Differentiating Dizziness Versus Vertigo

  • Vertigo is an illusion of movement; a sensation as if the external world were revolving around the individual (objective vertigo), or as if the individual were revolving in space (subjective vertigo). 
  • Vertigo is not a symptom arising from the cervical spine, but rather is caused by peripheral vestibular disorders or lesions within the vestibular pathways of the central nervous system.
  • Dizziness is the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion. (unsteadiness, lightheaded, swaying, disequilibrium) 

Peripheral vs Central vestibular disorders

When we look at peripheral versus central vestibular disorders, peripheral vestibular system tends to mean the sensing organ located in the inner ear, and the vestibulocochlear nerve. 

The central vestibular system is what everything else refers to. The very part of the brain that relates the processing from the brainstem to the cerebellum, and to higher cortical areas.

Vertigo vs Dizziness

Vertigo can often be identified by asking patients “Can you describe to me what you mean by dizziness, but without using the word dizziness?”.

With this line of questioning, what you will often find is that patients might use their hands. Further questions to differentiate are “Do you feel that the world is spinning, or you’re spinning?”. If it is vertigo, they will answer “the world is spinning relative to me.”  It is that sense of motion (sense of spinning typically, it can be a tumbling action as well, although not too often).

Dizziness on the other hand is different, and encompasses almost everything else. That could be defined as lightheadedness, as a rocking, or swing, as a pull, or as an unsteadiness. With cervicogenic dizziness you certainly do get that unsteadiness and that rocking or that “I feel lightheaded” type of sensation. But more often than not, you don’t get that true vertigo. 

There are many different presentations, and each one of those have their own etiology. Understanding and being able to dissect what they describe can give you an understanding whether it’s an autonomic problem, or whether it’s a vascular problem. Whether it’s a medication based problem, or whether it’s something else entirely, psychogenic in nature for example.

Asking The Right Questions

Asking the right questions can help tease that out further. 

How long does the dizziness or vertigo last? What are the triggers? Is it positional? Is it getting up out of a chair? Is it sitting in a car, stopping and starting? Is it walking through a shopping aisle? Is it bearing down on the toilet? Is it when they’ve had a bad night’s sleep?

The triggers are very consistent with certain conditions. For example, when someone has dizziness when the weather changes, and demonstrates sensitivity to lights and noise, you can almost be confident to say that it’s a vestibular migraine.

As another example, if a patient says that they have brief episodes of spinning when they’re rolling over in bed, but it dissipates after 10 seconds, you can be very confident it’s going to be benign paroxysmal positional vertigo. 

Understanding the duration and the trigger is very pathognomonic for the particular condition.

As part of our algorithm and answering and the question “do you have psychogenic dizziness”, you need to rule out any other form of vestibular conditions because you don’t want to confuse BPPV, or mal de debarquement, or anything else with cervicogenic dizziness because that’s not going to do you or the patient any favours.

Kerber, Baloh. The evaluation of a patient with dizziness. Neurol Clin Pract. 2011 Dec;1(1):24-33