Vertigo & Dizziness

These two words get used interchangeably, and they point in different directions.

Vertigo is a false sense of movement: the room spins, tilts or slides, or you feel like you're falling, even though nothing is moving ¹. That's the one this page is about.

Dizziness is the broader, vaguer feeling: lightheaded, giddy, faint or unsteady on your feet ¹. Standing up too fast and grabbing the bench is dizziness, not vertigo.

Vertigo is a symptom, not a diagnosis ⁶. "You've got vertigo" describes what you're experiencing, not why. Which canal, which ear, or which other cause: that's what an assessment is for.

BPPV is usually diagnosed with a bedside test, not a scan. If your story and a positional test both point to it, the clinical guideline recommends against imaging and further balance testing unless something doesn't fit ⁷. You'll be asked which movements set it off, about your other health problems and medicines, and your hearing, eyes and balance are checked ¹.

The test is the Dix-Hallpike. Your head is turned 45 degrees to one side and you're taken from sitting to lying with that ear down. In BPPV the vertigo comes on and your eyes flick in a recognisable pattern (nystagmus) the clinician watches for ⁷. Blood tests, scans or a referral are for ruling out a more serious cause ¹, or for symptoms that don't fit the pattern or involve both ears ².

The first job is working out which of those two you're describing, and if it's vertigo, what's behind it: what sets it off, how long each episode lasts, what comes with it, then testing it physically instead of guessing.

BPPV is identified using positional tests (the Dix-Hallpike test and the Supine Roll Test), which provoke the symptom briefly and show which canal the crystals are sitting in ⁷. The posterior canal is most commonly involved ⁷. That answer matters, because the treatment is canal-specific.

For BPPV, the treatment with the best evidence is canalith repositioning: a sequence of head and body positions that uses gravity to move the crystals back out of the canal. The Epley manoeuvre is the best known, and Australian government health guidance describes it as performed by a doctor or a physiotherapist trained in the technique ^1,2. A Cochrane review of 11 randomised trials found it safe and effective for posterior canal BPPV, clearly better than sham or no treatment ³. Sometimes a second treatment is needed ².

The limits are worth stating: Epley is not better than the Semont or Gans manoeuvres, its advantage over Brandt-Daroff exercises was significant at seven days but gone by one month, and the studies were mostly small with short follow-up ³. It's a good treatment, not a magic one.

If your unsteadiness is about strength and confidence on your feet rather than a spinning sensation, that's a different problem. Our Falls Prevention program is built for it. What happens at an actual appointment is set out on our Vestibular Physiotherapy page.

Vertigo is not a tissue injury, so on The Well Motion Recovery Path™ nothing has to heal: something is put back, then retrained. You move up a phase on what your balance can do, not on a date.

• Reset: the first visit or two. A positional test finds the canal ⁷, then our trained clinician does the repositioning manoeuvre for that canal ^1,2. Expect a short burst of spinning, and possibly nausea ³. You move on when the test no longer sets the vertigo off.
• Rebuild: for unsteadiness that lingers after the spinning stops, and for vertigo that isn't BPPV. Vestibular rehabilitation exercises ⁴, progressed as you cope. Expect mild dizziness from them at first. We move you on when turning and walking feel steady.
• Return: back to what you have been avoiding ⁷: rolling over in bed, looking up, driving, work. The positional test is rechecked within a month ⁷. You leave with a plan for the next episode, because BPPV often returns ².

How long it usually takes. BPPV tends to respond quickly: 1 or 2 repositioning treatments are enough for 79 to 93% of people ⁷. Left alone, about 20% recover by 1 month and up to 50% by 3 months ⁷. Inner ear infections are slower: balance usually returns over 2 to 6 weeks ⁹. These are averages, and a recurrence starts the count again.

BPPV has a habit of returning: symptoms often stop for weeks or months, then come back ². One thing has been tested in a trial for making that happen less often, and the guideline settles a few others:

• Get your vitamin D checked. A randomised trial followed more than 1,000 people whose BPPV had just been treated. Half had their vitamin D measured and, if it was low, took vitamin D and calcium for a year. In that group 38% had another episode, against 47% of those who were simply followed up ⁸. That's a blood test and a GP conversation, not something to start on your own.
• Skip the sleeping-upright routine. You don't need to restrict your posture after a repositioning manoeuvre. The guideline recommends against it ⁷.
• Go back for the review. The guideline recommends a reassessment within a month to confirm the vertigo has cleared ⁷.
• Have a plan for the next episode. Sit down as soon as you feel dizzy, get out of bed slowly, and steer clear of the head positions that set it off while it's active ¹.