Have you ever been lightheaded? Felt the room spin? Been unsteady or unbalanced?

While we use words such as “dizzy” or “vertigo” for these feelings, medical experts say each is a distinct sensation that has a specific cause and hopefully, a successful treatment option.

We spoke with two UCHealth experts at the University of Colorado Anschutz Medical Campus and UCHealth Boulder Health Center to provide perspective on the issue: Lina Kleinschmidt, a physical therapist, and Cassandra Constine, a doctor of physical therapy.

Dizziness vs. vertigo: What are they and what’s the difference?

“There’s a big difference between the two,” Kleinschmidt said. “Vertigo is such a commonly thrown-out term, and on the other hand, we see patients who say, ‘I have dizziness.’ There are dozens of terms for what dizziness might be, and sometimes it’s difficult for people to explain exactly what they’re experiencing.”

Dizziness is an umbrella term for a variety of sensations including rocking, feeling faint, weak woozy or unsteady. Vertigo is a more specific feeling that you, or the world around you, is spinning (think Teacup ride in Disneyland).

What causes dizziness and vertigo?

Dizziness can be caused by a variety of scenarios: something as straightforward as dehydration or standing up too quickly. In addition, some medications can cause side effects that make people feel dizzy. Serious health conditions like strokes and heart attacks also can cause dizziness. Because dizziness can originate from any one of multiple organs such as the eyes, ears, brain or heart, it makes it that much more difficult for physicians to tackle.

Vertigo is mainly caused by problems stemming from the inner ear. The most common reason for vertigo is benign paroxysmal positional vertigo (BPPV), which is triggered by a positional change of your head when you are laying down.  This condition, which occurs when small calcium crystals in the inner ear become loose, usually goes away on its own. If it doesn’t resolve itself, it can be treated by health care professionals through a movement called the Epley Maneuver, which is the positioning of the head and neck in a certain way so as to remove the crystals from the ear canal.

“BPPV is easily remedied,” Kleinschmidt said. “There isn’t one overarching reason why people get it, though research shows that it happens to women more often. Other risk factors might include being sedentary for long period of time, being on steroids, having osteoporosis or experiencing head trauma.”

A less common cause of vertigo includes something called vestibular hypo function, occurring when the part of the inner ear that controls balance is not working properly. The vestibular system is a complex set of neural pathways that give us our sense of balance and equilibrium, with the five major vestibular structures located in the inner ear.

Vestibular hypo function can be caused by viruses, head trauma, certain medications, and even long Covid-19 effects. Trying to pinpoint exactly what caused the problem can be frustrating for patients, and the treatment plan can look different for each person, taking months, if not longer, for patients to improve.

“You have to retrain your brain to use your vestibular system correctly,” Kleinschmidt said. “With certain chronic vestibular conditions, your brain is getting too overstimulated by sensory information. It’s a processing problem.”

Are dizziness and vertigo related to COVID-19?

Yes. Experts at the U.S. Centers for Disease Control and Prevention have identified dizziness and vertigo as common symptoms for people who are dealing with long COVID.

Are there medications that work to treat vertigo?

There is no medication that “fixes” a compromised vestibular system, although there are some that help manage symptoms. These include anti-nausea medications for acute vertigo and drugs for vestibular migraines (a neurological diseases that causes vertigo) and Meniere’s disease (an inner ear disease that causes vertigo).

“The tricky thing is, some of these medications mask your symptoms and don’t fix the problem,” Kleinschmidt said.

As people become more aware of their vertigo, they hopefully can become better at managing triggers; for instance, avoiding certain physical movements that elicit symptoms as well as various sensory experiences having to do with light, sound and smell that can exacerbate feelings of dizziness or vertigo.

Are more women affected by vertigo and dizziness than men? 

Yes. Especially when it comes to vertigo, more women than men suffer from it. Researchers are looking at hormones as a potential culprit.

What types of doctors and medical providers treat these problems?

It’s good to start with an ear, nose and throat specialist, also known as an ENT. These doctors can perform a hearing test and more specifically, a videonystagmography (VNG) test, which measures the health of the inner ear, along with eye movements you can’t control. These tests can help determine if you have Meniere’s disease or vestibular migraines. If more testing is required, you might be referred to a neurologist for a potential MRI, CT or EEG test to see whether any potential abnormalities in your ear or brain are causing your symptoms.

Anywhere along the way, physical therapy is a good option to relieve symptoms as well.

How does physical therapy help?

“The first thing we do is we ask our patients how they feel,” Constine said. “Part of what we do is to recreate a person’s dizziness to help determine what is making them feel bad.”

They might ask a patient: Do you feel you are in a teacup? A wobbly boat? A fun house? Do you ever see stars?

“Everyone explains it so differently, and we try to create a space where people can feel free,” Kleinschmidt said. “Our first step is differential diagnosis. Could it be vestibular? Cardiovascular? Neurological?”

If patients suffer from BPPV, they can usually successfully be treated with Epley maneuvers within a few sessions over a couple weeks. If it’s something other than BPPV, therapists will conduct head and eye movement exercises to see how well the two organs are communicating.

Other PT sessions might include balance exercises and ones that counteract the actions that cause dizziness. Conversely, some of the exercises might induce a slight amount of dizziness in a patient so the brain retrains itself to work through it.

“For many of these patients, their brain is confused. Their eyes are telling their brain one set of information, and the vestibular system is telling it another. We need to retrain the brain to communicate with the vestibular system better and the brain to process that information better,” Kleinschmidt said.

The result for patients? Hopefully, a “retrained” vestibular system, where the eyes are doing 10 percent of maintaining the body’s balance, the inner ear 20 percent, and the somatosensory, 70 percent.

The somatosensory is your body’s awareness of where you are in the world around you.

What should I do if I feel dizzy?

Dizziness is a disconnect from the world around you, so it’s important that people experiencing it get additional sensory input from the environment. For instance, you will typically feel less dizzy if you lay down. Using weighted blankets, relaxation techniques and calming strategies are also beneficial.

“A huge part of our role is education. Dizziness is scary and not being in control of being dizzy is scary as well,” Kleinschmidt said.

Can I drive with vertigo or dizziness?

It depends.

“We need to know what is provoking their dizziness. If looking over your shoulder or moving your head is causing dizziness, then no, you shouldn’t be driving.” Constine said. “It’s completely dependent upon the person and what is causing their symptoms and safety is always the number one priority.”

Is there new research into the causes of vertigo and dizziness?

Yes. Researchers are trying to find new maneuvers to help BPPV. The positions required for the maneuvers can be more difficult for individuals with other health challenges like knee and back pain, so new research is looking at positioning that is easier for patients to manage.

Will dizziness and vertigo go away? 

It is never too late to go to physical therapist no matter how many years you have been experiencing these symptoms. For some people, the symptoms may become chronic, depending on what other conditions you have. You should always seek medical treatment if you are experiencing these afflictions for more than a few days.

Can certain foods or vitamins help?

For some people, a noninflammatory diet is beneficial. This includes a low-salt, low-sugar, low-caffeine diet. Medical experts also encourage anyone with vertigo or dizziness to reduce or eliminate their alcohol consumption since alcohol can aggravate symptoms. Some research shows that vitamins C and D may help alleviate symptoms of dizziness and vertigo.

What should I do if I experience dizziness or vertigo?

Both Kleinschmidt and Constine encourage you to quickly seek medical attention if you have dizziness or vertigo, especially if it comes with nausea and vomiting, chest pain, headache or vision issues.

“Dizziness comes in so many shapes, forms, sensations. They all matter, and they are all important to that person,” Kleinschmidt said. “Talk to your primary care physician or physical therapist about it because we can help. It doesn’t matter how long you’ve had it. We still can help. We need people to be OK with telling us symptoms even if they sound weird. Especially with women, it’s overlooked for so long. It all matters. Your voice matters.”