Dizziness and balance disorders

Dizziness, vertigo and balance disorders are some of the most common patient complaints in primary care and emergency care. These symptoms can occur due to many different causes (sometimes in combination), including conditions involving the heart, brain and peripheral nerves, eyes, ears, muscles and joints, and as a result of certain medications.  Here at UCHealth, we have experts dedicated to helping patients with these symptoms. Our team includes physicians and advanced practice providers specializing in neurology, otology and neurotology, ophthalmology, primary care, audiologists and physical therapists.

Dizziness can have numerous causes- fortunately most are not severe or life-threatening, however symptoms can still be very debilitating. The cause can be from the inner ear, the brain and peripheral nerves, the eyes, the cardiovascular system, the musculoskeletal system or the use of certain medications. Some people have multiple causes of dizziness. Our team is a strong network of providers that are able to narrow down the type of dizziness and provide treatment from the most appropriate provider for that condition.

Dizziness is an all-encompassing term- other words used include lightheadedness, wooziness, floating, imbalance and disequilibrium. Vertigo is the feeling or sensation of motion or spinning when no movement is present. Imbalance is the feeling of being unable to maintain upright posture. These terms are often used interchangeably, though the causes, workup and treatment of each can be different. This is why we spend time with each patient to gain the best understanding of their symptoms and come up with a plan together on how to move forward.

Conditions we treat

We manage a wide array of balance and dizziness disorders. Learn more below.

Vestibular Migraine

Vestibular migraine is a type of migraine that affects balance function and spatial orientation. Individuals with vestibular migraine may experience symptoms such as vertigo (a sensation of spinning or motion when at rest), dizziness, imbalance, nausea, and sensitivity to light or sound.

The exact cause of vestibular migraine is not fully understood, but it is believed to involve abnormal activation or dysfunction of the vestibular system in response to migraine triggers. These triggers include certain foods, stress, hormonal changes, sleep disturbances, weather changes and more.

Diagnosis of vestibular migraine is typically based on clinical symptoms and medical history, although additional tests such as vestibular function tests or imaging studies may be conducted to rule out other possible causes of symptoms.

Treatment for vestibular migraine often involves a combination of lifestyle modifications, dietary changes, medications to manage migraine symptoms and prevent attacks, and vestibular rehabilitation therapy to improve balance and reduce symptoms of dizziness and vertigo. Additionally, identifying and avoiding triggers can help to reduce the frequency and severity of vestibular migraine episodes.


Persistent Postural Perceptual Disorder

Persistent Postural-Perceptual Dizziness (PPPD), previously known as Chronic Subjective Dizziness (CSD), is a condition characterized by persistent feelings of dizziness, unsteadiness, and/or imbalance that are typically provoked or worsened by upright posture, active or passive motion, and exposure to complex or visually stimulating environments. Individuals with PPPD often report symptoms such as feeling like they are swaying, rocking, floating or bobbing, even when they are standing still.

PPPD is thought to result from a combination of factors involving sensory integration and central nervous system processing. It is not a psychiatric disorder. It may develop following an acute vestibular disorder, such as vestibular neuritis or labyrinthitis, but can also arise independently or be triggered by other factors such as migraine, anxiety or a cardiovascular event.

Diagnosis of PPPD is based on clinical symptoms and medical history, as there are no specific diagnostic tests for the condition. Healthcare providers may perform a thorough evaluation to rule out other potential causes of dizziness and balance problems.

Treatment for PPPD typically involves a multidisciplinary approach, including vestibular rehabilitation therapy to improve balance and reduce symptoms, cognitive-behavioral therapy (CBT) to address coping strategies, medications and lifestyle modifications. The goal of treatment is to help individuals manage their symptoms and improve their quality of life.


Meniere’s Disease

Meniere's disease is a disorder of the inner ear that affects balance and hearing. It's characterized by episodes of vertigo (a sensation of spinning), hearing loss, tinnitus (ringing in the ear), and a feeling of fullness or pressure in the affected ear.

The exact cause of Meniere's disease is not fully understood, but it's believed to involve fluid buildup in the compartments of the inner ear, known as the labyrinth. This fluid buildup, called endolymphatic hydrops, can affect the function of the inner ear structures responsible for balance and hearing.

Meniere's disease typically presents in recurrent episodes or "attacks" that can vary in duration and severity. Between attacks, individuals may experience periods of remission where symptoms improve or resolve completely. Over time, however, some individuals may develop permanent hearing loss in the affected ear. The diagnosis of Meniere's disease is based on a combination of symptoms, medical history and diagnostic tests, which may include hearing tests, balance assessments and imaging studies to rule out other potential causes of symptoms.

Treatment for Meniere's disease aims to manage symptoms and reduce the frequency and severity of episodes. This may involve dietary changes (such as reducing salt intake), medications to control symptoms of vertigo, vestibular rehabilitation therapy, and in some cases, surgical procedures or other interventions to alleviate fluid buildup in the inner ear. The specific treatment approach may vary depending on the individual's symptoms and response to treatment.


Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder characterized by brief episodes of vertigo (a spinning sensation) that are triggered by changes in head position. BPPV occurs when small calcium carbonate crystals, called otoconia, become dislodged from their normal position within the inner ear and migrate into one of the semicircular canals, which are fluid-filled structures responsible for sensing rotational movement.

When the head is moved, these displaced crystals can cause abnormal fluid movement within the semicircular canal, leading to a sensation of spinning or dizziness. The vertigo experienced in BPPV is typically short-lived and triggered by specific head movements, such as rolling over in bed, tilting the head back or looking up.

Common symptoms of BPPV include brief episodes of vertigo lasting less than one minute, typically triggered by changes in head position, as well as accompanying symptoms of nausea, imbalance, and occasionally, nystagmus (involuntary eye movements).

Diagnosis of BPPV is typically based on a combination of clinical history and physical examination maneuvers, such as the Dix-Hallpike test or the supine roll test, which aim to provoke and reproduce characteristic vertigo and nystagmus associated with the condition. Additional tests, such as videonystagmography (VNG) or electronystagmography (ENG), may be performed to confirm the diagnosis and rule out other potential causes of vertigo. Treatment for BPPV often involves a series of simple maneuvers known as canalith repositioning procedures or particle repositioning maneuvers, such as the Epley maneuver or the Half Somersault maneuver, which aim to reposition the displaced otoconia within the inner ear and alleviate symptoms. These maneuvers can often provide rapid relief from vertigo and may be performed by a healthcare provider or taught for self-administration at home. In some cases, additional treatments or follow-up maneuvers may be necessary to fully resolve symptoms.

Vestibular Neuritis

Vestibular neuritis is a condition characterized by inflammation of the vestibular nerve, which connects the inner ear to the brainstem and plays a crucial role in maintaining balance and spatial orientation. This inflammation typically results from a viral infection, often involving the same viruses responsible for causing colds or other upper respiratory infections.

The inflammation of the vestibular nerve can disrupt the transmission of signals between the inner ear and the brain, leading to symptoms such as:

  • Vertigo: A sensation of spinning or whirling, typically severe and sudden in onset, often triggered by changes in head position.
  • Nausea and vomiting: Vertigo associated with vestibular neuritis can be intense enough to cause nausea and vomiting.
  • Unsteadiness or imbalance: Individuals with vestibular neuritis may experience feelings of unsteadiness or imbalance, particularly during episodes of vertigo.
  • Nystagmus: Involuntary rapid eye movements, often characterized by horizontal or rotary movements, may occur during episodes of vertigo.

Unlike labyrinthitis, the symptoms of vestibular neuritis are typically not associated with hearing loss or tinnitus (ringing in the ears) as the inflammation primarily affects the vestibular portion of the inner ear.

The diagnosis of vestibular neuritis is based on a combination of clinical history, physical examination findings, and ruling out other potential causes of symptoms. Additional tests, such as vestibular function tests or imaging studies, may be performed to confirm the diagnosis and assess the extent of vestibular dysfunction. Treatment for vestibular neuritis often involves symptomatic management to alleviate vertigo and associated symptoms, such as anti-vertigo medications, anti-nausea medications, and vestibular rehabilitation therapy to promote compensation for vestibular deficits and improve balance. While symptoms of vestibular neuritis can be debilitating initially, most individuals experience significant improvement over time, with many achieving complete resolution of symptoms within a few weeks to months.


Labyrinthitis is a condition characterized by inflammation of the labyrinth, a complex structure within the inner ear that includes the cochlea (responsible for hearing) and the vestibular system (responsible for balance). Labyrinthitis typically occurs as a result of a viral or bacterial infection, although it can also be triggered by other factors such as allergies, autoimmune disorders or certain medications.

The inflammation of the labyrinth can disrupt both hearing and balance, leading to symptoms such as:

  • Vertigo: A sensation of spinning or whirling, often severe and sudden in onset, typically triggered by changes in head position.
  • Hearing loss: Labyrinthitis can cause temporary or permanent hearing loss, which may affect one or both ears. The severity of hearing loss can vary depending on the extent of inflammation and damage to the cochlea.
  • Tinnitus: Ringing, buzzing or other noises in the ear may occur in individuals with labyrinthitis, often associated with hearing loss.
  • Nausea and vomiting: Vertigo associated with labyrinthitis can be intense enough to cause nausea and vomiting.
  • Imbalance: Feelings of unsteadiness or imbalance may occur, particularly during episodes of vertigo.

Diagnosis of labyrinthitis is typically based on clinical history, physical examination findings (such as the presence of characteristic nystagmus), and ruling out other potential causes of symptoms. Additional tests, such as hearing tests (audiometry) and vestibular function tests, may be performed to assess the extent of hearing and balance dysfunction.

Treatment for labyrinthitis often involves symptomatic management to alleviate vertigo and associated symptoms, such as anti-vertigo medications, anti-nausea medications, and vestibular rehabilitation therapy to promote compensation for vestibular deficits and improve balance. In cases where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed. Most individuals with labyrinthitis experience significant improvement in symptoms over time, although recovery may take several weeks to months, particularly in cases of severe inflammation or permanent hearing loss.

Superior Semicircular Canal Dehiscence

Superior semicircular canal dehiscence (SSCD) is a rare medical condition where there is an abnormal opening or thinning in the bone covering the superior semicircular canal of the inner ear. This canal is one of the three semicircular canals responsible for detecting rotational movements of the head and maintaining balance.

In SSCD, the dehiscence (opening) in the bone can lead to abnormal communication between the inner ear and surrounding structures, causing various symptoms such as:

  • Vertigo: Individuals with SSCD may experience vertigo or dizziness, often triggered by loud noises or changes in middle ear or intracranial pressure.
  • Dizziness or imbalance: Some individuals may feel unsteady or imbalanced, particularly in situations where pressure changes, such as during straining, coughing or sneezing.
  • Hearing symptoms: While hearing loss is not a common symptom of SSCD, individuals may experience certain auditory symptoms such as sensitivity to sound (hyperacusis) or hearing one's own voice abnormally loud (autophony).
  • Pulsatile tinnitus: Some individuals may experience a pulsing or rhythmic sound in the affected ear, which can be synchronous with the heartbeat.

Diagnosis of SSCD involves a combination of clinical history, physical examination, and specialized tests such a VNG and/or a CT scan to confirm the presence of a dehiscence in the superior semicircular canal.

Treatment for SSCD may include conservative management, such as lifestyle modifications to avoid triggers, vestibular rehabilitation therapy and use of hearing protection to minimize sound-induced symptoms. In cases where symptoms are severe or significantly affect quality of life, surgical repair of the dehiscence may be considered. However, the decision for surgical intervention is based on individual symptoms, severity and patient preferences, and should be discussed with a healthcare provider experienced in managing SSCD.

Post-concussion dizziness

Post-concussion dizziness refers to dizziness or vertigo that occurs following a concussion, which is a type of traumatic brain injury typically caused by a blow to the head or a sudden jolt to the body. Dizziness is a common symptom following a concussion and can significantly impact an individual's daily functioning and quality of life.

Post-concussion dizziness can manifest in various ways, including:

  • Vertigo: A sensation of spinning or whirling, often triggered by changes in head position.
  • Lightheadedness: A feeling of faintness or feeling like one might pass out.
  • Unsteadiness: A sense of imbalance or feeling like one might fall.
  • Visual disturbances: Blurred vision, sensitivity to light or difficulty focusing may occur.
  • Nausea: Dizziness can often be accompanied by feelings of nausea or vomiting.

The exact mechanisms underlying post-concussion dizziness are not fully understood but may involve dysfunction of the vestibular system (responsible for balance) or other structures within the inner ear and brain that regulate balance and spatial orientation. Additionally, factors such as inflammation, changes in blood flow or disruptions in neurotransmitter function may contribute to dizziness following a concussion. Management of post-concussion dizziness typically involves a multidisciplinary approach, including rest and gradual return to activities, symptomatic management (such as medications for dizziness or nausea), vestibular rehabilitation therapy to improve balance and reduce symptoms, and cognitive-behavioral therapy (CBT) or other psychological interventions to address anxiety or other emotional factors that may exacerbate symptoms.

It's essential for people experiencing post-concussion dizziness to seek evaluation and management from a healthcare provider experienced in treating concussion and related symptoms. A comprehensive assessment can help identify the underlying causes of dizziness and guide appropriate treatment strategies to promote recovery and improve quality of life.

Fall risk in the elderly

Fall risk in the elderly is a significant concern due to the increased likelihood of falls and potential for serious injuries. Several factors contribute to the increased risk of falls among older adults:

  • Age-related changes: As people age, changes in vision, balance, muscle strength and coordination can increase the risk of falls.
  • Medical conditions: Chronic health conditions such as arthritis, osteoporosis, Parkinson's disease, stroke, diabetes and cardiovascular disease can affect mobility and increase fall risk.
  • Medications: Certain medications, especially those that affect blood pressure, balance or cognition, can increase the risk of falls. Polypharmacy (taking multiple medications) is also a risk factor.
  • Environmental factors: Hazards in the home environment, such as poor lighting, slippery floors, uneven surfaces and lack of handrails or grab bars, can contribute to falls.
  • Nutritional factors: Malnutrition, dehydration, and vitamin D deficiency can weaken muscles and bones, increasing the risk of falls.
  • Cognitive impairment: Conditions such as dementia or Alzheimer's disease can affect judgment, spatial awareness and decision-making, leading to an increased risk of falls.

To reduce fall risk in elderly individuals, it's essential to implement preventive strategies:

  • Regular exercise: Engaging in regular physical activity to improve strength, balance and flexibility can help reduce fall risk. Activities such as walking, tai chi and strength training are beneficial.
  • Medication management: Reviewing medications with a healthcare provider to identify potential side effects or interactions that may increase fall risk. Minimizing the use of sedatives, tranquilizers and medications that lower blood pressure can be beneficial.
  • Home modifications: Making modifications to the home environment to remove hazards and improve safety, such as installing handrails, grab bars, nonslip mats and adequate lighting.
  • Vision and hearing checks: Regular vision and hearing assessments can identify impairments that may contribute to falls. Corrective lenses and hearing aids can help improve sensory function.
  • Nutrition: Ensuring adequate intake of nutrients, including calcium and vitamin D, to support bone health and muscle strength.
  • Fall detection and response: Using devices such as medical alert systems or fall detection sensors can provide assistance in the event of a fall.
  • Regular healthcare visits: Regular check-ups with healthcare providers to assess overall health, mobility and fall risk, and to address any underlying medical conditions or concerns

By addressing these factors and implementing preventive measures, the risk of falls in elderly individuals can be reduced, promoting safety, independence and quality of life.

Other less common causes of dizziness, vertigo and imbalance

When dizziness occurs as a result of a stroke, it may be accompanied by other symptoms such as weakness or numbness on one side of the body, difficulty speaking or understanding speech, sudden severe headache, and loss of coordination or balance.

Dizziness associated with stroke can have various underlying causes, including disruption of blood flow to the brain due to a blockage (ischemic stroke) or bleeding into the brain tissue (hemorrhagic stroke). Depending on the location and extent of the brain injury, dizziness may occur as a result of damage to structures involved in balance and spatial orientation, such as the brainstem, cerebellum or vestibular nuclei.

It's important to note that dizziness can also be caused by other medical conditions unrelated to stroke, such as inner ear disorders, vestibular migraines or benign positional vertigo. Therefore, if you or someone else experiences sudden or severe dizziness, especially if it is accompanied by other symptoms suggestive of stroke, it's crucial to seek immediate medical attention.

If you suspect someone is having a stroke, remember the acronym FAST to recognize and respond to stroke symptoms:

  • F: Face drooping
  • A: Arm weakness
  • S: Speech difficulty
  • T: Time to call emergency services

Prompt medical treatment is essential in stroke management to minimize brain damage and improve outcomes. If you or someone else is experiencing symptoms of stroke, do not delay - call emergency services immediately.

Multiple Sclerosis

Dizziness is a common symptom experienced by individuals with Multiple Sclerosis (MS), a chronic autoimmune disease that affects the central nervous system. Dizziness in MS can have various underlying causes and may present in different forms, including vertigo, lightheadedness, or feelings of unsteadiness or imbalance.

The exact mechanisms underlying dizziness in MS are not fully understood but may involve damage or disruption to areas of the brain and spinal cord responsible for processing sensory information, maintaining balance and coordinating movement. MS lesions (areas of inflammation and demyelination) can affect structures such as the brainstem, cerebellum and vestibular nuclei, which play crucial roles in balance and spatial orientation.

Dizziness in MS may occur as a result of various factors, including:

  • Lesions affecting the vestibular system: Damage to the vestibular nuclei or other vestibular structures can lead to vertigo (a sensation of spinning or motion), dizziness or feelings of unsteadiness.
  • Sensory disturbances: MS-related sensory disturbances, such as altered proprioception (sense of body position) or disrupted visual processing, can contribute to feelings of imbalance or unsteadiness.
  • Fatigue: Fatigue is a common symptom of MS and can exacerbate feelings of dizziness or lightheadedness, particularly during periods of increased physical or cognitive exertion.
  • Medications: Some medications used to manage MS symptoms, such as muscle relaxants or medications for spasticity, may cause dizziness or lightheadedness as side effects.

Managing dizziness in MS often involves a multidisciplinary approach, including:

  • Medication: Medications may be prescribed to manage specific symptoms such as vertigo or lightheadedness.
  • Vestibular rehabilitation therapy: Exercises and techniques aimed at improving balance, coordination and compensating for vestibular dysfunction.
  • Lifestyle modifications: Strategies to minimize triggers for dizziness, such as avoiding sudden head movements, staying hydrated and managing fatigue.
  • Regular monitoring: Regular assessment by healthcare providers to monitor symptoms, adjust treatment as needed and address any new or worsening symptoms promptly.

Individuals with MS experiencing dizziness or balance problems should consult with their healthcare provider for a comprehensive evaluation and personalized management plan.

Cerebellar Disorders

Cerebellar dizziness refers to dizziness or vertigo that arises due to dysfunction or damage to the cerebellum, a structure located at the back of the brain responsible for coordinating movement, balance and posture. The cerebellum plays a crucial role in processing sensory information from the vestibular system (responsible for balance) and integrating it with motor commands to maintain smooth and coordinated movements.

Dizziness associated with cerebellar dysfunction can manifest in various ways, including:

  • Vertigo: A sensation of spinning or whirling, often severe and sudden in onset, which may be exacerbated by certain head movements.
  • Ataxia: Difficulty with coordination and balance, leading to unsteady or staggering gait (walking pattern) and difficulty with fine motor tasks such as writing or buttoning clothes.
  • Nystagmus: Involuntary, rhythmic eye movements, which may be horizontal, vertical or rotary in nature.
  • Dysmetria: Difficulty accurately judging the distance or range of movement, leading to overshooting or undershooting targets during reaching or pointing tasks.
  • Dysarthria: Speech difficulties characterized by slurred or poorly articulated speech, often due to impaired coordination of the muscles involved in speech production.

Cerebellar dizziness can occur as a result of various underlying conditions or factors, including:

  • Cerebellar stroke: Interruption of blood flow to the cerebellum can lead to cerebellar infarction or hemorrhage, resulting in dizziness and other neurological symptoms.
  • Cerebellar degenerative disorders: Conditions such as spinocerebellar ataxia, multiple system atrophy or cerebellar tumors can cause progressive dysfunction and damage to the cerebellum, leading to dizziness and other cerebellar symptoms.
  • Cerebellar lesions: Traumatic brain injury, tumors, infections or autoimmune conditions affecting the cerebellum can result in dizziness and other neurological deficits.

Management of cerebellar dizziness involves addressing the underlying cause, as well as symptomatic management to alleviate dizziness and improve function. Treatment may include medications to manage symptoms, vestibular rehabilitation therapy to improve balance and coordination, speech therapy for dysarthria, and surgical intervention or other treatments depending on the underlying condition. Individuals experiencing cerebellar dizziness should seek evaluation and management from a healthcare provider experienced in neurological disorders for comprehensive assessment and personalized treatment.


VEMP stands for Vestibular Evoked Myogenic Potential. It's a type of diagnostic test used to evaluate the function of the otolith organs within the inner ear, specifically the saccule and utricle, which are responsible for detecting linear acceleration and head position relative to gravity.

During a VEMP test, surface electrodes are typically placed on the skin overlying certain muscles, such as the sternocleidomastoid muscle in the neck or the orbicularis oculi muscle around the eyes. The patient is then instructed to perform specific actions, such as turning the head to one side or looking upward, which activates the otolith organs.

The VEMP test measures the electrical responses generated by the otolith organs in response to these stimuli. Specifically, it assesses the myogenic (muscle-generated) response of the muscles being monitored. The test helps evaluate the integrity and function of the vestibular system, particularly the saccule and utricle, and can aid in the diagnosis of certain vestibular disorders, such as superior semicircular canal dehiscence (SSCD), Meniere's disease and vestibular neuritis.

VEMP testing is often performed alongside other vestibular function tests, such as videonystagmography (VNG) or electronystagmography (ENG) and can provide valuable information to clinicians in diagnosing and managing vestibular disorders.

How to prepare:

  1. Medication: do not stop any long-term daily medications. Do not take vestibular suppressants such as antihistamines (Benadryl, Meclizine, Bonine), benzodiazepines (Valium, Xanax, Ativan), or other sedating medications such as sleep aids 24-48 hours prior to testing.
  2. Avoid caffeine and nicotine: It's often recommended to avoid caffeine and nicotine for a certain period before the test, as they can affect vestibular function and eye movements.
  3. Eat a light meal: Having a light meal before the test is generally recommended, as the test can occasionally cause nausea.
  4. Wear comfortable clothing: Dress comfortably for the test, as you may be lying down or sitting for an extended period during the procedure.
  5. Remove eye makeup and contact lenses: If you wear eye makeup or contact lenses, you may be asked to remove them before the test.
  6. Plan for transportation: Since the test may induce dizziness or vertigo, it's a good idea to arrange for someone to drive you home afterward, especially if you anticipate feeling unwell or dizzy.

MRI stands for Magnetic Resonance Imaging. It is a medical imaging technique used to visualize internal structures of the body in detail. MRI utilizes strong magnetic fields and radio waves to generate images of organs, tissues and other body structures. Unlike X-rays or CT scans, MRI does not use ionizing radiation, making it safer for repeated use. MRI is commonly used to diagnose and monitor a variety of medical conditions such as tumors, injuries, infections and neurological disorders.

A CT scan, or Computed Tomography scan, is a medical imaging technique that uses X-rays to create detailed cross-sectional images of the body. The CT scanner rotates around the patient, taking multiple X-ray images from different angles. A computer then processes these images to create cross-sectional slices, which can be viewed in various planes (e.g., axial, sagittal, coronal).

CT scans are valuable for diagnosing a wide range of conditions, including bone and joint disorders, internal injuries, tumors and infections. They provide detailed images of soft tissues, organs, bones and blood vessels, making them particularly useful for detecting abnormalities and guiding medical interventions.           

While CT scans provide high-resolution images, they do expose patients to ionizing radiation, which can pose risks, particularly with repeated scans. However, advancements in technology have led to reduced radiation doses in modern CT scanners, making them safer while still providing high-quality images.