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Vertigo and Dizziness: What’s the Difference, and When Should You Get Help?
By DEB’s Audiology Team – March 2026 – 15 min read
Article Summary
Vertigo and dizziness affect an estimated 20% of adults at some point in their lives. In India, they are among the most common reasons for GP visits — yet they are also among the most frequently misunderstood, with patients often prescribed medication that manages symptoms without addressing the underlying cause.
This article covers:
- The precise definitions of vertigo and dizziness — and why the difference matters for diagnosis
- The most common inner ear causes of vertigo: BPPV, vestibular neuritis, and Ménière’s disease
- Central (neurological) causes and the red-flag symptoms that require emergency attention
- Non-vestibular causes of dizziness: blood pressure, medication, anxiety, anaemia
- How a vestibular assessment diagnoses the cause accurately
- Treatment options: from the Epley manoeuvre to vestibular rehabilitation therapy
The key takeaway: vertigo and dizziness are symptoms, not diagnoses. Getting the right diagnosis — through a structured vestibular assessment — is the only reliable route to the right treatment.
Few symptoms are as disorienting — literally — as vertigo and dizziness. They affect your ability to walk, to drive, to work, and sometimes to simply stand up without holding on to something. And yet they are among the most commonly mismanaged conditions in outpatient medicine, because the cause is rarely properly investigated.
Understanding the difference between vertigo and dizziness is the starting point. It shapes what questions a clinician asks, what tests they run, and what treatment is appropriate.
What Is Vertigo?
Vertigo is the false sensation of spinning or rotational movement — either you feel like you are spinning, or the environment around you is. It is not a general feeling of being unwell or lightheaded. It is a specific, directional sensation that is almost always caused by a problem with the vestibular system: the balance organ of the inner ear, or the brain’s pathways that process balance information.
Vertigo can be brief and episodic — lasting seconds to minutes — or persistent and continuous, lasting hours to days. The pattern, the triggers, and the duration all point toward different underlying causes.
What Is Dizziness?
Dizziness is a broader term that describes a range of sensations: lightheadedness, a floating feeling, unsteadiness, a sense of being about to faint, or simply feeling ‘off-balance’ without true spinning. Unlike vertigo, it does not always originate from the vestibular system. It can have cardiovascular, neurological, metabolic, or psychological causes.
Because dizziness is such a non-specific symptom, it is particularly important that its investigation goes beyond a brief consultation. What feels like ‘just dizziness’ to a patient is a symptom cluster that requires careful unpacking.
The Key Difference:
Vertigo is a spinning sensation. Almost always caused by the inner ear or brain’s balance pathways.
Dizziness is a non-specific feeling of imbalance or lightheadedness. The causes range from inner ear problems to blood pressure, medication, and anxiety.
The distinction matters because the investigation and treatment are different. A patient describing true vertigo is steered toward vestibular assessment. A patient describing lightheadedness without spinning requires a broader clinical workup.
Common Causes of Vertigo
The vast majority of vertigo has a vestibular (inner ear) origin. These are called peripheral causes. A smaller proportion originate in the brain — called central causes — and require a different and more urgent response.
BPPV — Benign Paroxysmal Positional Vertigo
BPPV is the most common cause of vertigo in India, accounting for more than half of all peripheral vertigo cases. It occurs when calcium crystals in the inner ear become dislodged and migrate into the semicircular canals, causing brief but intense spinning triggered by head movements. It is highly treatable — often resolved in a single clinic visit with the Epley manoeuvre.
Vestibular Neuritis
Vestibular neuritis is inflammation of the vestibular nerve, typically following a viral illness. It causes acute, severe vertigo that lasts hours to days, is not triggered by head movement, and often makes walking extremely difficult. There is no hearing loss in vestibular neuritis — if hearing is also affected, the condition is called labyrinthitis. Most cases resolve over weeks, aided by vestibular rehabilitation.
Ménière’s Disease
Ménière’s disease produces episodic vertigo attacks lasting 20 minutes to several hours, accompanied by fluctuating hearing loss, ringing in the ears (tinnitus), and a sensation of ear fullness. It is caused by abnormal fluid pressure in the inner ear. Management focuses on reducing the frequency and severity of attacks through dietary changes, medication, and in some cases, medical intervention.
Central Causes
A minority of vertigo cases originate in the brain — from the brainstem or cerebellum — rather than the inner ear. These include stroke, transient ischaemic attack (TIA), multiple sclerosis, and vestibular migraine. Central vertigo requires neurological investigation and should not be managed as a vestibular disorder.
Common Causes of Dizziness (Non-Vertigo)
When the sensation is lightheadedness or unsteadiness rather than spinning, the cause may lie outside the vestibular system entirely. Common non-vestibular causes of dizziness include:
- Orthostatic hypotension — a sudden drop in blood pressure on standing, particularly common in older adults and in India’s heat
- Anaemia — low haemoglobin reduces oxygen delivery to the brain, causing lightheadedness
- Poorly controlled blood pressure — both hypertension and hypotension
- Diabetes and blood sugar fluctuations
- Anxiety and panic disorder — can produce persistent dizziness and a sense of unreality
- Medication side effects — particularly antihypertensives, sedatives, and certain antibiotics
- Dehydration — a significant factor in Mumbai’s climate, particularly in summer
In practice, many patients present with a combination of vestibular and non-vestibular contributors. A thorough assessment considers both.
When to Seek Emergency Help
Seek emergency medical attention immediately if vertigo or dizziness is accompanied by any of the following:
- Sudden severe headache unlike any you have had before
- Facial drooping, slurred speech, or arm weakness
- Sudden difficulty walking or loss of coordination
- Double vision or sudden vision loss
- Sudden hearing loss in one ear
- Chest pain or palpitations alongside dizziness
These symptoms may indicate a stroke or other serious neurological event. Do not wait for an appointment — go to the nearest emergency department, at the earliest.
How Are These Conditions Assessed?
Vertigo and dizziness require structured investigation — not just a brief symptom check. A vestibular assessment by a specialist audiologist examines the inner ear’s balance organs directly, using tests including videonystagmography (VNG), the Dix-Hallpike manoeuvre, VEMP testing, and a concurrent hearing evaluation.
This combination of tests identifies whether the vestibular system is involved, which part of it is affected, and whether the issue is in the inner ear (peripheral) or the brain’s processing (central). The results directly determine the treatment path.
What Treatment Options Are Available?
Treatment depends on the diagnosis.
BPPV: Canalith repositioning using the Epley manoeuvre. Success rate of 80–90% after one to two sessions. Performed by Dr. Sarmistha Nayak at DEB’s Audiology in Borivali West, Mumbai.
Vestibular Neuritis / Labyrinthitis: Vestibular rehabilitation therapy to help the brain compensate for the reduced vestibular signal. Symptom relief medication in the acute phase.
Ménière’s Disease: Low-sodium diet, diuretics, and management of triggers. Hearing aids for the associated hearing loss where relevant.
Central Vertigo: Requires neurological referral. The audiologist’s assessment helps rule out peripheral causes and flags when central investigation is needed.
Non-Vestibular Dizziness: Directed back to the appropriate specialist — cardiologist, GP, or physician — with the vestibular assessment confirming that the inner ear is not the cause.
What to Do Next
If dizziness or vertigo is affecting your quality of life — whether it is episodic and brief or persistent and exhausting — a structured vestibular assessment will identify the cause and point toward the right treatment.
