Vertigo and Dizziness

What is Vertigo and Dizziness?

Vertigo is the perception of spinning or moving when there is no actual movement. Dizziness is a broader, vaguer term that covers several different sensations, which is why doctors ask you to describe the feeling in your own words.^[1]

Common symptoms

The symptoms depend on the cause. Vertigo from the inner ear often comes with nausea and balance trouble, and BPPV, the most common cause, typically brings brief spinning episodes lasting a minute or less when the head moves.^{[1, 2]}

• Spinning or tilting, especially with head or position changes
• Unsteadiness or trouble walking in a straight line
• Nausea or vomiting during attacks
• In chronic dizziness, a constant sense of swaying or being off balance that can worsen in busy places^[3]

Causes and risk factors

Causes are grouped as peripheral, from the inner ear or its nerve, and central, from the brain. BPPV is the most frequent peripheral cause and accounts for more than half of cases of peripheral vertigo.^[1] It is caused by small crystals that have moved into the wrong part of the inner ear canals.^[4]

Other causes include vestibular neuritis, an inflammation of the balance nerve usually thought to follow a viral infection, and Ménière's disease, which brings attacks of vertigo with hearing loss and tinnitus.^{[1, 2]} Vestibular migraine is an underdiagnosed cause.^[5] Chronic dizziness syndromes include persistent postural-perceptual dizziness.^[3] Central causes, such as stroke, can look similar and are dangerous.^[1]

How it is diagnosed and treated conventionally

Diagnosis depends on the timing, triggers and associated symptoms. For BPPV, doctors use positional tests such as the Dix-Hallpike maneuver, and imaging is not routinely needed unless a central cause is suspected.^{[1, 6]}

BPPV is treated with canalith repositioning maneuvers, which are strongly recommended in guidelines. Guidelines recommend against routine use of vestibular suppressant medicines such as antihistamines or benzodiazepines for it.^[6] A meta-analysis found that neither benzodiazepines nor antihistamines taken daily were shown to beat placebo for acute vertigo at one week or one month, although those longer-term trials had a high risk of bias.^[7]

Vestibular rehabilitation, a program of exercises, is an evidence-supported treatment for ongoing problems from one inner ear. A Cochrane review of 39 studies found moderate to strong evidence that it is safe and effective for unilateral peripheral vestibular dysfunction.^[8] Vestibular neuritis is treated with supportive medicines, then rehabilitation, and chronic dizziness syndromes with rehabilitation, CBT and sometimes antidepressants.^{[2, 3]}

Why Vertigo and Dizziness calls for a whole-person approach

Dizziness rarely has one simple cause. The inner ear, neck, brain, migraine tendency, stress and sleep can all contribute, and chronic syndromes are driven partly by environmental stressors.^{[3, 5]}

Care that looks at several of these at once is a reasonable addition to treatment aimed at the specific cause.

The inner ear and balance system

Most vertigo starts in the inner ear, and treatment depends on the exact diagnosis. This is why a proper evaluation comes before complementary care.^{[1, 8]}

Migraine

Vestibular migraine shares the mechanisms of migraine, and people with this pattern may respond to migraine preventive treatment.^[5]

Neck and circulation

Chinese medicine research often addresses dizziness thought to come from the neck, called cervical or cervicogenic vertigo, and from reduced blood flow in the back of the brain. Whether dizziness truly comes from the neck needs a doctor's assessment.^{[9, 10]}

Anxiety, stress and sleep

Chronic dizziness is managed partly by changing factors that worsen symptoms and by CBT, and treatments that reduce anxiety are used.^[3] A 2025 review of 22 trials of persistent postural-perceptual dizziness found that an SSRI combined with vestibular rehabilitation improved dizziness handicap and anxiety scores more than either alone.^[11]

Acupuncture for Vertigo and Dizziness

What the research shows

The research suggests acupuncture may help some kinds of dizziness, but the studies are small and low quality, so the evidence is limited. A 2017 meta-analysis of 10 trials with 914 people with cervical vertigo found acupuncture more effective than conventional medicine on effectiveness rate and improvement in vertigo. The authors rated the evidence as low or very low quality and called for larger trials.^[9]

For Ménière's disease, a 2024 review of six trials found that acupuncture, alone or with Western medicine, improved efficacy rate, dizziness handicap and ear symptoms compared with Western medicine alone. The trials were unblinded and varied widely.^[12]

Other studies are small. In a pilot cohort study of 60 emergency department patients with dizziness or vertigo, those who received acupuncture had a greater drop in dizziness scores at 30 minutes and 7 days than the control group, but handicap scores did not differ at 7 days. Patients with life-threatening or central nervous system causes were excluded.^[13] A trial of 100 people with chronic subjective dizziness found that ultrasound-guided acupuncture did better than shallow needling on several measures.^[14] A narrative review of 34 articles suggests that acupuncture is used for inner ear vertigo, but it is a summary of reports and not a test of effect.^[15]

How acupuncture may work

The mechanisms are not established. Researchers have proposed improved blood flow in the arteries at the back of the brain and effects on the autonomic nervous system, based on measurements in cervical vertigo and emergency department studies.^{[9, 13, 15]} These are proposed explanations and not settled facts.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the head, neck, ears, hands and legs, usually left in place for about 20 to 40 minutes. A course is several visits, and we reassess to see whether treatment is helping.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[16] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). If you feel dizzy, tell the practitioner so that you can lie down for treatment.

Ayurvedic medicine for Vertigo and Dizziness

The Ayurvedic view

In Ayurveda, vertigo and dizziness are described as Bhrama, and are generally linked to aggravated Vata and Pitta, sometimes with a role for stress, poor sleep and irregular routine. This is a traditional framework for choosing treatment, not a biomedical diagnosis.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular meals, hydration, steady sleep hours and stress-calming routines
• Gentle oil massage of the head, neck and shoulders, and warm oil applied to the scalp (Shirodhara)
• Breathing practices and meditation
• Individually prescribed herbs, discussed below under herbal medicine

Managing stress, sleep and other factors that worsen symptoms is also part of standard care for chronic dizziness, although no study has tested the Ayurvedic versions.^[3]

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and is not used when the cause of dizziness is unknown or may be serious. Heavy, hot or stimulating therapies can worsen some people's dizziness. About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic, so sourcing matters.^[17]

What the research shows

No clinical trials of Ayurvedic herbs, Shirodhara or Panchakarma for vertigo or dizziness were found in a PubMed search, so there is no evidence on whether they help.

Herbal medicine for Vertigo and Dizziness

Herbs and formulas that have been studied

Chinese herbal formulas have been studied, mainly for cervicogenic dizziness. A review of trials for cervicogenic dizziness looked at six types of modified formulas, with Dingxuan Tang and Yiqi Congming Tang described as showing the most reliable effects for particular patterns.^[10]

Transdermal medication therapy, herbal preparations applied to the skin, is offered at the clinic, but we found no trials of it for vertigo or dizziness.

What the research shows

The evidence is limited. A 2022 review of 35 randomized trials with 3,862 people with cervicogenic dizziness found that herbal formulas added to other treatments worked better than the other treatments alone. More than half the trials were low quality, so the conclusion is that herbs may enhance other treatments, and no serious adverse events were reported.^[10]

We found no trials of herbal medicine for BPPV, vestibular migraine or Ménière's disease that would support a conclusion.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe serious problems, including bleeding, when warfarin was combined with herbs including ginkgo, dang gui (Angelica sinensis), dan shen (Salvia miltiorrhiza), ginger, ginseng and Boswellia.^[18] People taking blood thinners need a practitioner's review before using any herb.

Some herbs and medicines can themselves cause dizziness, so tell us about everything you take, including antihypertensive and sedating medicines. Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes dizziness as arising from patterns such as liver wind, phlegm obstruction or deficiency of qi, blood or kidney essence. Researchers working with acupuncture and herbs measure things that loosely parallel this, such as blood flow in the arteries to the back of the brain and autonomic nervous system activity.^{[9, 13]}

Ayurveda's aggravated Vata describes instability and restlessness. It loosely echoes the role of stress, anxiety and sleep in chronic dizziness studied in modern research.^[3] No study has shown that a dosha or a pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for vertigo and dizziness is complementary. Keep your physician, ear, nose and throat specialist, neurologist and physical therapist, and do not stop or change prescribed medicines without talking to your prescriber. Treatments such as repositioning maneuvers and vestibular rehabilitation have the strongest support for BPPV and inner ear problems.^{[6, 8]}

We do not diagnose the cause of dizziness. New, severe or unexplained dizziness should be medically evaluated before complementary care begins. Please bring your diagnosis, any hearing or balance test results, imaging reports, and a full list of medicines and supplements.

When to seek urgent medical care

Dizziness can be a sign of stroke or another serious problem, and central causes may mimic benign ones.^[1]

• Sudden severe dizziness with trouble walking, speaking or seeing
• Weakness, numbness or drooping of the face, arm or leg
• A sudden severe headache or neck pain
• Fainting, chest pain or a racing or irregular heartbeat
• Sudden hearing loss, or dizziness after a head injury
• Dizziness with a high fever, stiff neck or repeated vomiting

If any of these occur, call 911 or go to the nearest emergency department.