What is the difference between vertigo and dizziness in terms of symptoms, causes, and treatment options?

Difference Between Vertigo and Dizziness

Vertigo is a specific subtype of dizziness characterized by a false sensation of spinning or rotational movement, while dizziness is a broader, non-specific term encompassing multiple distinct sensations including lightheadedness, imbalance, and vertigo itself. 1, 2

Core Definitions

Vertigo represents a false sensation of self-motion or that the visual surroundings are spinning or flowing, indicating vestibular system pathology (either peripheral or central). 1 This is a specific diagnosis pointing to dysfunction in the vestibular apparatus, brainstem, or cerebellum. 3, 4

Dizziness is a general, non-specific umbrella term describing various sensations of disorientation. 4 The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that focusing on timing and triggers of symptoms is more diagnostically valuable than the specific descriptive terms patients use. 5, 2

Symptom Characteristics

Vertigo-Specific Features

• Rotational or spinning sensation - patient reports the room is moving around them or they are spinning 1, 2
• Accompanied by nausea and vomiting in most cases 1
• Difficulty with balance and intolerance to head motion 5
• Nystagmus (involuntary eye movements) typically present on examination 5, 6
• Episodes can be triggered by specific head positions (as in BPPV) or occur spontaneously 5, 2

Non-Vertigo Dizziness Features

• Lightheadedness/presyncope - sensation of impending faint, "floating," or about to pass out 1, 2
• Associated with orthostatic changes, palpitations, tremulousness, generalized weakness 1
• Visual symptoms like "tunnel vision" or "graying out" 1
• Disequilibrium - sense of imbalance or unsteadiness without spinning 3, 7
• Vague lightheadedness - non-specific sensation difficult to characterize 3

Underlying Causes

Vertigo Causes (Vestibular System Disorders)

Peripheral Vestibular Causes:

• Benign Paroxysmal Positional Vertigo (BPPV) - most common cause, accounting for 42% of vertigo cases in general practice, triggered by head position changes, episodes last <1 minute 5, 6, 2
• Vestibular neuritis - accounts for 41% of cases, acute onset lasting days to weeks 5, 6
• Ménière's disease - episodic vertigo with fluctuating hearing loss, tinnitus, and aural fullness, episodes last hours 5, 6
• Labyrinthitis - inflammation with associated hearing loss 5, 6
• Superior canal dehiscence syndrome - triggered by pressure changes, not position 5
• Perilymphatic fistula - pressure-triggered vertigo 5

Central Vestibular Causes:

• Posterior circulation stroke or TIA - accounts for 3-7% of all vertigo, but 25% of acute vestibular syndrome presentations 6
• Vestibular migraine - episodes lasting minutes to 24+ hours, associated with migraine features 6
• Demyelinating diseases (multiple sclerosis) 5
• Posterior fossa tumors 6
• Vertebrobasilar insufficiency - episodes typically <30 minutes 5, 6

Non-Vertigo Dizziness Causes

• Orthostatic hypotension - most common cardiovascular cause 1
• Cardiac arrhythmias 1
• Medication side effects - antihypertensives, cardiovascular drugs, anticonvulsants 5, 1, 6
• Dehydration and electrolyte imbalances 1
• Anxiety or panic disorders 5, 1
• Metabolic conditions (hypoglycemia, anemia) 5
• Postural hypotension 5

Diagnostic Approach

For Vertigo

The American Academy of Otolaryngology-Head and Neck Surgery recommends classifying vertigo by timing and triggers rather than patient descriptors: 5, 2

• Triggered Episodic Vestibular Syndrome - episodes <1 minute, specific head position triggers (BPPV, postural hypotension) 5, 2
• Spontaneous Episodic Vestibular Syndrome - episodes minutes to hours, no specific trigger (Ménière's disease, vestibular migraine, TIA) 5, 2
• Acute Vestibular Syndrome - continuous dizziness lasting days to weeks with nausea/vomiting (vestibular neuritis, labyrinthitis, stroke) 5, 2
• Chronic Vestibular Syndrome - dizziness lasting weeks to months (anxiety disorders, medication effects, posterior fossa masses) 5, 2

Key examination maneuvers:

• Dix-Hallpike maneuver - essential for diagnosing BPPV, produces characteristic nystagmus with latency and fatigability 5, 6, 2
• Examination for nystagmus - pattern distinguishes peripheral from central causes 5, 6
• Hearing assessment - distinguishes conditions with hearing loss (Ménière's, labyrinthitis) from those without 6, 2

For Non-Vertigo Dizziness

• Orthostatic blood pressure measurements - standing and supine 1
• Cardiac evaluation - ECG, rhythm monitoring if indicated 1
• Medication review - identify vestibulotoxic or hypotension-causing agents 1, 6
• Metabolic workup - glucose, electrolytes, CBC if clinically indicated 1

Treatment Differences

Vertigo Treatment

BPPV (most common):

• Canalith repositioning procedures (Epley maneuver) - first-line therapy, 80% success after 1-3 treatments 6
• Avoid vestibular suppressants - they prevent central compensation and delay recovery 1, 6

Vestibular neuritis/labyrinthitis:

• Short-term vestibular suppressants (meclizine 25-100 mg daily) only in acute phase 8
• Early vestibular rehabilitation 6

Ménière's disease:

• Dietary sodium restriction and diuretics 6
• Vestibular rehabilitation 6

Vestibular migraine:

• Migraine prophylaxis medications 1, 6
• Dietary modifications and lifestyle interventions 6

Non-Vertigo Dizziness Treatment

Orthostatic hypotension:

• Hydration and electrolyte replacement 1
• Medication adjustment - reduce or eliminate offending agents 1
• Compression stockings and physical countermaneuvers 1

Anxiety-related:

• Cognitive behavioral therapy 1
• Breathing exercises 1
• Anxiolytics if necessary 1

Medication-induced:

• Review and discontinue offending medications 1, 6

Critical Red Flags Requiring Urgent Evaluation

These symptoms with vertigo demand immediate neuroimaging to rule out stroke: 6

• Severe postural instability with falling 6
• New-onset severe headache 6
• Any additional neurological symptoms (dysarthria, diplopia, weakness, sensory deficits) 6
• Vertical nystagmus without torsional component 6
• Baseline nystagmus without provocative maneuvers 6
• Failure to respond to appropriate peripheral vertigo treatments 6

Common Pitfalls

• Misdiagnosing stroke as peripheral vertigo - approximately 10% of cerebellar strokes present similarly to peripheral vestibular disorders 6
• Overlooking vestibular migraine - extremely common but under-recognized, lifetime prevalence 3.2% 6
• Prescribing vestibular suppressants for BPPV - delays recovery and prevents central compensation 1, 6
• Failing to distinguish fluctuating hearing loss (Ménière's) from stable/absent hearing loss (vestibular migraine) 6
• Ignoring medication side effects - many common drugs cause dizziness or vertigo 1, 6
• Prolonged use of vestibular suppressants - should only be used short-term in acute vestibular syndrome 1