Our balance system is quite complex, therefore, any dizziness or vertigo can be multifactorial. For some people balance problems or vertigo is linked to the inner ear (peripheral dizziness) and for others, it may be linked to problems in the central pathway, leading up to the brain (central dizziness). That is why it is important to obtain an accurate and thorough history which can then be backed up with tests if required.

Without realising it, our bodies work quite hard in order to remain balanced. Our eyes are connected to our ears with something called the vestibulo-ocular reflex. This allows us to focus and stabilise an image when we turn our heads. We also have balance organs in our ears, which sends information to our brains to tell us when we are making certain movements. Imagine your ears working like the wings on an aeroplane. All of this information needs to pair up with our muscles, spine and movement and what is sent to our brains. If one or more of the signals are impaired or broken, it can cause us to feel dizzy.

Benign Paroxysmal Positional Vertigo (BPPV). This type of dizziness usually presents as you get older or following head trauma. It is a balance condition that affects the semi-circular canals in the inner ear. It is linked to the displacement of crystals of calcium carbonate which moves around or attaches to areas it shouldn’t be. Symptoms include dizziness when you move your head, for example when you roll over in bed or dizziness when hanging up the clothes. This type of dizziness can be tested for and treated easily for most people.

Meniere’s Disease (MD) is a balance condition that usually comes with a warning sign, commonly a fluctuating low frequency hearing loss and tinnitus. You may also feel a pressure sensation in the ear before you are about to feel dizzy. Episodes of dizziness can occur regularly during the acute phase and then usually burns out leaving you with a permanent hearing loss on one side. Management in the form of rehabilitation exercises can be beneficial.

Migraine associated vertigo (MAV) can present itself with similar symptoms as Meniere’s (MD) and can present without any headaches. Rehabilitation exercises may be beneficial for MAV.