What is the difference between dizziness and vertigo?

Difference Between Dizziness and Vertigo

Vertigo is a specific type of dizziness characterized by a false sensation of spinning or rotational movement, while dizziness is a broader, non-specific term describing disturbed spatial orientation without the illusion of motion. 1

Key Definitions

Vertigo is defined by the Barany Society as a false sensation of self-motion or a false sensation that the visual surroundings are spinning or flowing—this represents true vestibular dysfunction. 1 A confident description of spinning is typically specific for inner ear pathology. 1

Dizziness is defined by the Barany Society as the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion. 1 This vague descriptor may indicate:

• Lightheadedness 1
• Presyncope (near-fainting) 1, 2
• Disequilibrium (imbalance) 2
• Non-specific spatial disorientation 1

Clinical Significance of the Distinction

The distinction matters because vertigo indicates vestibular system pathology (peripheral or central), while non-vertiginous dizziness suggests cardiovascular, metabolic, psychiatric, or other non-vestibular causes. 1, 3

When Patients Report "Dizziness":

Many patients use "dizziness" as a vague catch-all term that may describe lightheadedness or presyncopal episodes, which are NOT consistent with vestibular disorders like Ménière's disease. 1 This unreliable terminology can lead to misdiagnosis and mismanagement. 1

Critical caveat: The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that clinicians should focus on timing and triggers rather than the specific descriptor patients use, as patients have difficulty accurately describing symptom quality. 1, 4

Practical Clinical Approach

Ask Specific Questions to Clarify:

For suspected vertigo: 1

• "Do you feel like you or the room is spinning?"
• Duration of spinning episodes (seconds, minutes, hours)
• Triggers (head position changes, spontaneous onset)
• Associated otologic symptoms (hearing loss, tinnitus, aural fullness)

For non-vertiginous dizziness: 2, 3

• "Do you feel lightheaded or like you might faint?" (presyncope)
• "Do you feel unsteady on your feet?" (disequilibrium)
• Relationship to standing up (orthostatic hypotension)
• Medication review (antihypertensives, cardiovascular drugs) 1

Classification by Timing and Triggers:

The American College of Radiology recommends classifying presentations into four vestibular syndromes: 1, 5

1. Triggered episodic vestibular syndrome (e.g., BPPV—brief episodes with position changes) 1, 4
2. Spontaneous episodic vestibular syndrome (e.g., Ménière's disease, vestibular migraine—minutes to hours, no specific trigger) 1
3. Acute vestibular syndrome (e.g., vestibular neuritis, stroke—continuous for days) 1, 4
4. Chronic vestibular syndrome (weeks to months of persistent symptoms) 1

Common Pitfalls to Avoid

Do not assume all "dizziness" complaints are benign. 1 Patients with panic disorder, anxiety, or hyperventilation may complain of dizziness symptoms, but these can coexist with true vestibular dysfunction. 1

Elderly patients with long-standing Ménière's disease may not manifest frank vertigo but rather present with vague "dizziness." 1 This atypical presentation requires high clinical suspicion.

Loss of consciousness is NEVER a symptom of vestibular disorders like Ménière's disease—this indicates a different etiology entirely. 1

Educate patients to clearly define their symptoms using specific terminology (spinning vs. lightheadedness vs. imbalance) to improve diagnostic accuracy in future encounters. 1