All Things Dizziness
What is a vestibular disorder?
Dizziness and vertigo are among the most common, and most debilitating, complaints in doctors offices and Emergency Departments; about 20-30% of the population is affected by dizziness annually (1). Despite it being one of the most common complaints, it is not a symptom that many physicians and other providers know a lot about. So, if you are a person who lives with dizziness, let’s dive into what that could look like for you, and what the reason could be.
The most common reason for dizziness and vertigo is within your vestibular system, either a central or peripheral vestibular dysfunction. The vestibular system is in your inner ear, and is attached to the cochlea (your hearing organ). The vestibular system is responsible for balance, acceleration, generally keeping you upright, and most other movement related functions. If you’d like to read more about ear anatomy and how the vestibular system works, you can click here.
Dizziness is a nondescript term describing all kinds of disequilibrium, feeling of being generally ‘off’, feeling light headed, vertigo, and more. Dizziness is an umbrella term, and it’s not an incredibly descriptive symptom. These symptoms are associated with many different diagnoses, which is why being able to describe what your dizziness feels like in more descriptive terms can be helpful so that you and your healthcare team can work together to provide the best diagnosis and treatment for you in particular. If you live with dizziness and are having trouble getting a diagnosis, I recommend taking some time to jot down what your dizziness feels like prior to your next doctor’s visit. This way, you and your doctor can more quickly and easily get to the bottom of what may be causing your symptoms.
Dizziness symptoms I frequently hear about in my clinic are:
- Heavy headedness
- ‘Like my head is a hot air balloon’
- Cotton candy head
- Bobbing and swaying
- ‘Mud sliding around in my head’
- Rocking back and forth
- Sliding internally
- Walking on
- The room is spinning
- I am internally spinning
- And more!
All of these symptoms are different in your provider’s eyes. So, knowing the difference can help them come up with a more accurate diagnosis. For instance, if you see the room is spinning around you for 15-60s, you may have BPPV. But if you have long term room-spinning vertigo you should be evaluated for vestibular migraine and/or Meniere’s disease. All of these diagnoses are incredibly different, and have very different treatment protocols. So, getting the correct diagnosis is important. Therefore, describing your symptoms accurately is a very important part of this process.
Dizziness vs. Vertigo
Dizziness, again, is the non-descript symptom of disequilibrium, imbalance, and feeling off. The word dizziness could also be used to describe vertigo. However, not all dizziness is vertigo! Vertigo has an incredibly distinct definition: the incorrect perception that you, or the room around you, is moving, sliding, or spinning. This definition is vital to understand if you are experiencing dizziness.
If you are not experiencing false movement, you are not experiencing vertigo. If you are lightheaded, the word vertigo is not the correct word to use to describe your symptoms. Using the word vertigo should prompt your provider to ask if you are moving, or if the room around you is moving. But, if you’re lightheaded, that’s not false movement. (Yes, you could have vertigo AND lightheadedness, but it’s important to distinguish between the two & when each occurs).
In short, all vertigo is dizziness, but not all dizziness is vertigo. Be sure which you have, or if you have both at different times; this way, you can communicate with your doctor more easily about what’s going on to find answers.
Common Diagnoses in the Vestibular System
We can break down the vestibular ‘world’ into two categories: central disorders and peripheral disorders. Peripheral vestibular disorders are disorders of the inner ear itself. Central disorders are directly related to the brain and spinal cord.
Common peripheral vestibular disorders are:
- Meniere’s Disease
- Vestibular Neuritis
- Benign Paroxysmal Positional Vertigo (BPPV)
- Bilateral Vestibular Hypofunction (BVH)
Common central vestibular disorders are:
The three most common vestibular disorders are: BPPV, Vestibular Neuritis, and Vestibular Migraine. BPPV is the most common vestibular disorder peripherally, while Vestibular Migraine is the most common central vestibular disorder.
Figuring out which one you have can be incredibly difficult, but starting with a physical therapist, a neuro-otologist, and/or a headache specialist is a great place to start. Going back to the beginning, recognizing your symptoms, when they’re worse and when they’re better (even if it’s just slight), and writing down what your symptoms are in a short & concise way is a great way to start this journey to an accurate diagnosis.
How to treat a vestibular disorder
Each and every vestibular disorder has its own treatment protocol when it comes to medical attention. Medical treatments, medications, and more are all available for managing vestibular disorders – and are great options! That being said, comprehensive care requires us to look at a bigger picture. Many of the lifestyle changes and daily activities that we do in vestibular rehabilitation and in conservative care are largely the same. So, while you’re getting a diagnosis, here are a few tactics that can help on a day to basis, we will cover two here, but there’s many more on my website, here.
Breathing and grounding
Your breath is the fastest, and one of the most effective, ways to manage your autonomic nervous system. This means that if you’re feeling anxious or nervous about your dizziness – a very normal and natural response – that you can use your breath to help you feel a little calmer and less dizzy. My favorite activity to pair with breathing is grounding.
When you have a vestibular disorder, your three systems of balance (vision, vestibular, and proprioception) don’t quite work together all the time like they should. To give your body a little support and assistance, try grounding. Sit on the floor against the wall or in a firm chair – somewhere you’re comfortable. Next, start your breathing; you can breathe however you’d like, whether it’s 8-4-7 breathing, box breathing, or something else. Then, start with your feet and feel them against the floor. Remind yourself that you’re safe, and still. That you’re going to be okay, that the dizziness can go away. Remind your brain that you’re grateful for the alert, but that you’re safe and don’t need the alarm anymore.
Are there two things going to be the end all be all of dizziness? No. But, it’s a great way to calm down your brain and body when you’re feeling that sense of anxiety and dizziness because of your vestibular disorder.
When you have a vestibular disorder, one of the LAST things you want to do is move your body. I get that completely, because who would want to do something that makes them feel even dizzier? No one.
But, over time exercise and movement that is scaled to your specific needs is what gets people back to functioning more easily, reducing fatigue, and less dizziness. There’s quite a bit of anatomy and physiology that goes into this, but in short your body needs movement and so does your vestibular system.
Exercise reduces migraine attacks, helps people feel less dizzy than their non-exercising counterparts, and increases muscle mass which will reduce fatigue. Starting super small, even with 3 minutes at a time, and work your way up is the most effective way to do this. Find something you like, do it small and frequently.
If you’re dizzy and having a hard time with movement and exercise, you’re not alone! There are ways we can help, Vestibular Group Fit is an awesome program for: movement, mindset, support, and education all about vestibular disorders!
(1) Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008 Nov;14(6):355-64. doi: 10.1097/NRL.0b013e31817533a3. PMID: 19008741.
Dr. Madison Oak
Dr. Madison Oak is a physical therapist who specializes in treatment of Vestibular Migraine, Persistent Postural Perceptual Dizziness, and other vestibular disorders. Madison is the founder of Vestibular Group Fit, @TheVertigoDoctor, and Oak Physical Therapy & Wellness. Madison strives to provide excellent, evidence based, vestibular resources that are thorough, helpful, and actually make sense to people who have vestibular disorders.
Migraine and dizziness disorders affect SO many people in the US and the world. Madison’s journey began when she was working in an NYC outpatient Physical Therapy clinic. The day she saw an incredibly nervous, acutely dizzy, Manhattan bus driver, followed by a chronically dizzy concierge home visit patient, she realized that many people who need vestibular care cannot always access the care they need. There is not enough information about dizziness, why we get dizzy, and how to treat dizziness. It’s simple, but it feels so scary and complex when you’re actually dizzy. So, she started @TheVertigoDoctor on Instagram, a telehealth clinic in 8 states addressing only vestibular disorders, and Vestibular Group Fit. Between these three, there are accessible resources for all of those who live with vestibular disorders no matter your specific situation!
When she isn’t talking about the vestibular system, you can find Madison out skiing in Jackson Hole, baking chocolate chip banana bread, and hanging out with her dog, Hugo.