Vertigo: Causes, Assessment and Vestibular Physiotherapy

Common causes of vertigo

The NHS vertigo overview describes several possible causes, including:

• Benign paroxysmal positional vertigo (BPPV): specific changes in head position trigger spinning.
• Labyrinthitis or vestibular neuritis: problems affecting the inner ear or its balance nerve.
• Ménière's disease: an inner-ear condition that can also involve hearing changes or ringing in the ear.
• Migraine or medicine effects: other possible explanations that need appropriate assessment.

Feeling faint or lightheaded is not the same as spinning. Describe the sensation rather than assuming all dizziness is BPPV.

What to tell the clinician at assessment

Note when the problem began, how long episodes last, what brings them on and whether it happens when turning in bed or looking up. Explain any hearing or vision changes, headaches, falls, recent illness and medicines you take.

Assessment may involve an examination and positional testing. NHS MyHealth Devon's BPPV guidance explains that treatment depends on the affected side and that some neck, back or circulation problems can make a home manoeuvre unsuitable. Ask a healthcare professional before attempting one.

Repositioning treatment and vestibular rehabilitation

Repositioning manoeuvres for diagnosed BPPV

A clinician may use a manoeuvre such as the Epley to treat an appropriate form of BPPV. Ask which side and technique apply, whether you should repeat it at home and what support is needed. Copying a video before assessment can mean using the wrong approach.

Exercises selected for an assessed vestibular problem

Dartford and Gravesham NHS Trust's vestibular rehabilitation guidance describes a programme designed around findings from a clinical examination. It distinguishes that programme from repositioning treatment for BPPV.

Depending on the problem, a plan may work on keeping vision steady during head movement, becoming accustomed to selected movements, or practising balance and walking. The therapist should demonstrate the chosen tasks and agree on support, frequency and symptom limits. There is no single routine or recovery timetable for every cause.

Managing daily activities while dizzy

The NHS dizziness advice recommends moving carefully, resting while symptoms pass and getting up slowly. Avoid driving, climbing ladders or operating machinery while dizzy. Ask for help with activities that feel unsafe.

Tell the clinician if you cannot safely stand or walk for an assessment. Do not try an unsupported balance task just to show the movement on camera.

When vertigo needs urgent or emergency care

Seek emergency care for vertigo with new double vision or loss of vision, hearing loss, difficulty speaking, or weakness, numbness or tingling in an arm or leg. Get urgent medical advice for vertigo with a severe headache, significant nausea or vomiting, or a high temperature. These symptoms are listed in the NHS vertigo guidance linked above; do not wait for a physiotherapy appointment.

Arrange medical assessment if vertigo persists, keeps returning or interferes with daily life, even without emergency symptoms.

Planning physiotherapy and follow-up

Ask whether the clinician has appropriate vestibular assessment skills and whether an in-person examination is needed. Before seeking exercise support, share any diagnosis and existing care instructions.

Our neurological physiotherapy page explains movement assessment and supported rehabilitation. Confirm whether the service can meet your particular vestibular needs. The consultation process explains how appointments are arranged.

Should everyone with vertigo try the Epley manoeuvre?

No. Its use depends on the assessed type of BPPV and suitability. Other causes of vertigo require different care.

How do I know whether a programme is helping?

Agree on goals such as turning in bed, walking or returning to daily tasks. Record episodes and any exercise difficulties for review, and report new symptoms rather than simply increasing the exercises.