Many patients come to the clinic with dizziness and expect to have BPPV. We always test for it, and so often we find that you don’t have BPPV!! Epley maneuvers only work for BPPV. Repeating maneuvers when the problem is coming from a different condition will not help and can actually aggravate the dizziness.
BPPV, or more commonly known as ear crystals being out of place, is one of the most common reasons somebody can experience vertigo. This particular type of vertigo is triggered when changing head positions in relation to gravity such as laying down, rolling in bed, bending over, or looking up. Symptoms typically last <60 seconds but can occur frequently with changes in body position. Below are the other top 3 conditions that can cause a sense of vertigo (spinning).
Vestibular Migraine: Vestibular migraine diagnostic criteria (Bárány Society) require at least five episodes of moderate-to-severe vertigo/dizziness (5 mins-72 hrs), where 50% of episodes have migraine features (headache, light/sound sensitivity, visual aura, tinnitus, neck pain) or are associated with migraine triggers, and other causes are ruled out. Diagnosis relies heavily on patient history, identifying patterns of vertigo linked to typical migraine symptoms like throbbing pain, nausea, light/sound sensitivity, or aura. If you have a history of migraines, even if it was decades ago, or only a family history of migraines, and are experiencing vertigo this may be a reason. Many people never have a headache, or if so it is low grade and dull.
Reference: Lempert, Thomas, et al. “Vestibular migraine: Diagnostic criteria (Update) Consensus document of the Bárány Society and the International Headache Society.” Journal of Vestibular Research 32.1 (2022): 1-6.
Inner ear nerve inflammation such as a neuritis on labyrinthitis. Inflammation to the vestibular nerve can cause an acute onset of vertigo lasting 24-72 hours with additional symptoms of nausea, imbalance, and dizziness. This often occurs after having an infection elsewhere in the body such as an upper respiratory illness but can occur on its own as well. If you have having symptoms of vertigo, blurry vision with head movements, and imbalance this may be one reason for your symptoms. Of note, it is important to rule out any central (brain) related causes for these symptoms.
Reference: Smith T, Rider J, Cen S, et al. Vestibular Neuronitis. [Updated 2023 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549866/
Central vertigo. Central vertigo is a spinning sensation or imbalance caused by a problem in the brain, specifically the brainstem or cerebellum, unlike peripheral vertigo from the inner ear, and can signal other issues like stroke, MS, tumors, or migraines, presenting with symptoms like nausea, difficulty walking, and possibly other neurological signs (5 Ds: diplopia, dysarthria, dysphagia, dysmetria) alongside dizziness, requiring neurological evaluation like MRI to find the underlying CNS cause. Concussion can also cause central vertigo, and in this case MRI brain scans are normal. Our testing helps clear up the cause of the symptoms, rule out more serious problems, and leads to develping the most effective treatment to get you feeling better.
Reference: Lui F, Foris LA, Tadi P. Central Vertigo. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK441861/
