Neck Pain
Neck pain may be accompanied by stiffness, reduced movement, headaches or symptoms in the shoulder or arm. Learn about common causes, assessment and treatment options.
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Dizziness & Vertigo Assessment and Treatment
Understanding the cause of dizziness, vertigo and balance problems is the first step towards choosing the right treatment.
Dizziness can mean different things to different people. You may feel that the room is spinning, feel unsteady when walking, experience brief dizziness when turning in bed, or simply feel that your balance is not quite right.
There are many possible causes, including inner-ear conditions such as BPPV, migraine, medication and blood-pressure effects, neurological conditions and, in some people, problems associated with the neck.
At Isis Chiropractic Centres, we assess the pattern of your symptoms and relevant neurological, balance, vestibular and musculoskeletal findings to help determine the most appropriate next step.
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What Is Causing Your Dizziness or Vertigo?
Dizziness is a symptom rather than a single diagnosis, and finding the likely cause is important before deciding how it should be treated.
Vertigo usually describes a false sensation of movement or spinning. Other people describe light-headedness, imbalance, unsteadiness or a floating sensation.
The pattern can provide useful clues. Brief spinning triggered by rolling over in bed may suggest benign paroxysmal positional vertigo (BPPV), while dizziness associated with neck pain or restricted neck movement may sometimes have a cervical contribution.
Other presentations require medical or specialist assessment. Our first priority is therefore to establish whether the symptoms appear suitable for conservative care or whether another healthcare pathway is more appropriate.
What Is the Difference Between Dizziness and Vertigo?
The words dizziness and vertigo are often used interchangeably, but they do not necessarily describe the same experience.
Vertigo usually refers to an illusion of movement. You may feel that you or the surroundings are spinning or moving even though you are stationary.
Dizziness is a broader term and can include light-headedness, unsteadiness, imbalance, disorientation or a feeling that you may faint.
Understanding exactly what you experience, how long it lasts and what triggers it can provide important clues about the possible cause.
What Can Cause Dizziness and Vertigo?
There are many possible causes, and more than one factor may sometimes be involved.
These include:
- Benign paroxysmal positional vertigo (BPPV)
- Vestibular neuritis or labyrinthitis
- Vestibular migraine
- Blood-pressure changes and fainting-related conditions
- Medication effects
- Problems affecting balance or vision
- Neurological conditions
- Head or neck injury
- Musculoskeletal neck problems associated with dizziness in some people
The appropriate treatment therefore depends on identifying the likely cause rather than treating all dizziness in the same way.
What Is BPPV?
Benign paroxysmal positional vertigo (BPPV) is a common inner-ear cause of vertigo.
Inside the inner ear are structures involved in detecting movement and maintaining balance. In BPPV, tiny calcium carbonate particles called otoconia become displaced into one of the semicircular canals, where they can create abnormal signals when the head changes position.
This typically produces short episodes of spinning vertigo associated with particular head movements.
What Does BPPV Feel Like?
BPPV commonly causes brief episodes of rotational vertigo triggered by changes in head position.
Typical triggers can include:
- Rolling over in bed
- Getting into or out of bed
- Looking upwards
- Bending forwards
- Turning the head into a particular position
The spinning sensation is usually brief, although nausea or a sense of imbalance may persist for longer.
How Is BPPV Diagnosed?
The history often provides the first clue. Where BPPV is suspected and it is appropriate to do so, a positional test such as the Dix-Hallpike manoeuvre can be used to assess for posterior-canal BPPV.
The test involves moving the head and body into a particular position while observing for characteristic vertigo and involuntary eye movements called nystagmus.
Other positional tests may be appropriate where the history suggests a different semicircular canal is involved.
How Is BPPV Treated?
When BPPV has been identified, it can often be treated using a canalith repositioning manoeuvre.
The best known is the Epley manoeuvre. This uses a sequence of head and body positions intended to move the displaced particles out of the affected semicircular canal.
This is different from chiropractic manipulation of the neck. It is a specific treatment for an inner-ear disorder and is also used by appropriately trained medical and vestibular healthcare professionals.
Where BPPV is not the likely diagnosis, an Epley manoeuvre may not be appropriate and another cause of the dizziness should be considered.
This approach is consistent with NICE guidance, which recommends positional testing for suspected BPPV and a canalith repositioning manoeuvre such as the Epley manoeuvre when BPPV is confirmed and treatment is appropriate.
Read the NICE guidance on dizziness and vertigo →
Can Dizziness Come From the Neck?
Some people experience dizziness or unsteadiness alongside neck pain, stiffness or restricted neck movement. This is sometimes described as cervicogenic dizziness or cervical dizziness.
The proposed explanation involves altered sensory information from structures in the neck interacting with the visual and vestibular systems that help control balance and spatial orientation.
However, there is no single definitive test for cervicogenic dizziness. It is generally considered only after other important causes of dizziness have been assessed and the clinical pattern suggests an association with neck dysfunction.
How Is Cervicogenic Dizziness Assessed?
Assessment may consider whether dizziness occurs alongside neck pain, restricted movement or particular neck movements and whether there has been a previous neck injury.
The examination may include:
- Neck movement and musculoskeletal examination
- Neurological examination
- Balance and coordination
- Eye movements where clinically appropriate
- Positional testing when BPPV is suspected
- Assessment for findings suggesting another vestibular or neurological cause
Because cervicogenic dizziness is a diagnosis that requires consideration of other possible causes, persistent or unexplained dizziness may require medical, vestibular or neurological investigation.
Can Chiropractic Treatment Help Cervicogenic Dizziness?
Where dizziness appears to be associated with neck pain or dysfunction, manual therapy and rehabilitation may help some people.
Research has found improvements in dizziness symptoms following manual therapy for people diagnosed with cervicogenic or cervical-related dizziness. However, the evidence is still developing, and recent systematic reviews have rated the certainty of some of these findings as low or very low.
For this reason, treatment should only be considered after other important causes of dizziness have been assessed and where the clinical findings suggest that the neck may be contributing.
Depending on the individual assessment, treatment may include appropriate manual therapy, exercise, rehabilitation and advice about movement.
Read more about neck pain and chiropractic care →
What Is Vestibular Migraine?
Vestibular migraine can cause recurrent episodes of dizziness or vertigo, sometimes with and sometimes without a headache during the episode.
A history of migraine and the timing and characteristics of the dizziness can provide important diagnostic clues.
NICE advises clinicians to consider vestibular migraine in people with episodes of dizziness lasting between five minutes and 72 hours who have a history of recurrent headache.
Read more about migraine variants →
Is Dizziness After a Head or Neck Injury Normal?
Dizziness can occur following head or neck trauma, including whiplash.
There are several possible explanations, including vestibular disturbance, BPPV, concussion-related problems and symptoms associated with the cervical spine.
New dizziness following an injury should therefore be assessed rather than automatically attributed to the neck.
When Can Dizziness Be a Warning Sign?
Most dizziness is not caused by a serious neurological condition, but certain presentations require urgent medical assessment.
Seek urgent medical attention for sudden dizziness or vertigo associated with symptoms such as:
- New weakness or numbness affecting the face, arm or leg
- New difficulty speaking or understanding speech
- New severe difficulty walking or standing
- New loss of coordination
- Double vision or other sudden neurological symptoms
- New hearing loss associated with sudden severe dizziness
- Sudden severe or unusual headache with neurological symptoms
- Loss of consciousness or significant alteration of consciousness
Sudden continuous vertigo with nausea or vomiting and marked difficulty walking can represent an acute vestibular syndrome. Where a benign cause cannot be established, urgent medical assessment may be required to exclude a posterior circulation stroke.
Do I Need an MRI or X-Ray for Dizziness?
Imaging is not routinely required simply because somebody has dizziness.
For example, when the history and positional examination clearly support uncomplicated BPPV, routine imaging is generally unnecessary.
Imaging or specialist investigation may be appropriate when the diagnosis is uncertain or when the history or examination identifies neurological findings or other features that require further assessment.
X-rays do not diagnose BPPV or most vestibular disorders.
Can Exercise Help With Dizziness and Balance?
Exercise and rehabilitation can be useful for some causes of dizziness and balance problems.
Depending on the diagnosis, this may include vestibular rehabilitation, balance exercises, movement exercises or rehabilitation addressing associated neck dysfunction.
The appropriate exercises depend on the underlying problem, so rehabilitation should be matched to the diagnosis rather than using the same programme for every person with dizziness.
What Does the Research Say About Cervicogenic Dizziness?
Research into cervicogenic dizziness is still developing, partly because there is no single definitive diagnostic test for the condition.
A 2022 systematic review and meta-analysis found moderate-quality evidence that manual therapy reduced dizziness, neck and balance symptoms in people diagnosed with cervicogenic dizziness. The authors found that combining manual therapy with exercise may provide additional benefit, although the evidence for the combined approach was of very low quality.
More recent research has been more cautious. A 2025 systematic review and meta-analysis of randomised controlled trials found improvements in the impact and intensity of dizziness following upper-cervical manual therapy compared with control or placebo treatment, but rated the certainty of the evidence as low to very low for several outcomes.
A separate 2025 systematic review also reported predominantly short-term improvements in dizziness intensity and cervical movement, while concluding that longer-term effects remain uncertain.
Overall, the research suggests that manual therapy may help some appropriately selected people with cervical-related dizziness, but it does not support assuming that dizziness is caused by the neck without first considering other possible causes.
Research:
Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness (2022)
Is manual therapy effective for cervical dizziness? A systematic review and meta-analysis of randomised controlled trials (2025)
Effectiveness of manual therapy for cervicogenic dizziness: systematic review (2025)
Why Is Getting the Diagnosis Right So Important?
The word “dizziness” can describe conditions ranging from uncomplicated BPPV to migraine, neck-related symptoms, medication effects and neurological disease.
The treatment for each can be very different.
For example, BPPV may respond to a canalith repositioning manoeuvre, while suspected cervicogenic dizziness may be managed with an appropriate combination of manual therapy and rehabilitation. Other presentations may require assessment by a GP, vestibular specialist, ENT specialist or neurologist.
Good management therefore begins by deciding what the dizziness most likely represents.
Dizziness and Vertigo Assessment Near You
Milton Keynes
Our Milton Keynes clinic assesses dizziness, vertigo, balance problems and associated neck symptoms to help determine whether conservative treatment is appropriate or further investigation is required.
Northampton
Our Northampton clinic provides assessment for dizziness, vertigo and associated neck or balance symptoms, with treatment or referral according to the clinical findings.
Aylesbury
Our Aylesbury clinic assesses dizziness, vertigo and associated neck symptoms to help determine the most appropriate treatment or referral pathway.
Frequently Asked Questions About Dizziness and Vertigo
Is dizziness the same as vertigo?
No. Vertigo usually describes an illusion of spinning or movement. Dizziness is a broader term that can include light-headedness, imbalance, unsteadiness and other sensations.
How do I know if I have BPPV?
BPPV typically causes short episodes of spinning vertigo triggered by particular head movements, such as rolling over in bed. A positional examination such as the Dix-Hallpike manoeuvre can help confirm the diagnosis.
Can a chiropractor perform the Epley manoeuvre?
An appropriately trained chiropractor can perform positional assessment and canalith repositioning manoeuvres such as the Epley manoeuvre when BPPV is identified and there are no contraindications.
Can neck problems make me dizzy?
Neck pain and dysfunction can sometimes be associated with dizziness, commonly described as cervicogenic or cervical dizziness. However, other vestibular, neurological and medical causes should be considered before assuming that the neck is responsible.
Does cervicogenic dizziness respond to treatment?
Research suggests that manual therapy can improve dizziness and neck-related symptoms in some appropriately selected people with cervicogenic dizziness. The evidence is more convincing for short-term improvement than for long-term effects.
Should I see a chiropractor for sudden severe vertigo?
Sudden severe or continuous vertigo, particularly when accompanied by significant unsteadiness, neurological symptoms or new hearing loss, may require urgent medical assessment rather than routine chiropractic treatment.
Start by Understanding What Is Causing Your Dizziness
Dizziness and vertigo can have many different causes, so the right treatment begins with the right assessment.
Whether your symptoms appear consistent with BPPV, are associated with neck dysfunction or require further medical or vestibular investigation, the first step is determining the most appropriate pathway for you.