If you've ever experienced vertigo, you know how unsettling it can be. The sensation that the room is spinning or that your body is moving when you're actually standing still can be frightening.
But how do you know when vertigo is something that can be treated through vestibular rehabilitation and when it could be a sign of something more serious?
As a physical therapist who works with patients experiencing dizziness, vertigo and balance problems, one of the most important parts of my job is recognizing when symptoms may require further medical evaluation.
New, severe or unexplained vertigo should not simply be ignored.
You should seek medical evaluation when vertigo is:
Most importantly, certain neurological symptoms accompanying dizziness or vertigo can be warning signs of a serious medical condition.
Some of the symptoms we watch for in vestibular rehabilitation are sometimes referred to as the “Deadly Ds.”
These include:
Not every one of these symptoms means someone has a serious neurological condition. However, their presence can indicate that further medical evaluation is necessary.
This is one reason it is important not to automatically assume that dizziness or vertigo is caused by an inner-ear problem.
Sudden dizziness or vertigo accompanied by symptoms such as new weakness, numbness, difficulty speaking, difficulty swallowing or double vision requires immediate medical attention.
If you are unsure whether symptoms could represent an emergency, it is safer to seek urgent medical evaluation rather than waiting to see if the vertigo goes away.
No.
While many causes of vertigo involve the vestibular system and inner ear, dizziness and vertigo can also be related to the brain, migraine, metabolic conditions, autonomic dysfunction, concussion and other factors.
For example, BPPV (benign paroxysmal positional vertigo) is caused by displaced crystals in the inner ear. Vestibular migraine, on the other hand, is a neurological condition that can cause vertigo and dizziness even without a typical headache.
This is why identifying the cause matters.
Dizziness and vertigo are common symptoms following concussion, but there isn't one explanation for every case.
A concussion can affect:
A concussion can also trigger BPPV by dislodging the tiny crystals in the inner ear.
Because several systems may be involved, someone with persistent dizziness after a concussion may benefit from a comprehensive evaluation rather than assuming the symptoms will simply resolve on their own.
BPPV often causes brief episodes of positional vertigo.
For example, you may experience a sudden spinning sensation when:
BPPV is generally treatable with specific positional repositioning maneuvers.
However, even when symptoms sound like BPPV, an appropriate evaluation is important to confirm the diagnosis and determine which canal is involved.
A vestibular physical therapist can perform a detailed evaluation of dizziness, balance, eye movements, movement tolerance and other factors associated with vestibular function.
Physical therapists also screen for signs that may indicate a need for medical evaluation.
If the symptoms are consistent with a condition that can be treated through vestibular rehabilitation, treatment may include repositioning maneuvers, balance exercises, gaze-stability exercises, habituation or other individualized interventions.
If something during the evaluation raises concern for a condition outside the scope of physical therapy, the appropriate next step may be referral for medical evaluation.
Safety comes first.
If you suddenly experience vertigo:
For people with recurrent vertigo or balance problems, fall prevention is especially important. A physical therapist can help identify individual fall risks and teach exercises and strategies to improve safety.
That depends on the cause.
Some types of vertigo, including BPPV, may respond quickly to treatment. Other conditions, including vestibular migraine, PPPD or concussion-related vestibular dysfunction, may require longer-term rehabilitation.
The important thing is not to assume that all vertigo is the same.
If symptoms are new, severe, persistent or unexplained, seek medical evaluation rather than simply waiting for them to disappear.
Vertigo isn't always a sign of something serious. Many common causes, including BPPV, can be effectively treated.
However, sudden or severe vertigo accompanied by neurological symptoms should be treated as a medical concern.
If you experience new weakness, numbness, difficulty speaking, difficulty swallowing, double vision, sudden falls or other sudden neurological changes along with dizziness or vertigo, seek immediate medical attention.
Once serious conditions have been ruled out, vestibular physical therapy may be an important part of determining what is causing your symptoms and helping you return to normal activities.
Want to speak to an expert about treatment for vertigo? Contact us at (203) 284-2888 or fill out an appointment request form on our outpatient neurological rehabilitation page.
This content is for educational purposes only and is meant to provide general information. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider with any questions or concerns about your health. In case of a medical emergency, contact your doctor or call 911 right away.