Feeling like the room is spinning when you’re lying still? Or getting lightheaded just by turning your head too fast? You’re not alone. Vertigo and dizziness are among the most common reasons people visit doctors-especially those over 65. But here’s the thing: most people don’t know the difference between simple dizziness and true vertigo, and that confusion leads to wrong treatments, wasted time, and unnecessary stress.
Vertigo isn’t just feeling off-balance. It’s the illusion that you or everything around you is spinning, often accompanied by nausea, sweating, or vomiting. Dizziness? That’s more like feeling faint, woozy, or unsteady without the spinning sensation. The root cause? In about 80% of cases, it’s your inner ear.
Why Your Inner Ear Is the Main Culprit
Your inner ear isn’t just for hearing. It’s your body’s built-in GPS for balance. Inside each ear, there are three fluid-filled loops called semicircular canals, lined with tiny hair cells and calcium crystals called otoconia. When you move your head, the fluid shifts, the hairs bend, and your brain gets the signal: “You’re turning left,” or “You’re tilting back.”
Problems happen when those crystals get loose. That’s benign paroxysmal positional vertigo (BPPV)-the most common cause of vertigo. It accounts for up to 30% of all dizziness cases, and over half of cases in people over 60. One wrong head movement-rolling over in bed, looking up at a shelf, bending down to tie your shoes-and suddenly, the room spins. The episode lasts seconds to a minute, then fades. But it comes back. And back. And back.
Other inner ear issues include vestibular neuritis, where a virus inflames the nerve connecting your ear to your brain. This causes sudden, intense vertigo that lasts days, not seconds. You might feel too sick to get out of bed. Hearing stays normal, but balance is shattered.
Then there’s Meniere’s disease. This one’s trickier. It’s not just vertigo. It’s vertigo plus ringing in the ear (tinnitus), a feeling of fullness or pressure, and fluctuating hearing loss. Episodes can last from 20 minutes to half a day. It’s caused by too much fluid building up in the inner ear. While rare-only about 0.2% of people have it-it’s devastating when it hits.
When It’s Not Your Ear: The Brain Factor
Not all vertigo starts in the ear. About 20% of cases come from the brain-this is called central vertigo. The most common cause? Vestibular migraine. You might not even have a headache. Just dizziness, sensitivity to light or sound, and a foggy feeling. It’s often misdiagnosed as anxiety or stress. But if you’ve had migraines before, or if your vertigo episodes last hours and come with visual disturbances, this could be it.
Then there’s the scary stuff: stroke. A stroke in the back of the brain can mimic vertigo. That’s why doctors now use the HINTS exam-a quick test involving eye movements-to tell the difference. If done within 48 hours of symptoms, it’s 97% accurate at spotting stroke. No MRI needed. Just a trained eye and a few simple head movements.
That’s why you can’t just assume it’s BPPV. If your vertigo comes with slurred speech, double vision, numbness, or weakness on one side, get to a hospital immediately. Don’t wait. Don’t take a pill. Get checked.
The Right Treatment for the Right Cause
Treating vertigo isn’t about popping pills and hoping for the best. It’s about matching the fix to the cause.
For BPPV, the answer is movement-not medication. The Epley maneuver is a series of slow head positions that guide the loose crystals back into the right part of the ear. Done right, it works in 80-90% of cases after one or two tries. You can do it at home with a video guide, but many people mess it up. The head needs to be tilted at exactly 30 degrees, and each position held for 30 seconds. If done poorly, it doesn’t work. That’s why many doctors recommend seeing a physical therapist first.
For vestibular neuritis, the body heals itself over weeks. But during that time, motion sickness drugs like meclizine (Antivert) can help with nausea. Here’s the catch: taking them too long-beyond 72 hours-slows down your brain’s ability to adapt. Your brain needs to relearn balance. Medication can block that. So use them sparingly. Move as much as you can. Walk. Sit up. Look around. Let your brain catch up.
For Meniere’s disease, it’s a two-pronged approach: diet and drugs. Cut sodium to 1,500-2,000 mg a day. That means no processed food, no canned soup, no soy sauce, no fast food. Most people don’t realize how much salt hides in everyday meals. Pair that with a water pill like hydrochlorothiazide, and 60-80% of patients see their attacks drop by half. Some even stop having them altogether.
For vestibular migraine, it’s migraine prevention-not vertigo treatment. Beta-blockers like propranolol or calcium channel blockers like verapamil are used daily, even when you’re not dizzy. It takes weeks to work. But if you track your triggers-stress, sleep loss, certain foods-you can cut attacks by 50% or more.
Vestibular Therapy: The Game-Changer
There’s one treatment that works across most inner ear disorders: vestibular rehabilitation therapy (VRT). It’s not a magic wand. It’s a personalized exercise program designed to retrain your brain to rely on other senses-your eyes, your legs, your body-when your inner ear isn’t sending reliable signals.
Common exercises include:
- Gaze stabilization: Keep your eyes locked on a target while moving your head side to side or up and down.
- Balance retraining: Standing on one foot, walking heel-to-toe, standing on foam.
- Habituation: Repeatedly doing movements that trigger dizziness, so your brain gets used to them.
Studies show 70-80% of people improve within 4-6 weeks of doing these exercises twice a day. But here’s the hard truth: 30% of people quit because the first week feels worse. You’ll get dizzy doing the exercises. You might feel nauseous. You might want to stop. That’s normal. It means your brain is rewiring. Stick with it.
One patient in Cape Town, 72, had BPPV for eight months. She tried pills, rest, and prayer. Nothing worked. Then she started VRT. After three weeks, she was walking her dog without fear. “I didn’t know my brain could fix itself,” she told her therapist.
What Doesn’t Work (And Why)
Antihistamines like meclizine or promethazine? Fine for a day or two during a bad attack. But if you take them for weeks, you’re not helping-you’re hurting. Your brain needs to adapt. Drugs suppress the signals, so your brain never learns to compensate. Studies show prolonged use delays recovery by 30-50%.
“I was on Antivert for a month,” one Reddit user wrote. “I felt like a zombie. My vertigo didn’t get better. I finally stopped, started the Epley maneuver, and within a week, I was back to normal.”
Same goes for bed rest. Lying still won’t fix BPPV. It won’t fix neuritis. It just makes your balance system weaker. Movement is medicine.
When to See a Specialist
You don’t need to see a specialist for every dizzy spell. But if any of these apply, get evaluated:
- Your dizziness lasts more than a few days.
- You have hearing loss, ringing in the ears, or fullness.
- You have neurological symptoms: numbness, slurred speech, vision changes.
- You’ve had more than one episode in a month.
- Over-the-counter meds don’t help.
Start with your doctor. Ask: “Could this be BPPV? Can you do the Dix-Hallpike test?” If they say no, or if you’re not getting better, ask for a referral to an ENT or vestibular therapist. Don’t settle for “it’s probably anxiety.”
What You Can Do Today
Even if you’re waiting for an appointment, you can start helping yourself:
- If you suspect BPPV: Try the Epley maneuver using a trusted video (YouTube has good ones from certified therapists).
- Write down your triggers: What were you doing before the dizziness started? Turning? Standing up? Walking in a store?
- Reduce sodium. Even if you don’t have Meniere’s, less salt helps your inner ear fluid stay balanced.
- Move daily. Walk 10 minutes. Stand on one foot while brushing your teeth. Blink your eyes while turning your head. Small movements build big recovery.
- Stop taking dizziness pills unless it’s day one or two of a bad attack.
Vertigo isn’t a life sentence. It’s a signal. Your body is trying to tell you something. And with the right approach, most people recover fully-no surgery, no lifelong meds, just time, movement, and patience.
Is vertigo the same as dizziness?
No. Dizziness is a general term that includes feeling lightheaded, faint, or unsteady. Vertigo is a specific type of dizziness where you feel like you or your surroundings are spinning. It’s caused by a problem in your inner ear or brain’s balance system. If you’re not spinning, it’s not vertigo.
Can BPPV go away on its own?
Yes, sometimes. BPPV can resolve in a few weeks as the crystals dissolve or settle. But it often comes back. The Epley maneuver fixes it in one or two sessions for most people. Waiting means more days of nausea, fear of movement, and risk of falls. Why wait when a 5-minute maneuver can fix it?
Do I need an MRI for vertigo?
Not usually. Most vertigo is caused by inner ear problems, and MRIs won’t show those. Doctors only order MRIs if they suspect a brain issue-like a stroke or tumor-based on symptoms like slurred speech, weakness, or double vision. The HINTS exam is a faster, cheaper way to rule out stroke in the ER.
Can vestibular therapy help if I’ve had vertigo for years?
Yes. Even people with chronic vertigo for 5, 10, or 20 years can improve with vestibular therapy. The brain never stops learning. If your balance system has been out of sync for years, therapy helps your brain build new pathways to compensate. It takes longer, but results are still strong-up to 75% improvement in long-term cases.
Is it safe to do the Epley maneuver at home?
Yes, if you do it correctly. Many people successfully treat BPPV at home using video guides from certified physical therapists. But if you’re unsure, or if you have neck problems, osteoporosis, or a history of stroke, see a professional first. Doing it wrong can make symptoms worse or move crystals to another canal.
What foods should I avoid if I have Meniere’s disease?
Avoid high-sodium foods: canned soups, processed meats, soy sauce, pickles, chips, fast food, and restaurant meals. Also limit caffeine, alcohol, and MSG, as they can trigger fluid buildup in the inner ear. Stick to fresh fruits, vegetables, lean meats, and plain grains. Reading labels is essential-many “healthy” foods are loaded with hidden salt.
Can stress cause vertigo?
Stress doesn’t directly cause BPPV or Meniere’s, but it can trigger vestibular migraines and make existing vertigo worse. Stress raises cortisol, which affects fluid balance in the inner ear and can increase sensitivity to motion. Managing stress through sleep, breathing, and routine can reduce attack frequency-especially for those with vestibular migraine.
How long does vestibular therapy take to work?
Most people notice improvement in 2-4 weeks, with major gains by 6-8 weeks. You need to do exercises twice daily. Skipping days slows progress. The first week might feel harder-dizziness can increase temporarily. That’s normal. It means your brain is adjusting. Stick with it. Those who persist see 70-80% improvement.
If you’ve been living with vertigo, you know how it steals your confidence, your routine, your peace. But you don’t have to live with it. The science is clear: the right diagnosis, the right treatment, and the right persistence can bring you back to normal. Your inner ear isn’t broken. It’s just out of sync. And your brain? It’s ready to fix it.