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Dizziness: Causes and Diagnosis

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and appropriate treatment, please consult your attending physician.

Table of contents:

What is this condition?

Prevalence of the condition

The main causes of vertigo

How dizziness develops: the mechanism of balance disorder

Symptoms of the condition

Possible complications

When you need to see a doctor urgently

Checklist: Symptoms You Shouldn’t Ignore

Examinations at the REMSI Diagnostics Clinic

Modern methods of treatment

Preventive measures

Frequently Asked Questions

List of references

Dizziness (vertigo) often evokes feelings of fear and helplessness: a person fears falling, losing consciousness, or experiencing signs of a stroke. However, it is not a disease in itself, but rather a symptom that can be caused by dozens of different factors, from overwork to serious problems with the inner ear or brain.

In this article, we’ll explore the causes of dizziness, the different types of dizziness, and when it’s necessary to seek immediate expert diagnosis.

What is this condition?

In medicine, this term refers to the illusion of movement of a person or objects around him in space.

This false sense arises from a malfunction in the orientation system. Our brain receives information every second from the eyes, the vestibular system (the balance organ in the ear), and the receptors in the muscles. When these signals conflict, a “system error” occurs, which a person perceives as vertigo or a whirlwind of vision.

How does this condition differ from weakness and loss of balance?

It is important to distinguish between true (systemic) dizziness and conditions that resemble it:

• Weakness, which may be accompanied by dizziness, is often caused by low blood pressure or sugar levels. It’s more likely to be a pre-syncope state (darkening of vision), when it feels like fainting is approaching.
• Loss of balance (ataxia). While the mind may be clear, the gait becomes unsteady. The problem is most often localized in the cerebellum and spinal cord.

True (systemic) vertigo is a distinct sensation of spinning (like being on a merry-go-round), often accompanied by nausea and vomiting. Such symptoms always indicate a problem with the vestibular system.

Prevalence of the condition

Vertigo is a common complaint that patients seek medical attention from their primary care physician or neurologist. It is second in frequency only to migraines and back pain.

This condition occurs 2-3 times more often in women than in men. This is associated with hormonal changes, characteristics of the autonomic nervous system, and a higher susceptibility to migraines.

In the elderly, the prevalence of this symptom reaches 30% or more. With age, the vestibular system wears out, and concomitant vascular diseases exacerbate the situation.

In young people, the cause is often stress, vascular malformations, or specific inner ear diseases (for example, BPPV – benign positional vertigo).

The main causes of vertigo

To understand what may cause dizziness, doctors divide all factors into peripheral (ear problems) and central (brain problems).

Diseases of the inner ear and vestibular system

More than 40% of all cases are related to the balance sensor in the ear:

• BPPV (benign paroxysmal positional vertigo). This common cause is caused by the displacement of tiny calcium crystals (otoliths) in the semicircular canals of the ear. Dizziness occurs with any movement or bending—even in bed.
• Meniere’s disease. A buildup of excess fluid in the inner ear. It is accompanied by ear congestion, noise, and hearing loss.

Another trigger is vestibular neuronitis. This is an inflammation of the vestibular nerve (often following a viral infection), which causes a severe and prolonged attack.

Neurological and cardiovascular causes

If the organ of balance is in order, differential diagnosis is aimed at checking the brain, heart and blood vessels:

• Vestibular migraine. A special form of migraine in which intense spinning sensations occur instead of (or along with) pain.
• Circulatory failure (vertebrobasilar insufficiency). This occurs when the blood vessels supplying the brain are unable to cope with the strain. This condition is often accompanied by weakness.
• Tumors of the cerebellopontine angle can gradually compress the nerves.

Dizziness can occur suddenly following a stroke. In this case, the condition is associated with other neurological deficits.

Other possible factors

Often the first sign of discomfort is associated with the general condition of the body:

• Iron deficiency leads to hypoxia (oxygen starvation) of the brain.
• Psychogenic factors. Anxiety disorders and panic attacks often cause feelings of instability and mental fog.

Additionally, some antibiotics or blood pressure medications have a side effect of vertigo.

How dizziness develops: the mechanism of balance disorder

Balance is the result of the coordinated work of vision, the vestibular system, and proprioception (sensitivity receptors in muscles and joints that tell the brain where the limbs are).

The disorder occurs when conflicting signals reach the brain. For example, the eyes see a stationary wall, while the inner ear, due to inflammation or displacement of the otoliths (crystals), transmits a signal of rotation. The brain is unable to reconcile these data, resulting in a sensation of blurring. This is the first sign that the orientation system has malfunctioned.

Symptoms of the condition

In medicine, it is common to distinguish two main types of this condition. Correctly identifying the type will help the doctor more quickly understand the cause of the attack.

Signs of vertigo

This is true vertigo, which is characterized by the following symptoms:

• a feeling of rotation of objects or one’s own body in space;
• severe nausea, vomiting and cold sweat;
• hearing impairment or tinnitus.

The cause most often lies in a pathology of the inner ear.

Symptoms of non-systemic dizziness

There’s no distinct sense of rotation, but there is a general feeling of instability. Characteristic signs:

• a feeling of “wobbly legs,” “foggy head,” or walking on the deck of a ship;
• Weakness often occurs, the cause of which is related to blood vessels, stress, or a drop in glucose levels.

The condition may worsen in crowded places or with visual strain.

Possible complications

Many people underestimate this symptom, believing it to be temporary. However, severe dizziness carries hidden dangers:

• Sudden loss of coordination is a leading cause of falls, fractures, and traumatic brain injuries, especially in the elderly.
• Psychological problems. Constant fear of another attack can lead to the development of agoraphobia (fear of open spaces) and social isolation.

If diagnosis is ignored, a latent disease (for example, a tumor or vascular pathology) may progress to an irreversible stage and vertigo attacks will become permanent.

When you need to see a doctor urgently

If you experience severe dizziness and at least one of the following symptoms is present, call an ambulance:

• sudden unbearable headache;
• speech impairment (slurred pronunciation) or facial asymmetry;
• double vision or sudden loss of vision;
• numbness or sudden weakness in one arm or leg.
• loss of consciousness.

Do not self-medicate. Such conditions may indicate serious underlying conditions.

Checklist: Symptoms You Shouldn’t Ignore

If you frequently notice these early signs, then an examination is necessary:

• attacks occur when turning the head in bed or bending over to pick up shoes;
• dizziness is accompanied by ringing in the ears or hearing loss;
• instability occurs in the dark or on an uneven surface.

Diagnosis is also necessary in case of prolonged attacks (from a couple of minutes to a couple of hours), a feeling of slight swaying, which is accompanied by a constant feeling of anxiety.

Examinations at the REMSI Diagnostics Clinic

At the REMSI Diagnostics Medical Center, we have expert-grade equipment that allows us to rule out the most dangerous causes of vertigo.

Examinations for dizziness at our center include:

• MRI of the brain . Allows to rule out mini-strokes, tumors, multiple sclerosis lesions, and developmental anomalies.
• MRI and MSCT of the cervical spine. Helps identify herniated discs and protrusions that may compress the vertebral arteries.
• Ultrasound of the head and neck vessels . Blood flow check. We assess how well the head is supplied with blood and whether there are any obstructions such as plaques or spasms.
• MR angiography . A detailed study of the structure of the vascular bed without the introduction of contrast (in most cases).

Our radiologists know what nuances to pay attention to so that a neurologist can make an accurate diagnosis.

Modern methods of treatment

The cause of dizziness influences the choice of treatment strategy. Depending on this, it is necessary to consult a neurologist, endocrinologist, otolaryngologist, cardiologist, or psychotherapist.

Drug therapy

Treatment may include taking medications to improve microcirculation in the inner ear, vestibular suppressants (medications that calm the vestibular nerve during the acute period), and medications that normalize vascular function.

Vestibular rehabilitation

If the cause is BPPV (misalignment of crystals in the inner ear), the doctor performs special maneuvers (such as the Epley maneuver). This painless procedure allows the crystals to be repositioned in a “blind” area where they don’t cause irritation. Severe dizziness often resolves after just one such procedure.

Preventive measures

To minimize the risk of vertigo, follow these simple rules:

1. Smooth movements. Don’t jump out of bed abruptly after waking up. Sit for 30 seconds to allow your blood vessels to adjust.
2. Neck health. If you have a sedentary job, stretch your neck. Neck tension is a common accomplice to dizziness.
3. Fluid balance. Dehydration thickens the blood and lowers blood pressure, which triggers a type of dizziness.
4. Monitoring blood pressure and sugar levels is especially important for older adults.

In most cases, vertigo is a condition that can be successfully treated if the cause is identified early. Don’t try to get used to the discomfort—modern diagnostics and appropriate treatment can help restore your confidence.

Frequently Asked Questions

We answer frequently asked questions from patients.

Will taking motion sickness pills help with true vertigo?

Medications may temporarily alleviate the symptom, but they do not address its cause. Furthermore, long-term use of such medications can slow the natural recovery of vestibular function.

Can vertigo be associated with osteochondrosis?

Less common than commonly believed. Most often, the problem stems from a spasm of the neck muscles or a disruption of blood flow in the vertebral arteries, which is clearly visible on ultrasound and MRI.

What to do if an attack starts suddenly?

Your first aid for dizziness is to find support. Sit or lie down and focus your gaze on a stationary object. Ensure fresh air is available. If the attack doesn’t subside within 20-30 minutes or worsens, it’s best to call a doctor.

What is the difference between systemic and non-systemic vertigo?

Systemic (vertigo) is the sensation that the world is spinning around you or that you are rotating in space (often associated with a condition of the inner ear). Non-systemic (vertigo) is a feeling of unsteadiness or a pre-fainting state.

What is BPPV and why does it occur?

This is a benign paroxysmal positional vertigo. It occurs when tiny calcium crystals (otoliths) become displaced into the semicircular canals of the inner ear, causing severe attacks when turning the head.

When does dizziness require immediate medical attention?

If it is accompanied by sudden weakness in the legs and arms, slurred speech, double vision, severe migraine, or loss of coordination, this could indicate a stroke.

How can stress and anxiety cause feelings of vertigo?

Severe stress can cause persistent postural-perceptual dizziness (PPPD). The brain becomes overly sensitive to movement, resulting in a constant feeling of “swaying” or brain fog, without physical damage to the ear.

Why is vertigo often accompanied by nausea?

This occurs due to a “sensory conflict”: the eyes see one image, but the vestibular system transmits different signals about the body’s position to the brain. The brain perceives this contradiction as a sign of poisoning (hallucination) and triggers a defense mechanism—nausea.

List of references

1. Kim HJ., Park J., Kim JS. Update on benign paroxysmal positional vertigo. // J Neurol – 2021. Source: https://pubmed.ncbi.nlm.nih.gov/33231724/
2. Kim JS., Newman-Toker DE., Kerber KA., Jahn K., Bertholon P., Waterston J., Lee H., Bisdorff A., Strupp M. Vascular vertigo and dizziness: Diagnostic criteria. // J Vestib Res – 2022. Source: https://pubmed.ncbi.nlm.nih.gov/35367974/
3. Bery AK, Hale DE, Newman-Toker DE, Saber Tehrani AS. Evaluation of Acute Dizziness and Vertigo. // Med Clin North Am – 2025. Source: https://pubmed.ncbi.nlm.nih.gov/39893018/
4. Casani AP., Gufoni M., Capobianco S. Current Insights into Treating Vertigo in Older Adults. // Drugs Aging – 2021. Source: https://pubmed.ncbi.nlm.nih.gov/34159566/
5. Honaker J. Understanding Vertigo and Dizziness with Dr. Julie Honaker. // Health Essentials Episodes. Cleveland Clinic – 2025. Source: https://my.clevelandclinic.org/podcasts/health-essentials/understanding-vertigo-and-dizziness-with-dr-julie-honaker