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Dizziness and Vertigo

Updated: Jan 20, 2022

Article written by Dr Andreas Stridsland DC

The terms “dizziness” and “vertigo” are commonly used interchangeably. However, they are not the same thing. Therefore it is important to distinguish between the two.

Dizziness refers to a variety of uncomfortable sensations including, but not limited to, feeling light- headed, feeling faint, losing your sense of balance, feeling of instability, feeling woozy, and feeling like you are on a boat.

Vertigo specifically refers to a false sense of spinning. This can show up in two ways: A feeling that you are spinning in the world or room, or a feeling that the world or the room is spinning around you.

Dizziness and vertigo can occur for various reasons, and stem from various parts of the nervous system. However, in general, there are 3 main classifications of dizziness: peripheral, central, and systemic.

Peripheral causes are due to damage or changes to the vestibular apparatus (labyrinthine and otolithic systems), or physiologic changes/damage to the nerve endings in the vestibular apparatus. This is when a patient will describe the feeling of vertigo. The most common cause for a peripheral vertigo is Benign Paroxysmal Positional Vertigo (BPPV), and treatment for BPPV is a specific repositioning maneuver based on the exam.

Central causes refer to how the sensory information in your environment is processed and interpreted in the central nervous system (in the brainstem, cerebellum, and cortex). Patients will have many different ways of describing central dizziness depending on what the source is. Once life-threatening conditions are ruled out, it is important to dig deeper and thoroughly asses the nervous system in order to accurately diagnose and treat the source of the dizziness.

Systemic dizziness generally refers to dysfunction of the Autonomic Nervous System (ANS). The ANS is subdivided into two more systems: Sympathetic nervous system (commonly known as the “fight or flight” system) and the Parasympathetic nervous system (commonly known as the “rest and digest” system). These two are responsible for appropriately controlling the cardiovascular system in order to efficiently and effectively shunt blood to the right parts of the body as needed.

When there is a dys-regulation of the ANS, it is generally diagnosed as Dys-autonomia. Patients will commonly feel light headed, faint, or feel they will “pass out” especially when the stand up too quickly, or if they hold their head and neck in a certain position for too long. These sensations are important to differentiate from vertigo because it is a completely different part of the nervous system that is causing the dizziness. Common conditions due to an ANS dysfunction are Orthostatic Hypotension, and Postural Orthostatic Tachycardia Syndrome (POTS).

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