Vertigo is the sensation of feeling off-balance, where you perceive spinning or movement when none exists. This differs from general dizziness, which may feel like lightheadedness or unsteadiness. True vertigo is typically a symptom of an issue within the balance system, which involves the inner ear and the central nervous system in the brain. Because the underlying cause can range from a simple inner ear crystal displacement to a more complex neurological condition, a structured approach, starting with a general practitioner, helps ensure an accurate diagnosis and appropriate referral to a specialist.
Initial Consultation: The Primary Care Physician
The Primary Care Physician (PCP) is the first point of contact for most patients experiencing vertigo. Their function is to act as a gatekeeper, performing the initial triage to differentiate between causes of dizziness and true vertigo. During this visit, the PCP conducts a detailed medical history, focusing on the duration, frequency, and specific triggers of the spinning sensation.
The physical examination often includes tests to rule out causes of dizziness, such as dehydration, medication side effects, or cardiac issues. PCPs are trained to look for “red flag” symptoms that might indicate a serious central cause, such as a stroke, including persistent vertigo, double vision, or difficulty walking. For the most common cause of vertigo, Benign Paroxysmal Positional Vertigo (BPPV), many PCPs can perform the Dix-Hallpike maneuver to confirm the diagnosis.
Differentiating Medical Specialists: ENT vs. Neurologist
The two specialists who most frequently treat vertigo are Otolaryngologists (ENT specialists) and Neurologists, with the choice depending on the source of the balance disturbance. Otolaryngologists specialize in disorders of the ear, nose, and throat, making them experts in peripheral vertigo, which originates in the inner ear’s vestibular system. Peripheral causes like BPPV, Meniere’s disease, or labyrinthitis are diagnosed using tools like electronystagmography (ENG) or videonystagmography (VNG) to record involuntary eye movements (nystagmus) triggered by inner ear signals.
Neurologists specialize in the brain and primarily treat central vertigo, which stems from conditions affecting the brainstem or cerebellum. These causes include vestibular migraine, stroke, or multiple sclerosis, and present with more severe or persistent symptoms not triggered by simple head movements. Neurologists use a detailed neurological exam and sometimes advanced imaging like Magnetic Resonance Imaging (MRI) to identify central nervous system causes. The key distinction is that peripheral vertigo is usually intense but brief and positional, whereas central vertigo can be less dramatic but continuous, often accompanied by other neurological deficits.
Non-Physician Treatment: Vestibular Rehabilitation Therapy
A significant treatment component for many vertigo types is Vestibular Rehabilitation Therapy (VRT). VRT is a specialized, exercise-based program administered by Physical Therapists or Occupational Therapists who have advanced training in vestibular disorders.
VRT aims to retrain the brain and body to compensate for deficits in the inner ear’s balance system. Exercises fall into categories like habituation, which involves repeated exposure to movements that provoke dizziness to decrease sensitivity, and gaze stabilization, which improves visual clarity during head motion. For BPPV, the therapist performs the Canalith Repositioning Procedure, such as the Epley maneuver, a series of controlled head movements designed to guide displaced calcium crystals (otoconia) out of the inner ear canals. VRT is a long-term solution that helps the patient achieve functional recovery, even when the underlying cause cannot be fully cured.
Preparing for Your Vertigo Appointment
Keeping a detailed log of symptoms is helpful for diagnosis, noting the specific sensation—whether it is true spinning, tilting, or unsteadiness. The log should document the duration of each vertigo episode, whether it lasts seconds, minutes, or hours, and list any specific triggers, such as rolling over in bed or looking up.
Compiling a list of all current medications is important, as many drugs can cause dizziness as a side effect. Patients should also note any accompanying symptoms, such as hearing loss, ringing in the ears (tinnitus), severe headaches, or nausea. This organized information allows the physician to narrow down the potential cause and determine the most appropriate diagnostic testing or specialist referral.