Vertigo is more than just feeling dizzy. It’s the unsettling sensation that you or your surroundings are spinning or moving, even when they’re not. While many cases are benign, understanding the warning signs that indicate a more serious underlying issue is crucial. Knowing when to seek vestibular physiotherapy treatment can prevent further complications and lead to effective treatment.

Often, people assume all vertigo is Benign Paroxysmal Positional Vertigo (BPPV), the most common cause. However, there are significant differences. Recognising the red flags means knowing when your vertigo is NOT BPPV and requires immediate attention from a healthcare professional, potentially a physiotherapist specialising in vestibular conditions.

Warning Signs Your Vertigo Is NOT BPPV

While BPPV typically involves brief, intense spinning triggered by specific head movements, other forms of vertigo present differently. Here are key indicators that your vertigo may stem from a more complex cause, warranting a professional assessment:

Sudden Onset with Neurological Symptoms

If your vertigo suddenly appears alongside other neurological signs, it’s a significant red flag. These can include:

• Weakness or numbness in the face, arm, or leg, especially on one side of the body.
• Difficulty speaking (slurred speech) or understanding speech.
• Changes in vision, such as double vision, sudden blurred vision, or loss of vision.
• Severe, sudden headache unlike any you’ve experienced before.
• Difficulty walking, loss of balance, or sudden clumsiness.

These symptoms, particularly if new and sudden, could indicate a central nervous system issue, such as a stroke or transient ischaemic attack (TIA). This requires urgent medical attention.

Constant Vertigo Without Positional Triggers

BPPV is defined by its positional nature – movements like rolling over in bed or looking up trigger the spinning. If your vertigo is constant, present regardless of head position, or doesn’t subside after a few seconds, it suggests a different underlying cause. Conditions like vestibular neuritis or labyrinthitis can cause persistent vertigo, often accompanied by nausea and vomiting.

Associated Hearing Loss or Tinnitus

Vertigo accompanied by changes in hearing, ringing in the ears (tinnitus), or a feeling of fullness in one ear are strong indicators of an inner ear problem beyond BPPV. Meniere’s disease, for example, is characterised by episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Labyrinthitis can also present with both vertigo and hearing loss.

Vertigo Following a Head Injury

Any vertigo that develops after a head trauma, even a seemingly minor bump, should be evaluated. Post-concussion syndrome can manifest with dizziness and balance issues. It’s essential to rule out more serious complications like inner ear damage or a brain injury.

Unilateral Weakness or Sensory Changes

If you experience any new weakness, numbness, or altered sensation on one side of your body, concurrently with vertigo, it’s a critical sign. This points towards potential neurological involvement and warrants immediate medical review.

Other Concerning Symptoms

• High fever and severe headache: Could indicate an infection like meningitis.
• Severe neck pain or stiffness: Might be related to cervical spine issues or more serious conditions affecting the central nervous system.
• Changes in consciousness: Any fainting or feeling like you’re about to pass out needs urgent assessment.

When to See a Physio for Vertigo

If you experience any of the red flags mentioned above, your first step might be to consult your General Practitioner (GP) or seek emergency medical care, especially for acute neurological symptoms. However, for many forms of vertigo and dizziness, a vestibular physiotherapy expert is often the most effective pathway to diagnosis and recovery.

Physiotherapists with specialised training in vestibular rehabilitation are highly skilled in assessing and treating a wide range of balance and dizziness disorders. They can accurately diagnose conditions like BPPV, vestibular neuritis, labyrinthitis, and even cervicogenic dizziness (dizziness originating from the neck).

What to Expect from a Vestibular Physio

A vestibular physio will conduct a thorough assessment, which may include:

• Detailed history taking about your symptoms, triggers, and medical background.
• Specific eye movement tests to assess the function of your vestibular system.
• Balance and gait assessments.
• Positional testing, such as the Dix-Hallpike manoeuvre, to diagnose BPPV.

Based on their findings, they will develop a tailored treatment plan. This might include specific head and body manoeuvres (like the Epley manoeuvre for BPPV), habituation exercises, gaze stabilisation exercises, or balance retraining. Their goal is to reduce your symptoms, improve your balance, and get you back to your normal activities safely.

Conclusion

Vertigo can be debilitating, but it doesn’t always have to be a mystery. While BPPV is common, it’s vital to be aware of the red flags that suggest a different, potentially more serious, cause. Don’t dismiss persistent or unusual symptoms. Early diagnosis and intervention, often through expert vestibular physiotherapy, are key to managing your condition effectively and improving your quality of life.

Frequently Asked Questions

What is the difference between dizziness and vertigo?

Dizziness is a general term encompassing various sensations like lightheadedness, feeling faint, or unsteadiness. Vertigo, specifically, is the distinct sensation of spinning or whirling, either of yourself or your surroundings, and is often linked to issues with the inner ear or brain.

Can stress cause vertigo?

While stress doesn’t directly cause most forms of vertigo, it can certainly exacerbate symptoms and make existing vertigo worse. High stress levels can also contribute to other conditions like cervicogenic dizziness or tension headaches, which might mimic vertigo.

How long does vertigo typically last?

The duration of vertigo varies greatly depending on the cause. BPPV episodes are usually brief (seconds to a minute), while conditions like vestibular neuritis can cause constant vertigo for days or weeks. Some chronic conditions, like Meniere’s disease, involve episodic attacks that can last hours.

Is it safe to drive with vertigo?

No, it is generally not safe to drive when experiencing vertigo. The disorientation, spinning sensation, and potential for nausea or blurred vision can severely impair your ability to operate a vehicle safely. It’s best to avoid driving until your symptoms are well-managed and you feel stable.

What are the common treatments for vertigo?

Treatments depend on the cause. For BPPV, specific head manoeuvres performed by a physiotherapist are highly effective. Other treatments may include vestibular rehabilitation exercises, medication to manage nausea or inflammation, dietary changes (for Meniere’s), or addressing underlying neurological conditions.