Dizziness is one of the most common symptoms and can be very distressing for those affected. Many describe a feeling of loss of control, unsteadiness, or “not being quite there.”
Even though dizziness is often not very noticeable to others, it can severely limit daily life—whether walking, standing, working, or driving. What makes it particularly difficult is that the cause isn’t always immediately clear.
Types of Dizziness
From a medical perspective, various forms of dizziness can be distinguished, each providing clues about the underlying mechanisms:
- Vertigo (spinning sensation)
sensation of apparent movement, usually rotational
typical of peripheral vestibular causes (e.g., benign paroxysmal positional vertigo, vestibular neuritis) - Vertigo with swaying / unsteadiness while walking
Unsteadiness while standing or walking without a sensation of spinning
Often caused by central neurological or functional factors - Dizziness due to lightheadedness (nonspecific dizziness)
diffuse, “like cotton in the head,” often difficult to describe
often multifactorial or functional - phobic vertigo / functional vertigo
A combination of vertigo, unsteadiness, and autonomic arousal
Often exacerbated in certain situations (crowds, open spaces)
This distinction is crucial for diagnosis and treatment.
Possible causes
Dizziness is usually caused by a disruption in the interaction between the vestibular system, the nervous system, and body awareness.
1. Vestibular causes (inner ear / vestibular system)
- benign paroxysmal positional vertigo (BPPV)
- Vestibular neuritis
- Meniere's disease
2. Central neurological causes
- Circulatory disorders in the brainstem or cerebellum
- vestibular migraine
- neurodegenerative or inflammatory diseases
3. Cervicogenic vertigo (cervical spine)
- Dysfunction of the cervical spine
- Muscular imbalances and tension in the neck and shoulder area
- Impaired proprioception (depth perception) of the cervical spine
Cervical spine problems and muscle tensionoften play a significant role, especially in cases of persistent dizziness.
4. Circulatory and Internal Medicine Causes
- orthostatic dysregulation
- Fluctuations in blood pressure
- Dehydration
5. Psychological and Functional Factors
- Anxiety Disorders
- chronic tension
- Somatoform or functional forms of vertigo
In many cases, the cause is not a single factor, but rather amultifactorial process.
Why Dizziness Is So Distressing
The vestibular system is closely linked to orientation, balance, and body control.
As a result, malfunctions often lead to:
- Avoidance behavior
- increased muscle tension
- autonomic arousal (e.g., heart palpitations, sweating)
- growing uncertainty in everyday life
These reactions are understandable, but they can contribute to the condition becoming chronic.
Diagnosis and Treatment
Diagnosis depends on the type of vertigo and, depending on the specific issue, may include:
- neurological examination
- vestibular functional testing
- Orthopedic Evaluation of the Cervical Spine
- Internal medicine evaluation, if necessary
Treatment is tailored to the individual and often involves a combination of approaches:
- Specific positional maneuvers(provide rapid and straightforward relief in cases of paroxysmal positional vertigo)
- drug therapy(e.g., for vestibular migraine)
- Physical therapy and vestibular training
- Treatment of cervicogenic causes(cervical spine, muscle tension)
- Body-Oriented Therapyfor Functional Vertigo
- Psychiatric/psychotherapeutic supportfor anxiety or chronic conditions
Dizziness is often complex—but it can be explained in a way that’s easy to understand.
And that’s usually the first step toward getting better.
Our Approach
We do not view dizziness in isolation, but rather in the context of the interaction between the nervous system, the musculoskeletal system, and psychological stress.
The goal is:
- to classify the cause(s) in a differentiated manner
- to reduce unnecessary uncertainty
- and to develop a personalized treatment plan
Neurology– Diagnosis and differentiation of central and vestibular causes
Orthopedics– Evaluation and treatment of the cervical spine
(Psychosomatic) Physical Therapy– Balance, proprioception, and muscle tone regulation
Psychiatry– For anxiety, functional vertigo, or chronic conditions
Photos: freepic / magnific