What is the difference between vertigo, dizziness, and light‑headedness?

Distinguishing Vertigo, Dizziness, and Lightheadedness

Vertigo is a false sensation of self-motion or spinning of the visual surroundings that indicates vestibular system pathology, while lightheadedness suggests cardiovascular, metabolic, or psychiatric causes, and the term "dizziness" is an imprecise umbrella descriptor that patients use inconsistently—making it essential to focus on timing, triggers, and associated symptoms rather than the patient's subjective terminology. 1

Core Definitions

Vertigo represents true vestibular dysfunction and is defined as:

• A false sensation that you or the room is spinning or rotating 1
• Often accompanied by nausea, vomiting, and intolerance to head motion 2
• Specifically indicates pathology in the vestibular system (either peripheral from the ear/vestibular apparatus or central from the brainstem/cerebellum) 3, 1

Lightheadedness is characterized by:

• A sensation of impending faint, giddiness, or feeling "woozy" without spinning 4, 5
• Suggests non-vestibular causes including cardiovascular problems (orthostatic hypotension, arrhythmias), medication side effects, or psychiatric conditions 3, 2
• May indicate hyperventilation in patients with panic disorder or anxiety 3

Dizziness is:

• An imprecise umbrella term describing disturbed spatial orientation without a false sense of motion 1
• Used inconsistently by patients to describe vertigo, lightheadedness, disequilibrium, or vague sensations 4, 6
• Clinically unhelpful as a descriptor because patients cannot reliably distinguish between these sensations 1, 4

Critical Clinical Approach

The American College of Radiology and American Academy of Otolaryngology-Head and Neck Surgery emphasize that you should abandon attempts to classify based on patient descriptions of "spinning" versus "lightheaded" and instead focus on three key features: 2, 1

1. Timing Pattern

• Seconds (<1 minute): Suggests BPPV, which accounts for 42% of all vertigo cases 2
• Minutes to hours: Points toward vestibular migraine (14% of cases) or Ménière's disease 2
• Days to weeks: Indicates vestibular neuritis (41% of peripheral vertigo) or posterior circulation stroke 2

2. Triggers

• Positional changes (rolling over in bed, looking up): Classic for BPPV 2, 4
• Standing up from supine: Suggests postural hypotension, not vestibular pathology 3
• Spontaneous with no trigger: Consider vestibular migraine, Ménière's, or vertebrobasilar insufficiency 2

3. Associated Symptoms

• Hearing loss, tinnitus, aural fullness: Points to Ménière's disease or labyrinthitis 2, 4
• Headache with photophobia/phonophobia: Suggests vestibular migraine 2
• Focal neurologic deficits: Mandates immediate evaluation for stroke 2

Why Patient Descriptions Are Unreliable

Common pitfall: Patients with panic disorder or anxiety often describe "lightheadedness and dizziness" that clinicians attribute to hyperventilation, but studies show high prevalence of actual vestibular dysfunction in these patients, blurring the distinction. 3

Critical distinction: Loss of consciousness never occurs with vestibular disorders like Ménière's disease—if syncope is present, the etiology is cardiovascular or neurologic, not vestibular. 1

Medication-Induced Confusion

Several medications produce side effects described as both "dizziness" and "vertigo," including:

• Antihypertensive medications 3
• Cardiovascular medications 3
• Mysoline, carbamazepine, phenytoin 3
• These represent a leading reversible cause of chronic vestibular syndrome 2

Practical Questioning Strategy

Instead of asking "Are you dizzy?" ask:

• "Do you feel like you or the room is spinning?" (vertigo) 1
• "How long does each episode last—seconds, minutes, hours, or days?" 2
• "What brings it on—rolling over in bed, standing up, or nothing specific?" 2
• "Do you have hearing changes, ringing in the ears, or ear fullness?" 2
• "Have you ever lost consciousness during these episodes?" 1

Clinical Significance for Morbidity and Mortality

The distinction matters because:

• Vertigo indicates vestibular pathology requiring specific diagnostic maneuvers (Dix-Hallpike, HINTS examination) and treatments (Epley maneuver for BPPV) 2, 4
• Lightheadedness may signal dangerous cardiovascular causes (arrhythmias, severe orthostatic hypotension) requiring different evaluation 4, 7
• Central causes of vertigo (posterior circulation stroke) carry 25% prevalence in acute vestibular syndrome and require urgent MRI, while peripheral causes are generally benign 2
• Dizziness increases fall risk 12-fold in elderly patients, with BPPV present in 9% of elderly patients referred for geriatric evaluation 2