagnosis isn’t always quick, but it doesn’t have to be endless. With the right providers and persistence, it is possible to find answers and a plan forward.

👉 Want to dive deeper? Explore my book Navigating the Health Care System as a Dizzy Patient for resources designed to help you advocate for yourself.

FAQ – Dizziness Diagnosis

Q: Why does it take so long to diagnose dizziness?
A: Dizziness has many potential causes, and symptoms are often nonspecific. Misdiagnoses and incomplete assessments can delay accurate diagnosis.

Q: What tests are used to diagnose vertigo?
A: Tests may include vestibular function exams, balance testing, hearing tests, imaging (MRI/CT), and blood tests to rule out other conditions.

Q: How can I advocate for my dizziness care?
A: Keep a detailed symptom diary, request referrals to specialists, and communicate clearly with your providers.

TL;DR

Dizziness is often misdiagnosed or misunderstood, causing long delays in getting a proper diagnosis.

Delayed diagnosis impacts work, relationships, and independence.

Keep a symptom diary, request referrals to vestibular specialists, and communicate clearly with your healthcare team.

With persistence, accurate dizziness diagnosis and effective treatment are possible.

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The post Why Getting a Dizziness Diagnosis Takes So Long – Causes & Solutions appeared first on Vertigo Detective.

When temperatures rise or you’re sweating more than usual, hydration becomes more than just a comfort—it’s a necessity. Without enough fluids and electrolytes, you can find yourself feeling dizzy, lightheaded, or worse.

Dehydration is a common trigger for migraine episodes, low blood pressure, and even BPPV (Benign Paroxysmal Positional Vertigo). Those health issues can also cause dizziness or vertigo.

In this blog, I will share my favorite sugar-free lemonade recipe for vertigo.

Most people know they need to drink water, but many forget that electrolytes are just as essential—especially if you’re sweating heavily. Electrolytes like sodium, potassium, and magnesium help regulate nerve function, fluid balance, and muscle control.

Unfortunately, many store-bought electrolyte drinks (like typical sports drinks) are packed with sugar and artificial coloring, which may not be ideal for people who are sensitive to additives or managing chronic conditions.

My Go-To for Daily Electrolyte Support

Personally, I use Keto Chow electrolyte drops to keep my electrolytes in check. They’re simple, clean, and don’t have the extra sugar or dyes. I’ve found them helpful in preventing the kind of dehydration that can lead to vertigo or migraines—especially on the hottest days.

My Favorite Sugar-Free Lemonade Recipe for Vertigo

When I want something refreshing and a little more fun than plain water, I make a homemade sugar-free lemonade with:

Spring waterKeto Chow electrolyte dropsOrganic lemon juiceOrganic monk fruit sweetener

I shake it all up in a mason jar, and it’s instantly hydrating, cooling, and delicious—with no sugar crash.

The ingredients can be found in our store

Stay Ahead of Dehydration

Whether you’re spending time outdoors, working out, or simply enduring a heatwave, staying ahead of dehydration is one of the best ways to prevent unnecessary symptoms. Don’t wait until you feel bad—be proactive with water and electrolytes.

Still Struggling with Vertigo Symptoms?

Request a consultation to get a personalized treatment plan that helps you regain control and feel steady again. This lemonade recipe is ideal for dizziness or vertigo related to dehydration or low electrolytes, but there are other possible causes.

If you cannot work with me in person, please check out my book on Amazon.

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Did your parent recently have an ER visit for vertigo? After hours of tests, maybe they were diagnosed with “vertigo” and sent home with prescriptions like meclizine for dizziness and ondansetron for nausea.

If this sounds familiar, you’re not alone. I recently spoke with someone going through the exact same situation, so I’m sharing these five essential steps to take after an ER visit for vertigo.

1. Take the Medication as Prescribed

Acute vertigo can be overwhelming. In the first few days, taking prescribed medication can help reduce dizziness and nausea so your parent can rest and recover.

If your parent received “as needed” or PRN medications at the ER, it may help reduce their discomfort and cope with the acute vertigo.

You may need to provide reminders, verbal cues, or fill a pill box to help your parent take their new medication without making errors.

Monitor your parent closely for side effects and report any suspected medication side effects to their primary care provider.

Just remember—these medicines treat symptoms temporarily, not the root cause.

In most cases, the vertigo returns as soon as the medication wears off, so further action is usually needed for best outcomes.

2. Notify Their Primary Care Doctor

Follow up with your parent’s primary care physician or primary care provider (PCP) as soon as possible. The PCP may:

Review emergency room recordsPerform a drug interaction check with new medications from the ER and other current prescriptionsPrescribe additional new medicationsOrder additional diagnostic testsRefer your parent to specialists for further evaluationSchedule a follow up appointment to monitor the situation

Timely notification of the PCP ensures no important details are missed.

For more on what to discuss at this appointment, see this blog on how to explain vertigo to a healthcare provider by presenting evidence.

3. Get a Vestibular Specialist or Vestibular Physical Therapy Evaluation

The ER’s goal is immediate symptom relief and ruling out a life-threatening cause, but many patients leave the ER without any known root cause. This may have happened to your parent!

Identifying the underlying root cause is key to long-term recovery from vertigo. After all serious medical problems are ruled out by the ER and the PCP, many patients with vertigo hit a dead end with no answers or relief.

You may have to advocate for your parent to see a specialist.

Ask for an insurance-based referral or seek a private-pay consultation with:

A vestibular physical therapist (PT), orA specialized vestibular doctor

Detecting the root cause will guide an effective treatment plan and ensure the best outcomes long-term.

This blog can help you search for local vestibular doctors or PTs.

4. Keep Medication With Them at All Times

Vertigo often recurs—sometimes without warning. Encourage your parent to keep at least one dose of all prescribed vertigo medications with them at all times, especially:

When travelingAt workDuring long outingsWhen away from home

Having medication ready can help manage symptoms quickly and may prevent another ER visit.

Check out our guide to Vertigo Home Remedies, which may also help in the event of a vertigo flare up or recurrence.

If your parent is planning a trip soon, this blog may help them prepare for traveling.

5. Return to the ER if New Symptoms Appear

If vertigo returns with new or unusual symptoms—such as weakness, trouble speaking, vision changes, facial drooping, or severe headache—take your parent back to the ER immediately.

These signs could point to a different or more serious medical problem.

Learn more about when to return to the ER in our Vertigo Emergency Blog.

Bottom Line:

An ER visit for vertigo is the starting point—not the finish line. The goal is to identify and treat the root cause, prevent recurrences if possible, and know when to seek urgent care again.

If your parent has hit the end of the road with no hope for recovery from vertigo, check out this book on “Navigating the Health Care System as a Dizzy Patient” and order your copy today.

TL;DR – Parent in the ER for Vertigo

If your parent was in the ER for vertigo, here are the next steps:

Take prescribed meds like meclizine (for dizziness) and ondansetron (for nausea) as directed.

Follow up with their primary care doctor for tests and referrals.

Schedule vestibular therapy or a specialist consult to find the root cause.

Keep medication on hand in case vertigo recurs.

Return to the ER if new symptoms appear, such as weakness, vision changes, or severe headache.

👉 Learn more about vertigo emergencies.

The post Parent Had an ER Visit for Vertigo? Here Are 5 Important Next Steps appeared first on Vertigo Detective.