Vertigo and Dizziness: Causes, Symptoms, and How Physiotherapy Can Help

A lot of people come in worried about this.  And honestly, it makes sense.

Vertigo and dizziness are some of the most unsettling things you can experience. One moment you’re fine, and the next the room is spinning or you feel like you’re about to fall over even though you’re standing perfectly still. It’s scary, and we get that.

The good news? These are actually two of the most common things we see at Physio Club, and in most cases, they’re very treatable. We just need to work out what’s going on first.

This guide is for anyone experiencing dizziness or vertigo, or those supporting someone with these symptoms. Recognizing the causes and knowing when to seek help can make a significant difference in recovery and safety.

In this guide, we’ll walk you through what vertigo and dizziness actually are, what causes them, how to spot the symptoms, and most importantly what we can do to help. For more general injury and performance topics, our Physio Club physiotherapy blog is updated regularly with practical advice. For a comprehensive overview of dizziness symptoms and causes, you can also refer to the Mayo Clinic.

In This Article

•  What is the difference between vertigo and dizziness?

•  How common are these problems in Australia?

•  What causes vertigo?

•  What causes dizziness?

•  What does the balance system actually do?

•  Managing blood pressure and dizziness

•  Symptoms to look out for

•  When should you see a physio (or a doctor)?

•  How does physiotherapy treat vertigo and dizziness?

•  What to expect at your first appointment

•  Frequently asked questions

Key Takeaways

• Dizziness and vertigo are common symptoms that affect millions and can significantly impact daily life, especially in older adults.
• Vertigo is a specific type of dizziness characterized by a spinning sensation, often caused by inner ear disorders like benign paroxysmal positional vertigo (BPPV) or central nervous system issues such as vestibular migraine.
• Accurate diagnosis differentiating peripheral vertigo from central vertigo is crucial for effective treatment and to rule out serious conditions like stroke.
• Common causes of dizziness include dehydration, low blood sugar, medication side effects, and neck-related issues, among others.
• Physiotherapy, particularly vestibular rehabilitation therapy and canalith repositioning maneuvers like the Epley manoeuvre, offers effective treatment options for many causes of vertigo and dizziness.
• Monitoring blood pressure, staying hydrated, and managing underlying health conditions play important roles in reducing dizziness episodes.
• Immediate medical attention is necessary if dizziness is accompanied by neurological symptoms such as sudden weakness, vision changes, or severe headache.
• Patient education and a multidisciplinary approach improve outcomes and help individuals regain balance and confidence in daily activities.

What Is the Difference Between Vertigo and Dizziness?

It’s no secret that people use these words as if they mean the same thing. But they don’t and knowing the difference actually matters when it comes to finding the right treatment.

Dizziness is an imprecise term that patients often use to describe various related sensations, including faintness, light-headedness, and a spinning sensation. Dizziness may be categorized into different types, including vertigo (spinning), lightheadedness (near-fainting), and disequilibrium (unsteadiness).

Vertigo

Vertigo is that classic spinning sensation where you feel like you, or everything around you, is moving when nothing actually is. These are called vertiginous symptoms, and they can range from a brief, unsettling wobble to a full-on room-spinning episode that leaves you gripping the edge of a bed.

Think of vertigo like a headache. The headache tells you something’s wrong but it doesn’t tell you what. Vertigo is the same. It’s a symptom, not a condition in itself.

Episodes can be triggered by something as simple as lying down, rolling over in bed, or tilting your head back. They might last a few seconds or go on for minutes.

Vertigo can be further classified as either peripheral vertigo or central vertigo. Peripheral vertigo is most often caused by inner ear disorders or ear disorders, such as benign paroxysmal positional vertigo (BPPV) and Ménière’s disease. These conditions typically involve symptoms like hearing loss, tinnitus, or ear fullness. Central vertigo, on the other hand, originates from dysfunction within the brainstem or cerebellum and can be caused by issues like vestibular migraine, cerebrovascular disease, tumors, or other neurological disorders. Accurate diagnosis is important, as dizziness can result from both peripheral disorders (like BPPV and Ménière’s disease) and central disorders (such as vestibular migraine).

Dizziness

Dizziness is a broader term that covers a whole range of sensations feeling faint, lightheaded, off-balance, or just plain woozy. The key difference is that dizziness doesn’t usually involve that spinning feeling.

How Common Are Vertigo and Dizziness in Australia?

More common than most people realise, honestly.

At least 5% of Australians that’s over one million people will experience significant dizziness at some point in their lives. And up to 20% of adults experience it badly enough that it starts affecting everyday things like driving, working, or just getting around the house.

Dizziness and vertigo are part of a broader group known as balance disorders, which also include conditions like Meniere’s disease and vestibular neuritis. Identifying and diagnosing balance disorders is important for effective management and treatment.

It’s also one of the most common reasons people end up at their GP or even at the emergency department. What surprises a lot of people is that physiotherapy is often one of the most effective treatments available and most of them had no idea.

Dizziness affects both men and women, but it is about 2 to 3 times more common in women than in men. The one-year prevalence of dizziness in U.S. adults is 11% based on national health survey data. Dizziness can be temporary or chronic, with chronic dizziness being more common among older adults and leading to significant disability.

Did you know? BPPV a type of vertigo caused by tiny loose crystals in your inner ear is the single most common cause of vertigo. And it can often be sorted in just one to three physio sessions.

What Is Vertigo? The Most Common Causes

Vertigo is most often caused by something going on in the peripheral vestibular system the balance organs in your inner ear. These include structures like the semicircular canals, which detect head movement. Most cases of vertigo have a peripheral etiology, but it’s important to differentiate peripheral from central causes involving the central nervous system, as the underlying mechanisms and treatments can differ significantly. When something disrupts that system, the signals it sends to your brain get confused, and that’s when the spinning starts.

Here are the most common causes we see:

Dizziness can also be caused by inner ear issues such as BPPV, vestibular neuritis, dehydration, low blood pressure, anxiety, or medication side effects.

1. Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most common cause of vertigo, especially in people over 50. It happens when tiny calcium crystals (we sometimes call them “ear rocks” their proper name is otoconia) get dislodged from where they should be and end up floating around in the wrong part of the inner ear.

Diagnostic tests for vertigo may include the Dix-Hallpike maneuver, which is used to diagnose benign paroxysmal positional vertigo (BPPV).

When you move your head lying down, rolling over, looking up those rogue crystals shift around and send incorrect signals to your brain. The result? Sudden, intense spinning that usually lasts less than a minute.

The great news here is that BPPV responds really well to treatment. The primary treatment for benign paroxysmal positional vertigo focuses on specific head movements or head rotation maneuvers that dislodge calcium deposits. We use a technique called the Epley manoeuvre a series of guided head movements that gently guide those crystals back where they belong. Most people notice a significant difference after just one or two sessions.

Worth knowing: “Benign” literally means harmless. Despite how alarming BPPV feels in the moment, there’s nothing dangerous about it and it’s one of the most straightforward things we treat. BPPV is also a common cause of peripheral vertigo.

2. Vestibular Neuritis

This one happens when the vestibular nerve which carries balance signals from your inner ear to your brain gets inflamed, usually from a viral infection. Vestibular neuritis is a classic cause of acute vestibular syndrome, a sudden and severe onset of vertigo, imbalance, and nausea. Patients may also experience trouble walking as part of this acute vestibular syndrome, and this symptom should prompt careful evaluation, as it can indicate more serious underlying conditions.

Unlike BPPV, vestibular neuritis isn’t triggered by head movements. Treatment is about helping your brain adapt a process called vestibular compensation where it gradually learns to rely more on your eyes and joints to stay balanced.

3. Labyrinthitis

Very similar to vestibular neuritis, but labyrinthitis also involves the cochlea (the hearing part of your inner ear). So alongside dizziness and vertigo, you might also experience vestibular symptoms such as imbalance and spinning sensations, as well as ringing in your ears or some hearing loss.

4. Meniere’s Disease

Meniere’s disease is caused by an abnormal build-up of fluid in the inner ear. The symptoms of Meniere’s disease are caused by an increased volume of endolymph within the semicircular canals. It comes in episodes often lasting 20 minutes to several hours and can include severe vertigo, tinnitus (ringing in the ears), a feeling of fullness in the ear, and sometimes unilateral hearing loss. Unilateral hearing loss is actually a key sign that helps us differentiate Meniere’s from other causes.

There’s no cure for Meniere’s, but vestibular physiotherapy combined with some lifestyle adjustments can make a real difference to how often and how severely episodes occur. We focus on helping you manage it, not just endure it.

5. Vestibular Migraine

How good is it when something you thought was a mystery actually has a name? Vestibular migraine is one of the most under-diagnosed causes of recurring dizziness and it can happen even without a headache. Vestibular migraine is characterized by unilateral headaches associated with nausea, vomiting, photophobia, and phonophobia.

Episodes can include spinning, motion sensitivity, visual disturbances, and difficulty concentrating. Patients with vestibular migraine often experience dizziness, motion sickness, or mild hearing loss. The good news is that a combination of physiotherapy and migraine management strategies often makes a big difference.

Patients with vestibular migraine should be referred to a neurologist for management.

6. Cervicogenic Dizziness (Neck-Related Dizziness)

Not all dizziness starts in the ear. The joints and muscles at the top of your neck contain balance sensors that feed information to your brain. If they’re stiff, irritated, or injured think whiplash, chronic neck tension they can produce a real sense of dizziness or unsteadiness. Neck pain can also be a warning sign or associated symptom in cervicogenic dizziness, and should be carefully considered during evaluation.

This type responds very well to hands-on physiotherapy. Sometimes it’s the thing people have been dealing with for years without anyone making the connection.

What Causes Dizziness (Without Vertigo)?

Not every dizzy spell comes from your inner ear. There are plenty of other causes, and a lot of them are surprisingly straightforward to manage once you know what you’re dealing with:

1. Dehydration In hot Australian summers, this is a really common one. When you’re not drinking enough, blood pressure drops and the brain gets less circulation. Lightheadedness follows.
2. Low blood sugar Skipping meals or going too long without eating can cause your blood glucose to dip and leave you feeling faint and foggy.
3. Medication side effects Blood pressure tablets, sedatives, and some antibiotics can all list dizziness as a side effect. Worth a conversation with your GP if you’ve recently started something new.
4. Anaemia (low iron) Low red blood cell levels mean less oxygen getting to the brain, which shows up as persistent lightheadedness and fatigue.
5. Postural hypotension A sudden drop in blood pressure when you stand up too quickly. Very common, especially in older adults and very manageable. For more on managing this, see the National Heart, Lung, and Blood Institute’s guide on orthostatic hypotension.
6. Heart conditions Arrhythmias or reduced blood flow can sometimes cause dizziness. This is why ruling out cardiovascular causes with your GP is always a good first step.
7. Ear surgery Procedures involving the inner ear can sometimes disrupt the vestibular system, leading to dizziness or vertigo.
8. Anxiety and stress Anxiety changes how we breathe. Hyperventilation alters blood flow and can create real sensations of dizziness or detachment. Not imagined. Genuinely physiological.

Patients with dizziness often experience anxiety and depression, which can make their symptoms worse.

Understanding Your Balance System

To understand why dizziness happens, it helps to see how your body actually keeps you upright. Your brain is constantly pulling in information from three different systems at once:

Managing Blood Pressure and Dizziness

I want to talk about something that doesn’t always get enough attention when it comes to dizziness and that’s blood pressure.

Specifically, orthostatic hypotension. That’s the fancy term for when your blood pressure drops suddenly as you stand up and it can make vertigo symptoms significantly worse.

Here’s what actually helps:

1. Monitor your blood pressure regularly spotting patterns in drops can be genuinely useful, both for you and your GP, especially if you’re managing ongoing dizziness.
2. Stay well hydrated especially in warm weather or after exercise. Dehydration lowers blood pressure and makes dizziness more likely to show up.
3. Stand up slowly no more jumping out of bed like the house is on fire. Taking your time with position changes prevents those sudden dizzy spells.
4. Elevate your head slightly while sleeping it can help with overnight blood pressure changes and support better vestibular function.
5. Exercise regularly gentle, consistent movement improves circulation and helps your balance system adapt. Vestibular rehab exercises are particularly useful here.
6. Review your medications with your GP some blood pressure medications can occasionally make dizziness worse. Always check before making any changes.
7. Manage any underlying conditions if you have diabetes or a heart condition alongside dizziness, keeping those well controlled reduces the overall burden on your balance system.

Heads up: Some symptoms need urgent attention not home management. Sudden weakness, numbness, severe headache, chest pain, or changes in vision or speech can signal something serious. Get emergency care immediately if these come on suddenly alongside dizziness.

Symptoms of Vertigo and Dizziness: What to Watch For

These symptoms can come on while you’re sitting still, in certain positions, or with movement. It’s a longer list than people often expect:

Vestibular / Vertigo Symptoms:

•  Spinning sensation (you feel like you’re spinning, or the room is spinning around you)

•  Sudden intense dizziness triggered by head movements

•  Nystagmus (involuntary, jerky eye movements)

•  Nausea or vomiting

•  Difficulty walking in a straight line

•  Feeling off-balance or unsteady on your feet

•  Tinnitus (ringing, buzzing, or humming in one or both ears)

General Dizziness Symptoms:

•  Lightheadedness or feeling faint

•  A floating, rocking, or “drunk” sensation

•  Blurred or unfocused vision

•  Difficulty concentrating or brain fog

•  Sweating

•  Anxiety or a sense of panic (often a secondary response to dizziness)

•  Weakness, fatigue, or muscle weakness

•  Sensitivity to visual motion busy environments, scrolling screens, crowded shopping centres

Associated symptoms like tinnitus, hearing loss, or ear fullness are really useful clues they help us narrow down what’s driving everything.

Important: Symptoms alone are not a diagnosis. Two people can feel the same spinning sensation but have completely different causes behind it. This is exactly why a thorough clinical assessment matters treating the symptom without understanding the cause will only get you so far.

When Should You See a Physiotherapist and When Should You See a Doctor?

Most cases of vertigo and dizziness can be assessed and treated by a vestibular physiotherapist. But there are some situations where you should get medical attention first and we want to be really clear about that.

Go to a doctor or hospital immediately if you experience:

•  Sudden, severe headache alongside dizziness

•  Difficulty speaking, slurred speech, or facial drooping

•  Double vision or sudden vision loss

•  Weakness or numbness on one side of your body

•  Loss of consciousness or fainting

•  Dizziness following a head injury or trauma (recent head trauma increases the risk of traumatic brain injury)

These symptoms can occasionally point to a stroke or serious neurological condition. Transient ischemic attack (TIA), brain tumor, cerebrovascular disease, and other cerebrovascular disorders can also present with dizziness or vertigo and require urgent evaluation. Stroke risk factors like high blood pressure, high cholesterol, and atrial fibrillation can increase the likelihood of a central (brain-related) cause. Focal neurologic deficits are a key sign that may require brain imaging to diagnose stroke or other central causes. Lesions in the posterior fossa can cause vertigo and balance disturbances. Please don’t wait it out get assessed immediately.

Persistent dizziness can arise from disorders like multiple sclerosis, Parkinson’s disease, or stroke.

Come and see us if:

•  You feel like the room is spinning, especially when lying down or turning in bed

•  Dizziness is triggered or made worse by head movements

•  You’ve been feeling off-balance or unsteady for more than a few days

•  Your GP has seen you and ruled out anything serious

•  You’ve been told you have BPPV, labyrinthitis, or vestibular neuritis

•  Dizziness is affecting your ability to drive, work, or exercise

If initial checks suggest a central cause (like multiple sclerosis, Parkinson’s disease, or stroke-related), your physio or GP may recommend further testing to address central issues. We’ll always guide you to the right next step if that’s the case.

How Does Physiotherapy Treat Vertigo and Dizziness?

Vestibular physiotherapy is a specialist area of physiotherapy, and it’s something we take seriously here at Physio Club. We assess the whole balance system not just one part of it and build a treatment plan around what your body actually needs. Vertigo treatment may include medications known as vestibular suppressants, such as antihistamines, which can ease vertigo symptoms in acute cases. In clinical practice, evidence-based physiotherapy management is guided by established clinical practice guidelines to ensure the best outcomes for patients.

Here’s what that can look like:

Canalith Repositioning Manoeuvres (e.g. Epley Manoeuvre)

If you have BPPV, we can perform a canalith repositioning manoeuvre the most well-known being the Epley manoeuvre. This technique relies on changing your head position through a series of gentle, guided head and body movements to move those dislodged crystals out of the wrong canal and back where they belong.

These manoeuvres target the semicircular canals the parts of the inner ear responsible for detecting rotational movement. It’s non-invasive, safe, and often works faster than people expect. Many patients feel a significant improvement after a single session.

Vestibular Rehabilitation Therapy (VRT)

For ongoing dizziness, balance problems, or conditions like vestibular neuritis and Meniere’s disease, we design a personalised exercise program to help your brain compensate for impaired vestibular signals. Physiotherapt and exercise physiology play a really important role here especially for older adults at increased risk of falls.

VRT typically includes:

•  Gaze stabilisation exercises training your eyes and inner ear to work together so vision stays clear during head movement

•  Habituation exercises gradual, repeated exposure to the movements that trigger dizziness, to desensitise the vestibular system over time

•  Balance and postural training to improve steadiness and reduce fall risk

•  Head motion retraining gradually building tolerance to movement

Manual Therapy for Neck-Related Dizziness

If your dizziness is coming from the neck, we use gentle joint mobilisations, soft tissue therapy, dry needling, and sensorimotor retraining to restore normal function and reduce symptoms. We’d love to tell you how often this is the missing piece of the puzzle.

Education and Self-Management

Understanding what’s happening in your body makes a huge difference. We’ll explain your condition clearly, talk through what’s safe to do, help you manage symptoms at home, and set realistic expectations for recovery. Knowledge really is part of the treatment.

What to Expect at Your First Appointment

We know that walking into a clinic when you’re feeling dizzy and unsteady takes a bit of courage. We want to make it as straightforward as possible, and our community-focused Physio Club clinics are set up to support you from the moment you arrive.

Here’s what happens when you come in:

1. Detailed history We’ll ask about your symptoms: when they started, what triggers them, how long they last, and what makes them better or worse. A thorough medical history and physical examination are essential for accurate diagnosis of vertigo.
2. Clinical assessment We use bedside testing to examine eye movements (nystagmus), head movement responses, balance, coordination, and neck function. This includes a comprehensive neurologic examination, with specific tests like the HINTS test (Head Impulse, Nystagmus, Test of Skew) to help differentiate between central and peripheral causes of vertigo and assess cranial nerve function. If initial evaluations suggest a central cause, healthcare providers may recommend additional tests, such as brain imaging like an MRI, to address central issues.
3. Diagnosis and explanation We’ll explain what we found in plain language. No jargon, no guessing games.
4. Treatment In most cases, we’ll start treatment at the same appointment. For BPPV, that might mean a repositioning manoeuvre. For other conditions, we’ll kick off your rehabilitation program.
5. Take-home exercises You’ll leave with a clear plan: what to do at home, what to watch for, and when to come back.

Frequently Asked Questions

Can a physiotherapist diagnose vertigo?

Yes. Physiotherapists with vestibular training are equipped to diagnose common causes of vertigo and dizziness using clinical bedside tests. In many cases particularly with BPPV we can diagnose and treat in the same session.

Physiotherapists are also trained to recognize signs that may indicate a central cause of dizziness, such as stroke. If our assessment suggests the need to diagnose stroke or another serious condition, we’ll refer you for further evaluation by the appropriate specialist.

How many sessions will I need?

It depends on what’s causing your dizziness. BPPV often resolves in one to three sessions. Vestibular neuritis or ongoing vestibular hypofunction typically need a longer program often six to twelve weeks but most people start noticing improvements well before that.

Is it safe to exercise if I have vertigo?

In most cases, yes and it’s actually important for recovery. Avoiding all movement can slow down the brain’s ability to adapt. We’ll guide you on exactly what’s safe and appropriate for your situation.

Can vertigo come back after treatment?

BPPV can recur research suggests around 50% of people experience at least one recurrence within five years. But here’s the thing: once you’ve been through it once, subsequent episodes are usually much easier to manage. And you’ll know exactly who to call. 

Is vestibular physiotherapy covered by Medicare or private health insurance in Australia?

Vestibular physio falls under standard physiotherapy services. Most private health insurers with extras cover will include it. Some patients may also qualify for a Medicare Chronic Disease Management (CDM) plan through their GP, which can subsidise a number of allied health sessions. Worth checking your policy or asking your GP.

What is the Epley manoeuvre?

The Epley manoeuvre is the most widely used treatment for BPPV. Your physio guides your head through a specific sequence of positions to move the dislodged crystals back where they belong. It takes around 15 minutes and studies show success rates of over 80% after a single session. Simple, effective, and nothing to be nervous about.

Ready to Get Your Balance Back?

Vertigo and dizziness can knock your confidence and make everyday life genuinely hard driving, working, exercising, even just getting through the day. But most people make a full recovery with the right care.

We’re not just here to treat the symptom. We want to understand what’s driving it, explain it to you properly, and help you get back to doing the things you love.

If you’ve got questions, feel free to reach out to us directly