Vertigo and dizziness: symptoms, causes and treatment

If you have ever rolled over in bed and suddenly felt the room spin, or stood up and felt like you’re being pulled off centre, you will know how unsettling vertigo can be. It can be frightening and can knock your confidence. At Health Within Osteopathy in Westmere, Auckland, we regularly see people dealing with vertigo symptoms, and in many cases we are often able to help identify the cause and provide effective treatment.

Vertigo is not a diagnosis. It is a symptom that can have several different causes. Your balance system is waving a flag, telling you that something about how your brain is receiving or processing balance information is not running smoothly.

Not all dizziness is vertigo

Vertigo describes symptoms specifically related to your body’s ability to regulate balance. People often use the word dizziness to describe many different sensations, so part of our job is assessing exactly what you are experiencing and why. Vertigo is a specific feeling of motion that isn’t really happening. It might feel like spinning, tilting, swaying, rocking, or a sudden dropping sensation. It can be triggered by head movement or just changing position. It is different from other symptoms like light-headedness, feeling faint, or a vague unsteadiness which can point to different causes and require a different approach.

How we assess vertigo at Health Within

Our approach is to understand why your vertigo is happening. Assessment usually starts with a thorough history to understand the pattern. The timing, triggers, duration of symptoms, and any associated features such as hearing changes, headaches, neck pain, or recent illness all help point toward the most likely cause.

We can also examine the ears with an otoscope to check for contributors such as excess wax or signs of inflammation or infection. Sometimes the simplest factors are the easiest to miss.

The most common form of vertigo symptoms that patients present with at the clinic is Benign Paroxysmal Positional Vertigo (BPPV). If BPPV is suspected, we use positional tests such as the Dix Hallpike test, along with observation of eye movements called nystagmus. These eye movements can provide valuable clues because the balance system and eye tracking system are tightly linked. We also assess your balance and movement and, when relevant, examine the upper neck and jaw to see whether they may be contributing.

Our treatments

Treatment depends on the driver. If BPPV is confirmed, we can treat it using repositioning manoeuvres such as the Epley manoeuvre. For many people this can bring rapid improvement, sometimes within a session or two, although response varies.

If our assessment suggests that neck  dysfunction may be contributing to dizziness, treatment often focuses on the upper neck joints, surrounding soft tissues and circulation, posture related strain, and restoring clearer movement and position signals. If vestibular migraine is part of the picture, care usually combines hands on support for the neck and jaw with guidance to reduce triggers and calm nervous system overload, which may include pacing, sleep support, hydration, and strategies for managing sensory load.

When needed, we may also prescribe individualised vestibular exercises and supplements. These are designed to retrain balance pathways and improve coordination between the eyes, inner ear, and neck. The aim is not just to reduce symptoms, but to help you regain confidence with everyday movement.

Your balance system is a three way conversation

Balance is not just an “ear thing“. Your brain is constantly comparing information from the inner ear, the eyes, and the body’s sensors in muscles and joints, especially in the upper neck. When those signals agree, you feel steady. When they do not, your brain can interpret the mismatch as movement, and vertigo can be the result.

It’s surprising how much your neck contributes to balance. The upper cervical spine is packed with sensory receptors that help your brain map head position. That is why neck injuries, sustained posture, and upper neck tension can sometimes contribute to dizziness in ways people do not expect.

Common causes of vertigo

1. Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of ‘true spinning’ vertigo we see in clinic. It often causes short, intense bursts of vertigo lasting seconds to a minute, typically triggered by rolling in bed, looking up, bending down, or sitting up quickly. BPPV happens when tiny calcium carbonate particles in the inner ear, sometimes casually called “crystals”, move into a semicircular canal where they should not be. They are microscopic, but they can produce very loud symptoms. The Epley manoeuvre treatment that we perform is designed to guide these displaced particles back to where they belong.
2. Vestibular Neuritis: Another cause is vestibular Neuritis, which often follows a viral infection. It tends to come on more suddenly and can last for hours or days. Sometimes unsteadiness from vestibular neuritis can even linger for weeks. Hearing is usually not affected, and this detail matters because hearing changes can point toward other inner ear conditions that need different management.
3. Cervicogenic Dizziness: This is a neck related type of vertigo that is commonly overlooked. It is more likely when dizziness is linked with neck stiffness or pain & headaches. Symptoms are provoked by neck movement or linked to a history of whiplash or concussion. In these cases the issue is not that the neck is “making you spin” in the way BPPV can, but that altered neck input can confuse the brain’s sense of where the head is in space.
4. Vestibular Migraine: This type of migraine is important to consider. Migraine is a neurological condition and it can affect balance even when there is little or no headache. People may notice dizziness or vertigo alongside sensitivity to light or sound, nausea, visual disturbances, or a general sense that the nervous system is on high alert. These cases can often overlap with jaw tension, neck tightness, disrupted sleep, or stress load. In some cases, we will also refer you to a neurologist for further treatment. 
5. Concussion Vertigo: After concussion, vertigo and dizziness are very common and can persist beyond the initial injury. This is partly because concussion can involve more than one system at once. The inner ear can be affected, the upper neck can be injured, and the brain’s integration of balance signals can change. BPPV can also appear after head trauma, which is one reason careful testing can be so helpful.
6. Ménière’s Disease: This is a less common cause of vertigo symptoms. It often involves longer lasting vertigo episodes alongside fluctuating hearing loss, ear fullness, and tinnitus. If symptoms suggest Ménière’s, we can identify features consistent with it, support contributing factors such as neck tension and nervous system load, and refer you to an ENT specialist for further investigation and diagnosis.

When vertigo needs urgent medical attention

Most vertigo seen in clinics like ours is benign, but some symptoms need urgent medical assessment. If vertigo comes with sudden weakness or numbness, trouble speaking or swallowing, severe confusion, a new intense headache, double vision, or other sudden neurological changes, treat it as an emergency. If you are unsure, it is always better to be checked.

Our special interest in ear related conditions

Dr Rebecca Walker, osteopath at Health Within, has a special interest in ear related pathology, with PhD research focused on ear diseases. Rebecca completed her doctoral research at the School of Medicine, working alongside ENT surgeons. This experience adds depth to the assessment and management of vertigo, dizziness, and balance concerns, particularly where inner ear involvement is suspected.

If you are experiencing vertigo

Vertigo is common, but it is not something you should simply put up with. In many cases vertigo is treatable, and understanding the cause is the first step toward feeling steady again. If you would like an assessment, we are happy to help you work out what is going on and what to do next, with clear explanations along the way.

Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: systematic review and meta-analysis 2022 https://pubmed.ncbi.nlm.nih.gov/36220009/

The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo 2014 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003162.pub3/full

https://onlinelibrary.wiley.com/doi/10.1155/2011/835671