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What is the difference between vertigo and dizziness?

Vertigo is a false or distorted sense of motion when no motion is occurring. It is most commonly perceived as a spinning sensation. It may also feel like swaying, rocking or bobbing, like standing on a moving boat.

Dizziness is a false or distorted sense of spatial orientation within the environment. This affects your perception of position or direction. There is no false or distorted sense of motion like there is with vertigo.

Vertigo and dizziness can cause unsteadiness. This is postural instability when upright (sitting, standing, or walking). There is difficulty maintaining a stable posture. A person may fall over, or the feel like they are about to fall, or walk with an unsteady gait.

How does your brain control balance, posture and movement?

Your central nervous system includes your brain, brainstem and cerebellum. It relies on neural information from your eyes, ears and sensory nerves. It uses these to control balance, posture and movement of your whole body. This information comes from 3 systems:

  1. Visual system — your eyes detect movement and position.
  2. Vestibular system — the vestibular organs in your inner ears detect movement of your head in all directions, and position relative to gravity.
  3. Proprioceptive system — consists of sensory nerve receptors. These are in your muscles, tendons and joints, and detect movement and position of your body parts.

Information from these 3 systems is compared in your brainstem and cerebellum. This information co-ordinates movements of your eyes and stabilisation of your focus. It also controls the muscles responsible for posture, movement and balance. Dysfunction of one of these causes a sensory mismatch between the three systems. Your brain perceives this mismatch as dizziness or vertigo. This depends on which of the three systems is dysfunctional. The result is poorly co-ordinated movements, abnormal postures or unsteadiness. Medications are prescribed to reduce nausea and suppress vestibular system function. This can reduce troubling symptoms. But it also suppresses signs and symptoms necessary for accurate diagnosis. And they do not treat the cause. This mismatch leads to joint dysfunction and poor quality compensatory movement patterns. This results in pain and injury, requiring prolonged and costly treatment and rehabilitation. This is why it is important to seek help from a skilled healthcare professional as soon as possible.

What causes the spinning sensation of vertigo, and why does it cause nausea and vomiting?

Your vestibular system detects head movement. It controls fast reflexes that move your eyes in response to head movement to maintain focus. This enables you to maintain a steady gaze on something while your head is moving, such as walking down the street or keeping your eyes on a ball while playing sport. Vestibular system disorders result in inaccurate information in your brainstem. This results in inaccurate reflexive eye movements. Your brainstem responds by quickly moving your eyes to where they should be focused. This is a quick jerking movement called nystagmus that is important in diagnosis. But your eyes then drift back to their previous position. As your eyes drift back the environment appears to move across your visual field. Your brain falsely perceives that the environment is moving when it isn’t. This is the false or distorted sense of motion responsible for vertigo. Head movement worsens vertigo. This is because it is dependent upon the vestibular system to detect head movement. It controls reflexive movement of the eyes in response to head movement. Vertigo always involves dysfunction of the vestibular system.

Your brainstem plays an important role regulating your autonomic nervous system (ANS). This system automatically, and subconsciously manages many of your bodily functions. This includes your heart rate and digestion. Your vestibular system also communicates with your ANS. It is thought that this may be an evolutionary trait to protect us if we ingest something poisonous. Vertigo is one of many neurologic symptoms of poisoning. Vertigo signals part of your ANS in your brainstem (area postrema). It induces nausea and vomiting to expel poisons that you have ingested. Vestibular dysfunction causes the brainstem to respond with nausea and vomiting. Even though nothing poisonous has been ingested.

What causes dizziness?

There are many causes, including medications and low blood pressure. A common musculoskeletal cause is cervicogenic dizziness. This is due to neck pain or dysfunction that impairs muscles, ligaments and joints. Your brain then receives inaccurate proprioception from these tissues in your neck. This leads to an inaccurate sense of head positioning relative to the rest of your body. It also causes a sensory mismatch with your visual and vestibular systems. The result is a false or distorted sense of your spatial orientation. This is dizziness and disorientation. Your brain also relies on this (inaccurate) proprioception to control posture and movement. Movement can appear instantaneous to us. However, milliseconds before you move, your central nervous system (CNS) stabilises your body. It activates the muscles necessary to stabilise your spine. Pain or dysfunction impairs your CNS’s ability to stabilise your spine before moving. This is one of the causes of injuries such as low back pain and shoulder injuries. So why does this cause dizziness, but not vertigo? Proprioceptive system dysfunction doesn’t cause vertigo. This is because the vestibular system is still functioning correctly. This is why there is no false or distorted sense of motion.

There are many causes of dizziness and vertigo. These are 2 common causes:

Cervicogenic Dizziness

This is the most common musculoskeletal cause of dizziness. Its cause is dysfunction of your neck, right below the base of your skull. The joints, muscles and tendons in your upper neck contain specialised sensory nerves. These are proprioceptors. Your upper neck has the second highest concentration of these nerves in your body. (Your ankles have the highest). These signal your brain the accurate movement or position of your head relative to your trunk. Your brain uses this information to stabilise your head and the rest of your body. It also enables accurate positioning and movement of your head and body. It does this by controlling and sequencing muscle activity. Dysfunction of your neck results in inaccurate proprioception. This information doesn’t match vestibular and visual information. This results in a sensory mismatch, inaccurate stabilisation and movement. You perceive this as dizziness and unsteadiness.

What causes cervicogenic dizziness?

  • neck trauma such as whiplash or sports injuries
  • joint or ligament sprains in the neck
  • muscle strains in the neck
  • disc injury in the cervical spine
  • inflammation
  • degeneration or arthritis of cervical joints
  • muscle fatigue or spasm
  • neck pain

What are the symptoms of cervicogenic dizziness?

  • worse with neck movement or prolonged postures
  • usually occurs after neck pain
  • associated with a tight or stiff neck that restricts movement
  • associated with disorientation
  • may be associated with unsteadiness
  • episodes last minutes to hours, but can persist for weeks, months or even years following trauma
  • recurring over days, months or years
  • accompanied by cervicogenic or tension-type headache

How do you treat cervicogenic dizziness?

Research shows that cervicogenic dizziness responds well to manual treatments and rehabilitation exercises. This improves balance, function and proprioception. Medications may be prescribed to reduce the symptoms. These do not correct a sensory mismatch or neck dysfunction. They do not retrain proprioception or central nervous system function. They may even make diagnosis more difficult because they suppress symptoms.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

You can also download the Dizziness and Vertigo Questionnaire here.

Benign Paroxysmal Positional Vertigo (BPPV)

This is the most common cause of recurrent vertigo. It causes one-third of all vestibular disorders. It affects 2.4% of the population, or about 625,000 Australians. Women are afflicted 3.2 times more than men, usually during their 40s and 50s, whereas it can affect men at any age. It is benign, and not caused by a sinister pathology. The most common cause in people under 50 years of age is mild head trauma or whiplash.

What causes BPPV and what are the symptoms?

Your vestibular system monitors the movement and position of your head in space. The semicircular canals in your inner ear form your vestibular organs. These canals contain hair-like nerves that move within fluid when you move your head. These hairs have small calcium crystal weights. These crystals can dislodge and float around in the fluid. When they bump into another hair-like nerve, that nerve will send a signal to your brainstem. But this signal is erroneous. Your vestibular nerve sends an inaccurate signal of head movement to your brainstem. Your brainstem uses this information to co-ordinate accurate head and eye movements. These reflexive movements are amongst the fastest in your body. This inaccurate information leads to a sensory mismatch. Information from the dysfunctional vestibular system doesn’t match the visual and proprioceptive information. The dysfunctional vestibular system reflexively moves your eyes very quickly in one direction. This is visible as rapid repetitive jerking movements called nystagmus. Your visual and proprioceptive systems reposition your gaze. This repositioning is a slower movement. The visual system doesn’t process visual information from very rapid eye movements. But it does process visual information from slower movements. As your eyes slowly reposition the environment appears to move across your visual field. This is the false sense of movement when there is no movement, known as vertigo. BPPV vertigo episodes last less than 1 minute, usually less than 30 seconds. This is important for diagnosis. Your brain also relies on this information to control posture, balance and movement. This is why you may fall or bump into things with vertigo.

Some factors predispose people to BPPV:

  • head trauma
  • advancing age
  • female
  • physical inactivity, such as bed rest
  • low body mass index (BMI)
  • ear disease or infection
  • migraine
  • diseases of the blood vessels that perfuse the brain (cerebrovascular disease)
  • anxiety
  • genetic factors
  • osteoporosis and osteopenia
  • diabetes mellitus type I

What are the symptoms of BPPV?

BPPV occurs when you move your head in a specific direction. This depends on which semicircular canal has is affected. It usually affects the posterior semicircular canal. Most BPPV causes vertigo when you roll over in bed, or get up out of bed. It can also occur when you look up or bend forward. Vertigo begins 2–10 seconds after moving your head in the offending direction. The attack lasts less than 1 minute, usually about 20 seconds. This depends on the part of the vestibular organ that is dysfunctional.

Symptoms include:

  • poor balance or a sensation of tilting to the affected side
  • difficulty walking
  • vertigo
  • visual disturbances such as blurred or jumping vision
  • headache
  • increased sensitivity to widespread pain
  • lightheadedness
  • nausea
  • tinnitus

How do you treat BPPV?

BPPV responds well to gentle manual manoeuvres performed by a skilled clinician. The type of manoeuvre used depends upon the affected semicircular canal. Research shows that 80-90% of BPPV resolves with these manoeuvres. The manoeuvre aims to dislodged crystals away from the affected hair-like nerve receptor.

Dysfunction of your vestibular system leads to a sensory mismatch. Your brain compensates by increasing your reliance on your visual or proprioceptive systems. This compensation occurs within days. Compensation and medications do not improve the function of your vestibular system. Medications are not effective at treating BPPV or compensations. They may suppress troubling symptoms such as anxiety, nausea and vomiting. Unfortunately, they inhibit the function of the vestibular system. This delays recovery and prolongs rehabilitation when used for more than a few days. This is why it is important to seek treatment as soon as possible.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

You can also download the Dizziness and Vertigo Questionnaire here.

References for further information:

Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the International Classification of Vestibular Disorders. Neurol Clin. 2015;33(3):541-50

Carriot J, Jamali M, Cullen KE. Rapid adaptation of multisensory integration in vestibular pathways. Front Syst Neurosci. 2015;16(9):59

Donovan J, De Silva L, Cox H, Palmer G, Semciw AI. Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors. Clin Rehabil. 2023;37(9):1229-1247

Hillier S, McDonnell M. Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane Review. Eur J Phys Rehabil Med. 2016;52:541-56 

Hitier M, Besnard S, Smith PF. Vestibular pathways involved in cognition. Front Integr Neurosci. 2014;8:59 

Iglebekk W, Tjell C, Borenstein P. Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV). Scand J Pain. 2017;4(4):233-240

McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.:CD005397.pub4

Messina A, Casani AP, Manfrin M, Guidetti G. Italian survey on benign paroxysmal positional vertigo. Acta Otorhinolaryngol Ital. 2017;37(4):328-335

Nair MA, Mulavara AP, Bloomberg JJ, Sangi-Haghpeykar H, Cohen H. Visual dependence and spatial orientation in benign paroxysmal positional vertigo. J Vestib Res. 2018;27(5-6):279-286

Kolev OI, Sergeeva M. Vestibular disorders following different types of head and neck trauma. Funct Neurol. 2016;31(2):75–80

Smith PF, Zheng Y, Horil A, Darlington CL. Does vestibular damage cause cognitive dysfunction in humans? J Vestib Res. 2005;15(1):1-9

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