Vertigo is a specific type of dizziness characterized by the false sensation of spinning or rotational movement, originating from dysfunction in the vestibular system (inner ear balance organs). General dizziness or lightheadedness refers to feelings of faintness, wooziness, or unsteadiness that may result from various causes including low blood pressure, medication side effects, or metabolic issues. Vertigo typically indicates a problem in the inner ear or its connections to the brain, while lightheadedness often relates to whole-body systemic factors. Understanding this distinction helps guide appropriate diagnostic testing and treatment.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, occurring when calcium carbonate crystals (otoconia) dislodge from their normal position in the inner ear and migrate into the semicircular canals. When head position changes, these crystals cause inappropriate stimulation of the vestibular system, triggering brief episodes of intense spinning (typically 10-60 seconds). BPPV is treated with canalith repositioning maneuvers such as the Epley maneuver (90% effective), which uses gravity to move the crystals back to their proper location. The Semont maneuver is an alternative for refractory cases. The condition is benign (not dangerous) but significantly impacts quality of life and increases fall risk if untreated.

Acute symptoms of vestibular neuritis typically improve over several days to weeks, with most patients returning to normal activities within 2-4 weeks. However, complete vestibular compensation (where the brain fully adapts to the asymmetric input) can take 6 weeks to 3 months, and some patients may experience persistent imbalance or residual symptoms for 6-12 months. Early vestibular rehabilitation therapy significantly speeds recovery and improves long-term outcomes. The vestibular nerve function may not return to normal, but the brain learns to compensate effectively. A small percentage of patients develop chronic symptoms requiring ongoing management.

Vestibular migraine (also called migraine-associated vertigo) is one of the most common causes of recurrent vertigo, affecting up to 10% of migraine sufferers. It involves the same underlying mechanisms as migraine headaches but affects the vestibular pathways instead of causing head pain. Vertigo episodes can last 5 minutes to 72 hours and may or may not be accompanied by headache. Diagnosis is based on clinical criteria and requires excluding other causes. Treatment includes migraine prevention medications, trigger avoidance, dietary modifications, and vestibular rehabilitation. There is significant overlap between migraine, BPPV, and Meniere's disease, and patients may have more than one vestibular condition simultaneously.

Seek emergency care if vertigo is accompanied by: sudden severe headache, double vision, slurred speech, weakness or numbness, or difficulty walking (could indicate stroke); fever and stiff neck (meningitis); chest pain or irregular heartbeat; sudden hearing loss with vertigo (possible stroke or Meniere's attack); head trauma preceding symptoms; new vertigo after age 50 with risk factors; or symptoms that worsen progressively despite treatment. Central vertigo (from brainstem or cerebellar stroke) is a medical emergency requiring immediate evaluation. The HINTS exam (Head-Impulse, Nystagmus, Test of Skew) can help differentiate peripheral from central causes at the bedside.

Most major insurance plans cover vestibular diagnostics (audiometry, ENG/VNG, VEMP) and vestibular rehabilitation therapy when medically necessary. Coverage typically requires a physician referral and documentation of symptoms. Medicare covers diagnostic testing and limited PT sessions. Pre-authorization may be required for MRI or extensive therapy. Out-of-pocket costs vary by plan deductible and copay. If you have specific questions about coverage, contact your insurance provider before scheduling. Many clinics offer payment plans or self-pay options for uninsured or underinsured patients.