Vertigo vs. Dizziness: What’s Really Going On in Your Brain and Inner Ear

Vertigo vs. Dizziness: What’s Really Going On in Your Brain and Inner Ear Nov, 26 2025

Ever felt like the room was spinning? Or just plain lightheaded, like you might pass out? Both are called dizziness-but they’re not the same thing. And mixing them up can cost you months of confusion, wrong treatments, and unnecessary stress. If you’ve been told it’s "just stress" or "aging," but you still feel off, this is for you.

Vertigo Isn’t Just Dizziness-It’s a Hallucination of Motion

Vertigo isn’t feeling faint or unsteady. It’s your brain being tricked into thinking you or the world around you is moving-usually spinning, tilting, or swaying-when you’re perfectly still. Imagine lying in bed and suddenly the ceiling is circling above you. That’s vertigo. It’s not anxiety. It’s not fatigue. It’s a hardwired sensory error in your vestibular system, the part of your inner ear and brain that tells you where your body is in space.

This sensation comes from a mismatch between what your inner ear senses and what your eyes and body feel. When the tiny crystals in your inner ear (called otoconia) get loose and float into the wrong canal, they send false signals to your brain. That’s benign paroxysmal positional vertigo, or BPPV-the most common cause of vertigo, affecting about 2.4% of people each year. Half of those are over 50. It’s not dangerous, but it’s terrifying when it hits.

Doctors can spot vertigo by watching your eyes. If your eyes jerk involuntarily in a rhythmic pattern (called nystagmus) when you move your head, that’s a telltale sign. The speed and direction of those eye movements help tell if the problem is in your inner ear (peripheral) or your brain (central). Peripheral vertigo usually feels worse with head movement. Central vertigo? It’s often constant, and it comes with other red flags: double vision, slurred speech, weakness, or trouble walking in a straight line.

Dizziness Is the Bigger, Messier Category

Dizziness is the umbrella term. It includes vertigo, but also lightheadedness, feeling faint, wooziness, or just being off-balance without any spinning. This is what people mean when they say, "I feel dizzy." It’s not a diagnosis-it’s a symptom. And it can come from almost anywhere in your body.

Low blood pressure when you stand up? That’s orthostatic hypotension. A drop of 20 mmHg or more in systolic pressure can make you feel like you’re about to black out. Anemia? Not enough oxygen in your blood? You’ll feel weak and foggy. Low blood sugar? Your brain panics. Medications like blood pressure pills or antidepressants? They can throw off your balance. Even dehydration can trigger it.

Psychological factors play a big role too. Anxiety doesn’t cause vertigo, but it can make dizziness worse-or even create a cycle where the fear of feeling dizzy leads to more dizziness. This is called persistent postural-perceptual dizziness (PPPD). It’s real, it’s disabling, and it’s often mislabeled as "just anxiety."

Here’s the kicker: over half of older adults with dizziness have more than one cause. Maybe it’s low blood pressure, mild anemia, and a side effect from a statin. No single fix works. You need to untangle the web.

What’s Causing Your Vertigo? The Big Four

Not all vertigo is the same. Here’s what’s actually behind most cases:

  • BPPV (Benign Paroxysmal Positional Vertigo): Accounts for 20-30% of vertigo cases. Triggered by head movements-rolling over in bed, looking up, bending down. The fix? The Epley maneuver. A series of quick head turns done by a therapist or even at home. Success rate? 80-90% after one or two sessions.
  • Vestibular neuritis or labyrinthitis: Usually follows a viral infection. Sudden, intense spinning that lasts days, often with nausea. No hearing loss with neuritis; hearing loss with labyrinthitis. Treated with rest, anti-nausea meds, and later, vestibular rehab.
  • Ménière’s disease: Involves hearing loss, ringing in the ear, and pressure in the ear along with vertigo attacks that last 20 minutes to hours. Affects about 615,000 Americans. Triggers: salt, caffeine, stress. Treatment includes diet changes, diuretics, and sometimes injections into the ear.
  • Vestibular migraine: Often overlooked. You get vertigo without a headache-or with one. Episodes last minutes to hours. Diagnosed after ruling out other causes. Triggered by lights, smells, sleep changes. Treated like migraines: triggers tracked, meds like beta-blockers or topiramate.

Neurological causes like stroke or multiple sclerosis are rare-only 2-3% of vertigo cases-but they’re dangerous. If vertigo comes with slurred speech, numbness on one side, or sudden vision loss, get to the ER immediately. Most vertigo is harmless. But not all.

A doctor tests a patient's eye movements for vertigo while icons of common causes float nearby, and a therapist performs the Epley maneuver.

How Do Doctors Tell Them Apart?

It’s not guesswork. There are clear tools.

The head impulse test checks if your inner ear reflexes are working. If your eyes can’t stay locked on a target when your head is quickly turned, your vestibular nerve might be damaged.

Videonystagmography (VNG) uses special goggles to record eye movements while you follow lights or get cold/warm air blown into your ears. It’s 95% accurate for detecting inner ear problems.

For central causes, doctors look for signs that don’t fit the pattern. If your vertigo is constant, not triggered by position, and you have other neurological symptoms-like trouble reading or walking heel-to-toe-you might need an MRI. But here’s the truth: only 1-2% of vertigo cases need imaging. Most are diagnosed with a good history and physical exam.

Primary care doctors aren’t trained for this. A 2023 survey found only 12% feel "very confident" diagnosing vertigo. That’s why so many people wait months. One Reddit user waited 14 months before being correctly diagnosed with Ménière’s. Another was on antidepressants for two years before finding out it was vestibular migraine.

What Actually Helps? Real Treatments, Not Just Pills

Medication doesn’t fix most vertigo. It just masks nausea. The real solutions are physical.

  • Epley maneuver for BPPV: Done in a clinic in 15 minutes. Most people feel better right after. Home versions work too, if done correctly.
  • Vestibular rehabilitation therapy (VRT): Custom exercises to retrain your brain to rely less on your inner ear and more on vision and body sense. You do these daily for 6-8 weeks. Success rate? 89% for people who stick with it.
  • Diet and lifestyle for Ménière’s: Cut salt, caffeine, alcohol. Drink water. Manage stress. These aren’t optional-they’re part of the treatment.
  • Migraine management for vestibular migraine: Identify triggers. Use sleep trackers. Try magnesium or riboflavin. Some people need daily preventive meds.

And yes, there’s new tech. The FDA approved a home-based VRT device in May 2023. AI systems at Johns Hopkins can now analyze eye movements from a phone video and tell if vertigo is peripheral or central with 85% accuracy. That’s huge for remote areas or people who can’t get to a specialist.

Older adults doing balance exercises in a clinic, with neural pathways lighting up and an AI app analyzing eye movements on a phone.

Why So Many People Get It Wrong

Doctors aren’t ignoring you. The problem is systemic. Vestibular disorders are invisible. You look fine. No swelling. No rash. No lab test confirms BPPV. It’s all based on symptoms and movement tests.

Patients are told it’s anxiety. Or stress. Or aging. And they believe it-because no one offers a better explanation. But here’s what research shows: over 30% of vestibular migraine cases are first misdiagnosed as sinusitis or anxiety. And 50% of older adults with dizziness have multiple causes, making diagnosis messy.

One patient wrote: "After 18 months of being told it’s all in my head, a VNG test showed BPPV. One 15-minute maneuver changed my life." Another: "Still struggling with PPPD after three years. Doctors keep saying it’s anxiety, but I had a concussion. My balance is damaged. It’s not in my head-it’s in my brain."

The system is slow. But it’s changing. Medicare now pays $235 per vestibular test, up from $185 in 2020. Hospitals are opening specialized vestibular clinics. More therapists are certified. The message is clear: this is real. It’s treatable. And you deserve better than a shrug.

What You Can Do Today

If you’re dizzy or spinning:

  1. Write down when it happens. After you turn your head? When you stand? After coffee? During stress?
  2. Track how long it lasts. Seconds? Minutes? Hours?
  3. Do you have ringing in your ears? Hearing loss? Numbness? Double vision? These are red flags.
  4. Ask your doctor for a head impulse test or referral to vestibular rehab.
  5. Don’t accept "it’s just anxiety" without ruling out physical causes.

If you have BPPV, search for "Epley maneuver for BPPV" on YouTube. Watch a video from a certified physical therapist. Do it three times a day for two days. Most people feel better fast.

If you’re still dizzy after a week, don’t wait. Get a VNG test. Ask for vestibular rehab. You’re not crazy. You’re not broken. Your brain just needs the right signal to reset.

Is vertigo the same as dizziness?

No. Dizziness is a general term for feeling lightheaded, unsteady, or faint. Vertigo is a specific type of dizziness where you feel like you or your surroundings are spinning, even when you’re still. Vertigo is caused by problems in your inner ear or brain’s balance centers, while dizziness can come from many other sources like low blood pressure, anemia, or anxiety.

Can stress cause vertigo?

Stress doesn’t cause true vertigo, but it can trigger vestibular migraine or make existing dizziness worse. In some cases, prolonged stress leads to persistent postural-perceptual dizziness (PPPD), where the brain becomes overly sensitive to balance signals. Treating the underlying vestibular issue and managing stress together gives the best results.

How long does vertigo last?

It depends on the cause. BPPV episodes last seconds to minutes and come and go with head movement. Vestibular neuritis can cause intense vertigo for days, then slowly improve over weeks. Ménière’s attacks last 20 minutes to hours and may recur. Vestibular migraine attacks can last minutes to days. If vertigo lasts longer than a week without improvement, see a specialist.

What’s the best test for vertigo?

Videonystagmography (VNG) is the gold standard. It records eye movements during different head positions and stimuli to detect inner ear dysfunction. The head impulse test is also highly useful and can be done quickly in a clinic. For suspected neurological causes, an MRI may be needed-but only if there are red flags like weakness, slurred speech, or vision changes.

Can vertigo go away on its own?

Sometimes. Vestibular neuritis often improves over weeks as your brain adapts. BPPV can resolve spontaneously, but it often returns. The problem is, waiting means suffering longer and risking falls. The Epley maneuver fixes BPPV in minutes. Vestibular rehab speeds recovery for most types. Don’t wait for it to go away-get it properly diagnosed and treated.

When should I go to the ER for dizziness?

Go to the ER if your dizziness comes with sudden severe headache, double vision, trouble speaking, weakness on one side, numbness, chest pain, or loss of consciousness. These could signal a stroke or other neurological emergency. Even if you think it’s just dizziness, these symptoms require immediate evaluation.

What’s Next?

If you’ve been told it’s "just stress" and you still feel off, you’re not alone. Thousands of people have walked this path-wasting months, trying the wrong meds, feeling dismissed. But the science is clear: vertigo and dizziness have physical causes. And they have real, effective treatments.

Start with tracking your symptoms. Ask for the Epley maneuver if you have positional vertigo. Demand a referral to vestibular rehab if you’re still unsteady. Find a therapist certified by the Vestibular Disorders Association. You don’t need to live like this. Your brain can relearn balance. You just need the right map-and the right care.