Dizziness and Vertigo: Common Causes and When to Worry

Dizziness is one of the most common reasons people visit a neurologist — and one of the most misunderstood. "Dizzy" can mean lightheadedness, unsteadiness, or true vertigo, where the room seems to spin. Each points to different causes, and sorting them out is exactly what a neurological evaluation is for.

Vertigo vs. lightheadedness

True vertigo is a false sensation of movement — spinning, tilting, or rocking. It usually comes from the inner ear or the brain’s balance centers. Lightheadedness, the feeling that you might faint, more often relates to blood pressure, dehydration, medications, or heart rhythm. The distinction matters because the treatments are completely different.

Common, treatable causes

• BPPV — loose crystals in the inner ear; brief spinning when you roll over or look up, often fixed with a simple repositioning maneuver
• Vestibular migraine — dizziness with or without headache, frequently with light sensitivity
• Vestibular neuritis — sudden, intense vertigo after a viral illness
• Medication side effects — blood pressure drugs, sedatives, and some antidepressants
• Peripheral neuropathy — unsteadiness from reduced sensation in the feet, common with diabetes

When dizziness is a red flag

Seek emergency care if dizziness starts suddenly and comes with double vision, trouble speaking or swallowing, weakness or numbness on one side, a severe new headache, or inability to walk. In Miami’s older population especially, these can signal a stroke in the brain’s balance centers — call 911 rather than waiting it out.

How a neurologist finds the cause

The evaluation starts with the story: what the dizziness feels like, how long it lasts, and what triggers it. A focused exam of eye movements, balance, and sensation often identifies the source in one visit. When needed, we add hearing tests, imaging, or nerve studies. Most patients leave with a clear diagnosis — and most causes of dizziness, once named, respond well to treatment.