Understanding Dizziness: Common Causes and How Vestibular Physiotherapy Can Help

Dizziness is a complex and often distressing symptom that can significantly affect daily life. It’s one of the most frequent complaints reported to GPs, especially among older adults, with studies showing that up to 30% of people experience dizziness or imbalance at some point (Neuhauser, 2007). For some, it’s a brief inconvenience—but for others, it’s chronic and disabling.

At Physio on Patterson, we are trained and experienced in the assessment and treatment of dizziness using vestibular physiotherapy, an evidence-based approach that helps retrain the body’s balance systems.

Common Causes of Dizziness

Dizziness can result from a range of conditions affecting the inner ear (vestibular system), brain, or neck. Here are several of the most commonly recognised causes:

1. Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is one of the most common causes of vertigo. It occurs when calcium carbonate crystals (otoconia) become dislodged and move into the semicircular canals of the inner ear, disrupting balance signals to the brain. This leads to brief, intense episodes of vertigo, typically triggered by changes in head position (Bhattacharyya et al., 2017).

2. Vestibular Neuritis and Labyrinthitis

These conditions are caused by inflammation of the vestibular nerve or inner ear structures, usually following a viral infection. Symptoms can include sudden onset vertigo, nausea, and unsteadiness. Labyrinthitis may also involve hearing loss (Strupp & Brandt, 2009).

3. Vestibular Migraine

Vestibular migraine is increasingly recognised as a common cause of recurrent vertigo, even in people who do not experience a traditional migraine headache. Symptoms may include:

• Vertigo lasting minutes to hours

• Sensitivity to visual or motion stimuli

• Imbalance or light-headedness

Vestibular migraine is often underdiagnosed (Lempert et al., 2012). Diagnosis is clinical and based on symptom patterns, often requiring collaboration between neurologists and vestibular therapists.

4. Persistent Postural-Perceptual Dizziness (PPPD)

PPPD is a chronic condition involving a persistent sense of unsteadiness or dizziness, often triggered by motion, standing, or complex visual environments. It frequently develops after an acute vestibular event and is considered a functional neurological disorder (Popkirov et al., 2018). Symptoms are real, but not due to structural damage in the brain or ear.

5. Meniere’s Disease

Meniere’s disease is caused by abnormal fluid dynamics in the inner ear and presents with:

• Episodes of vertigo lasting 20 minutes to several hours

• Hearing loss

• Tinnitus (ringing in the ears)

• Aural fullness

The cause is still not fully understood, but it’s thought to involve endolymphatic hydrops (Lopez-Escamez et al., 2015).

6. Cervicogenic Dizziness

Cervicogenic dizziness, which is thought to be very rare, originates from dysfunction in the cervical spine—often linked to neck pain or trauma. It causes light-headedness or imbalance, especially with neck movement, and is commonly associated with neck pain or tension (Reid et al., 2012).

How Vestibular Physiotherapy Can Help

Vestibular physiotherapy is a specialised area of practice designed to assess and treat dizziness, vertigo, and balance issues. It’s supported by strong evidence for improving outcomes in a range of vestibular disorders.

At Physio on Patterson, our vestibular-trained physiotherapists will conduct a comprehensive assessment, which may include:

• Detailed history-taking and symptom analysis

• Positional testing (e.g. Dix-Hallpike)

• Gait and balance assessments

• Visual tracking and vestibulo-ocular reflex testing

• Neurological assessment

• Cervical spine screening

  
  

Evidence-Based Treatment Techniques May Include:

• Canalith repositioning maneuvers (e.g. Epley maneuver) for BPPV (Bhattacharyya et al., 2017)

• Gaze stabilisation exercises to retrain the vestibulo-ocular reflex

• Balance and postural training to reduce fall risk

• Vestibular habituation exercises for motion sensitivity and PPPD

• Education and pacing strategies for vestibular migraine

• Manual therapy and exercises for neck-related dizziness

  
  

Vestibular rehabilitation has been shown to significantly improve symptoms, function, and quality of life—particularly in BPPV, vestibular neuritis, vestibular migraine, and PPPD (Hall et al., 2016).

When to Seek Help

Consider booking a vestibular physiotherapy appointment if you experience:

• Recurring or unexplained dizziness or vertigo

• Sensitivity to motion, busy environments, or visual movement

• Unsteadiness or imbalance

• Dizziness triggered by neck or head movement

• A diagnosis of BPPV, vestibular migraine, or PPPD

Early intervention often leads to better outcomes and a faster return to normal activity.

Book an Appointment

Dizziness doesn't have to be something you just “put up with.” At Physio on Patterson, our team is here to help you find clarity, regain your confidence, and get back to doing the things you love.

References

Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., ... & Corrigan, M. D. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (Update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1–S47. https://doi.org/10.1177/0194599816689667

Hall, C. D., Herdman, S. J., Whitney, S. L., Cass, S. P., Clendaniel, R. A., Fife, T. D., ... & Woodhouse, S. N. (2016). Vestibular rehabilitation for peripheral vestibular hypofunction: An evidence-based clinical practice guideline. Journal of Neurologic Physical Therapy, 40(2), 124–155. https://doi.org/10.1097/NPT.0000000000000120

Lempert, T., Olesen, J., Furman, J., Waterston, J., Seemungal, B., Carey, J., ... & Bisdorff, A. (2012). Vestibular migraine: Diagnostic criteria. Journal of Vestibular Research, 22(4), 167–172. https://doi.org/10.3233/VES-2011-0453

Lopez-Escamez, J. A., Carey, J., Chung, W. H., Goebel, J. A., Magnusson, M., Mandalà, M., ... & Bisdorff, A. (2015). Diagnostic criteria for Menière’s disease. Journal of Vestibular Research, 25(1), 1–7. https://doi.org/10.3233/VES-150549

Neuhauser, H. K. (2007). Epidemiology of vertigo. Current Opinion in Neurology, 20(1), 40–46. https://doi.org/10.1097/WCO.0b013e3280141b78

Popkirov, S., Staab, J. P., & Stone, J. (2018). Persistent postural-perceptual dizziness (PPPD): A common, characteristic and treatable cause of chronic dizziness. Practical Neurology, 18(1), 5–13. https://doi.org/10.1136/practneurol-2017-001819

Reid, S. A., Rivett, D. A., Katekar, M. G., & Callister, R. (2012). Efficacy of treatment of cervicogenic dizziness: A systematic review. Manual Therapy, 17(4), 274–286. https://doi.org/10.1016/j.math.2012.02.019

Strupp, M., & Brandt, T. (2009). Vestibular neuritis. Seminars in Neurology, 29(5), 509–519. https://doi.org/10.1055/s-0029-1241040