Condition
Vertigo + Dizziness
Sorting the treatable mechanical causes from the ones that need a physician.
80%+
of BPPV cases resolve with one or two repositioning treatments
BPPV responds to a repositioning manoeuvre in one or two visits. Cervicogenic dizziness responds to neck treatment. Everything else gets referred, promptly.
What it feels like
- A spinning sensation triggered by rolling over in bed or looking up
- Brief intense episodes lasting under a minute (typical of BPPV)
- Unsteadiness or floating that accompanies neck pain and stiffness
- Nausea alongside the dizziness
- Light-headedness on standing quickly
What tends to cause it
- BPPV — displaced crystals in the inner ear, the most common cause of true vertigo
- Cervicogenic dizziness from upper cervical joint and proprioceptive dysfunction
- Vestibular neuritis or labyrinthitis, usually following a viral illness
- Ménière's disease, with hearing change and ear fullness
- Orthostatic hypotension, medication effects, or cardiovascular causes
- Central causes involving the brainstem or cerebellum
Dizziness is a symptom with a long list of possible causes spanning several medical specialties. Some of them are mechanical and treat beautifully in a chiropractic office. Some of them are emergencies.
Our job is to be very good at the first group and very fast at recognising the second.
The single most useful question
“Does the room spin, or do you feel like you might faint?”
True rotational vertigo points toward the vestibular system — inner ear or its central connections. Light-headedness and presyncope point toward blood pressure, cardiac causes, or medication. Unsteadiness without either points toward proprioceptive or neurological causes.
These three go to three different places. Getting the question right at the start saves people months.
BPPV, and why it is so satisfying to treat
Benign paroxysmal positional vertigo is the most common cause of true vertigo, and it is purely mechanical. Crystals that belong in one chamber of the inner ear have migrated into a canal where they disturb fluid during head movement.
The presentation is characteristic: brief, intense spinning triggered by specific position changes — rolling over in bed, lying down, looking up at a high shelf. Each episode lasts under a minute. Between episodes you feel fine.
The Dix-Hallpike test provokes it while we watch your eyes, and the nystagmus pattern identifies the involved canal. Then a sequence of head positions walks the crystals back out.
Most people are substantially better the same day. It is one of the few things in musculoskeletal practice that works like a switch.
When we send you elsewhere, immediately
Dizziness accompanied by double vision, slurred speech, facial weakness, limb weakness, severe headache, or difficulty walking is a possible posterior circulation stroke. That is an emergency call, not an appointment.
Sudden hearing loss with vertigo needs urgent ENT assessment. Dizziness with chest symptoms or fainting needs a cardiac workup.
We would rather send ten people to be checked unnecessarily than miss one.
How we treat it here
Establish what kind of dizziness this is
True vertigo — the room spinning — is a different problem from light-headedness or unsteadiness. The distinction narrows the list dramatically and it starts with careful history taking.
Test for BPPV
The Dix-Hallpike and roll tests provoke the symptom while we watch your eye movements. The direction and timing of the nystagmus tells us which semicircular canal is involved. This is a definitive test, not a guess.
Reposition if it is BPPV
The Epley manoeuvre and its variants move the displaced otoconia back where they belong using a sequence of head positions. When the diagnosis is right, this works quickly and it is one of the most satisfying treatments in practice.
Treat the neck if it is cervicogenic
When dizziness tracks with neck position and neck pain, and BPPV has been excluded, upper cervical treatment plus proprioceptive retraining is the approach.
Vertigo
Questions we get about this.
What actually is BPPV?
Your inner ear contains tiny calcium carbonate crystals that normally sit in a specific chamber and help detect head position. Sometimes they dislodge and drift into one of the semicircular canals, where they move fluid they were never meant to touch. Your brain interprets that fluid movement as violent rotation. Hence a spinning room with no rotation. It is entirely mechanical, which is why a mechanical fix works.
How fast does the Epley manoeuvre work?
Frequently the same day. A single correctly targeted treatment resolves a large majority of cases, and most of the rest resolve with a second. If you have had three treatments with no change, the diagnosis is wrong and we will reconsider it rather than repeat it.
Is cervicogenic dizziness a real diagnosis?
It is real but it is a diagnosis of exclusion, and it is over-diagnosed. Your upper cervical spine is densely populated with position sensors feeding your balance system, and dysfunction there can genuinely produce unsteadiness. But this should only be concluded after BPPV, vestibular, cardiovascular, and central causes have been ruled out. Any clinic that diagnoses it in the first ten minutes has skipped that work.
Can neck adjustments cause vertigo?
Transient light-headedness after upper cervical work happens occasionally and settles quickly. Persistent or severe vertigo after an adjustment is not normal and needs immediate assessment. We screen for vascular risk factors before treating the upper cervical spine.
New patient special — $59 New Patient Visit
Get your vertigo properly examined.
One visit, a real diagnosis, and a plan with a visit count and an end date. If it turns out we are not the right provider, we will say so and point you to who is.
Columbus, OH · Same-week appointments · Most insurance accepted