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Dizziness & Vertigo

Feeling faint, woozy or as if the room is spinning. Most dizziness isn’t serious and often settles or is easy to treat — but sudden dizziness with stroke or heart warning signs is an emergency.

Call 911 right away if dizziness comes on suddenly with any sign of a stroke. Sudden dizziness, loss of balance or trouble walking can be a stroke, especially with sudden trouble seeing, numbness or weakness of the face, arm or leg (often on one side), confusion, trouble speaking, or a sudden severe headache with no known cause (CDC). Vertigo with double vision, slurred speech or loss of coordination also needs 911 (MedlinePlus). The CDC uses B.E. F.A.S.T.:

  • B — Balance: is the person suddenly off-balance or dizzy?
  • E — Eyes: any sudden trouble seeing?
  • F — Face: ask them to smile. Does one side droop?
  • A — Arms: ask them to raise both arms. Does one drift down?
  • S — Speech: is their speech slurred or strange?
  • T — Time: call 911 now and note when the symptoms started. Don’t drive to the hospital — an ambulance crew can start treatment on the way (CDC).

Symptoms that pass after a few minutes may have been a “mini-stroke” (TIA), which still needs medical help right away (CDC). A drooping face always needs this check first — our Bell’s palsy guide explains why.

Also call 911 or go to the emergency room if you are dizzy and have chest pain, a skipping or irregular heartbeat, shortness of breath, weakness, can’t move an arm or leg, a change in vision or speech, a head injury, a seizure, a fever over 101°F (38.3°C), a headache or very stiff neck, trouble keeping fluids down, or you faint and stay less alert for more than a few minutes (MedlinePlus, MedlinePlus).

Sudden hearing loss with dizziness or spinning is urgent. Sudden hearing loss in one ear — sometimes with dizziness, ringing or a full feeling in the ear — should be treated as a medical emergency: see a doctor immediately, because treatment works best when it starts early (NIDCD).

What is dizziness? Lightheaded, spinning or unsteady

“Dizzy” means different things to different people (NIDCD), so being able to say exactly what you feel helps your doctor find the cause:

Most causes of dizziness are not serious, and they either get better quickly on their own or are easy to treat (MedlinePlus).

How common is it?

About 15 percent of American adults (33 million) had a balance or dizziness problem in 2008 (NIDCD). Dizziness and vertigo can happen to anyone, but they become more common with age, partly because people tend to have more health conditions and take more medicines (MedlinePlus).

Common causes

  • Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. Tiny calcium crystals in the inner ear break loose and float into its fluid-filled canals, so moving your head — rolling over in bed or looking up — sets off spinning that starts suddenly and lasts seconds to minutes (MedlinePlus). See BPPV and repositioning maneuvers below.
  • Vestibular neuritis and labyrinthitis. Vestibular neuritis is inflammation of the balance nerve, which can be caused by a virus and mainly causes vertigo (NIDCD). Labyrinthitis is swelling of the inner ear itself, usually after a virus such as a cold or flu; it can cause vertigo, hearing loss in one ear and ringing in the ear. It usually goes away within a few weeks, and most people are completely better within 2 to 3 months, though older adults may stay dizzy longer (MedlinePlus).
  • Vestibular migraine is a type of migraine that brings vertigo or dizziness, loss of balance, nausea and sensitivity to light, sound and movement, with or without a headache (Cleveland Clinic, MedlinePlus). Migraine is a common cause of dizziness (MedlinePlus).
  • Ménière’s disease is an inner-ear disorder with attacks of severe vertigo, ringing in the ear, hearing loss and a feeling of fullness in the ear, usually in one ear (NIDCD). A separate MBHA guide to Ménière’s disease is on the way.
  • Blood pressure that drops when you stand up (orthostatic hypotension) usually lasts only seconds or minutes (MedlinePlus). Older adults have a higher risk of dizziness on standing, and are more likely to have low blood pressure as a side effect of blood pressure medicines (NHLBI). See our Blood Pressure guide.
  • Medicines. Some medicines can cause dizziness or harm the inner ear (MedlinePlus, MedlinePlus). Tell your provider if you feel dizzy after taking a medicine (MedlinePlus).
  • Anxiety and stress. A panic attack can bring weakness or dizziness along with a pounding heart (NIMH), and dizziness itself can cause fear, anxiety or panic (NIDCD). See our Anxiety guide.
  • Motion sickness can also make you dizzy (MedlinePlus) — see our Air & Motion Sickness guide.
  • Serious causes include stroke, heart problems such as a heart attack or an abnormal heartbeat, and bleeding inside the body; other causes include seizures, multiple sclerosis and brain tumors. These usually come with other symptoms such as chest pain, a racing heart, loss of speech or a change in vision (MedlinePlus). Dizziness and fainting can be symptoms of an irregular heart rhythm (NHLBI).

Doctors also sort vertigo into peripheral (a problem in the inner ear or balance nerve, such as BPPV, labyrinthitis or Ménière’s) and central (a problem in the brain, such as stroke or vestibular migraine). Central vertigo may come with trouble swallowing, double vision, facial weakness, slurred speech or weak limbs (MedlinePlus).

How it’s diagnosed

Your provider will start by asking when the dizziness started, what it feels like, whether head movement sets it off, how long it lasts, whether you were ill beforehand, and about stress and anxiety (MedlinePlus). It helps to come ready to describe any hearing loss, ringing, ear pressure or headache that comes with it, and with a list of every medicine and supplement you take (NIDCD).

  • The Dix-Hallpike test: for suspected BPPV, the clinician moves you quickly from sitting to lying with your head turned, and watches your eyes for a telltale flicker (MedlinePlus). The U.S. ear, nose and throat guideline strongly recommends this test for diagnosing the most common form of BPPV (AAO-HNS guideline, 2017).
  • Blood pressure, an ECG (heart tracing), hearing tests and balance testing may be done (MedlinePlus). Balance and hearing checks are often done by an ear, nose and throat doctor (otolaryngologist) and an audiologist, and several tests may be needed (NIDCD).
  • Imaging only when needed. You may need a scan if your provider thinks you may have had a stroke or if you have had a head injury (MedlinePlus). For someone whose symptoms clearly fit BPPV, the guideline advises against routine imaging or extra balance testing unless other signs or symptoms call for it (AAO-HNS guideline).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Find the cause first. For BPPV, a clinician guides your head through repositioning moves such as the Epley maneuver; vestibular rehabilitation with a physical therapist for lasting inner-ear dizziness; short-term anti-dizziness or anti-nausea medicines only when needed; and treating the cause — migraine, Ménière’s, blood pressure drops or a medicine side effect. Physical or vestibular therapy about $50–$350+ a session without insurance, or a $10–$75 copay with it; Medicare Part B covers needed outpatient therapy (20% after the deductible). Specialist visits and testing: cost estimate being researched. Strong evidence: repositioning is the recommended treatment for the most common form of BPPV, though BPPV often comes back. Vestibular rehabilitation is safe and effective for many inner-ear problems. Anti-dizziness medicines can cause drowsiness and are not recommended routinely for BPPV.
Chiropractic Some trained chiropractors perform the Epley maneuver for BPPV. Others treat dizziness thought to come from the neck with hands-on neck treatment and exercises. About $50–$200 a visit without insurance ($15–$75 with); first evaluations $100–$250. Chiropractors trained in the Epley maneuver can use it for BPPV, but studies of chiropractic BPPV care are small case reports. Evidence that neck treatment helps neck-related dizziness is low to moderate quality. Neck manipulation carries a rare risk of artery tears and stroke — never have it when a stroke is possible.
Acupuncture Fine needles at points on the body; studied mostly for “cervical vertigo” (dizziness linked to the neck). About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews report benefits, but the evidence is low to very low quality. We found no good evidence for BPPV, and the NIH says there is no evidence it helps Ménière’s disease.
Herbal medicine Ginkgo is sometimes taken for vertigo, and ginger for queasiness. Cost estimate being researched. Evidence for ginkgo in vertigo is small and not conclusive — and dizziness is one of its common side effects. Most studies of ginger for motion sickness haven’t shown it helps. Herbs can interact with medicines.
Massage therapy Gentle relaxation and work on tight neck and shoulder muscles; not a treatment for the causes of vertigo. Private therapists about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour. May give short-term relief of neck pain. We found no good evidence that it treats dizziness or vertigo.
MBHA Wellness Coach Getting up slowly, drinking enough fluids, home exercises only as your clinician or therapist prescribes, a dizziness or migraine diary, limiting alcohol and caffeine, sleep, stress and anxiety skills, and staying safe behind the wheel. MBHA coaching cost estimate being researched. Supports — but doesn’t replace — a medical diagnosis. Avoiding known triggers may reduce vestibular migraine episodes, and simple habits such as getting up slowly help with dizziness on standing.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on the cause, so the first step is to find it. A specialist will check whether another health condition or a medicine is to blame, and treat that condition, change the medicine or refer you on (NIDCD). Dizziness often gets better on its own, but if it keeps happening your provider can help find the cause and the right treatment (MedlinePlus).

1. BPPV: canalith repositioning (the Epley maneuver)

For BPPV, a clinician moves your head through a series of positions that shift the loose crystals out of the balance canal (MedlinePlus). The 2017 U.S. ear, nose and throat guideline makes a strong recommendation that clinicians treat the most common (posterior canal) form of BPPV with a canalith repositioning procedure, or refer you to someone who can (AAO-HNS guideline, 2017). In many cases one session works; some people need it several times (NIDCD). More detail is in BPPV and repositioning maneuvers below.

2. Vestibular rehabilitation

Vestibular rehabilitation is a program of eye, head and balance exercises, usually taught by a physical therapist, that helps your brain adjust to an inner-ear problem (MedlinePlus). A Cochrane review of 39 trials (2,441 people) found moderate to strong evidence that it is safe and effective for problems affecting one inner ear, and moderate evidence that it eases symptoms and improves day-to-day function in the medium term. For BPPV, repositioning maneuvers worked better in the short term, while combining the two helped longer-term recovery (Cochrane review, 2015). It is also used for vestibular migraine (Cleveland Clinic) and long-lasting balance problems with Ménière’s (NIDCD).

3. Short-term medicines for symptoms

For a bad spell, a provider may suggest medicines for nausea and dizziness, such as dimenhydrinate or meclizine, or a sedative (MedlinePlus). These “vestibular suppressants” ease symptoms during a spell, with limits:

  • For BPPV, the guideline recommends against routinely treating it with vestibular suppressant medicines such as antihistamines or benzodiazepines (AAO-HNS guideline). These medicines often don’t work well for the vertigo of BPPV (MedlinePlus).
  • Anti-vertigo and anti-nausea medicines can make you drowsy (NIDCD). Meclizine can cause drowsiness, dry mouth and, more seriously, blurred vision, and older adults usually should not take it because other medicines are safer or work better (MedlinePlus).
  • Tell your doctor or pharmacist about every other medicine, vitamin and herbal product you take, and about glaucoma, an enlarged prostate or asthma, before you start (MedlinePlus). We don’t list doses here.

4. Treating the underlying cause

  • Vestibular neuritis and labyrinthitis: besides symptom medicines, a provider may use corticosteroids or antiviral medicines; severe vomiting may need a hospital stay (MedlinePlus).
  • Vestibular migraine: medicines taken regularly to prevent episodes may include tricyclic antidepressants, calcium channel blockers, anti-seizure medicines or beta-blockers, alongside lifestyle changes and avoiding triggers (Cleveland Clinic).
  • Ménière’s disease: there is no cure yet. Options include limiting salt, a diuretic (“water pill”), quitting smoking, medicines during attacks, vestibular rehabilitation, injections into the middle ear and, when other treatments have failed, surgery (NIDCD). Our separate guide will cover these in detail.
  • Blood pressure drops on standing: you may not need treatment. Depending on your symptoms, your provider may suggest more fluids, adjust medicines that lower blood pressure, or prescribe medicine to raise it (NHLBI).
  • Medicines: if dizziness started after taking a medicine, tell your provider (MedlinePlus). Don’t stop a prescribed medicine on your own — ask whether it can be changed.

What it costs

  • Physical and vestibular therapy: about $50–$350 or more a session without insurance, depending on the provider and setting; with insurance, typically a $10–$75 copay or 10–50% coinsurance (CostHelper, a consumer cost guide). Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it, with no yearly cap; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Doctor and specialist visits, hearing and balance tests, scans: cost estimate being researched.

How well it works — what to expect

Results depend on the cause. BPPV usually responds to repositioning, but it may come back without warning (MedlinePlus). Labyrinthitis usually settles within weeks to a few months (MedlinePlus). Migraine and Ménière’s can be managed but not cured (NINDS, NIDCD). Some people can’t fully relieve their dizziness, and a vestibular therapist can help them build a plan to cope with it (NIDCD).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic is a licensed health profession; treatment usually involves hands-on therapy, often spinal manipulation, and may include exercise and nutrition advice (NCCIH). For dizziness, chiropractic care comes up in two different ways.

The Epley maneuver for BPPV

Repositioning for BPPV is a set of head and body movements, not a spinal adjustment, and the guideline asks clinicians to treat BPPV this way or refer to someone who can (AAO-HNS guideline). Some chiropractors are trained to do it. A 2013 case series described eight people with lasting BPPV whose symptoms eased after chiropractors performed the Epley maneuver; it had no comparison group (case series, PubMed). If you see a chiropractor for BPPV, ask about their training in the Dix-Hallpike test and repositioning, and make sure the diagnosis is clear first.

Neck-related (“cervicogenic”) dizziness

Some people’s dizziness seems linked to neck pain or stiffness. The evidence for hands-on neck treatment here is limited:

  • A 2022 review of 13 trials (898 people) found moderate-quality evidence that manual therapy reduces neck-related dizziness, possibly more with exercise — but the evidence for the combination was very low quality (meta-analysis, PubMed).
  • A 2025 review of six trials found low to very low certainty evidence that treatment of the upper neck eases dizziness more than placebo or control treatments (meta-analysis, PubMed).

Neck treatment doesn’t address inner-ear problems, migraine, blood pressure drops or medicine side effects.

Safety: never have your neck manipulated when a stroke is possible. Short-lived soreness, stiffness or headache are common after spinal manipulation. Neck manipulation has been linked to small tears in the neck arteries that can lead to a stroke; this is rare, experts disagree about whether manipulation causes it, and serious side effects may be more likely in people with underlying health problems (NCCIH). Because sudden dizziness can itself be a sign of stroke (CDC), MBHA strongly advises seeing a medical doctor first for any new, sudden or severe dizziness, especially with headache, neck pain or any B.E. F.A.S.T. sign.

What it costs

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Most acupuncture research on dizziness looks at “cervical vertigo” — dizziness linked to the neck — and most of the trials come from China. The results sound promising, but the quality of the evidence is low.

What the research says

  • 2017 review: 10 studies (914 people) found acupuncture worked better than the comparison drug treatments for cervical vertigo, but the evidence was low to very low quality and long-term safety was uncertain; the authors called for larger, better trials (systematic review, PubMed).
  • 2026 review: 66 trials (5,797 people) compared needle-based treatments and Chinese massage (tuina) for neck-related vertigo. Acupuncture-based treatments ranked better than tuina alone, but most of the evidence was low or very low certainty and the authors said the rankings should be read cautiously (network meta-analysis, PubMed).
  • Emergency room pilot study: 60 people with dizziness or vertigo (people with life-threatening or brain causes were excluded) reported less discomfort after acupuncture at 30 minutes and 7 days, but a dizziness disability score did not differ after 7 days. It was a small, early study (pilot study, PubMed).
  • Ménière’s disease: the NIH says there is no evidence that acupuncture or acupressure works (NIDCD).

We found no good evidence that acupuncture treats BPPV, which responds to repositioning. If you try acupuncture, use it alongside — not instead of — a medical diagnosis.

Safety

Relatively few complications have been reported, but problems have come from non-sterile needles and poor technique. Needles must be sterile and single-use, and most states license acupuncturists (NCCIH). If you get dizzy easily, tell your acupuncturist and take your time getting up from the table.

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb has been shown to fix vertigo, and some can make dizziness worse or interact with your medicines.

Ginkgo

For vertigo, a small amount of evidence suggests a benefit from ginkgo, but the overall evidence is not conclusive (NCCIH); NCCIH also notes there is no conclusive evidence that ginkgo helps any health condition (NCCIH). Ginkgo has not been shown to help Ménière’s disease (NIDCD). Dizziness is one of ginkgo’s most common side effects, it may raise the risk of bleeding with blood thinners such as warfarin, and it may be unsafe in pregnancy (NCCIH).

Ginger

Ginger is a popular kitchen remedy for queasiness. Most studies of ginger for motion sickness haven’t shown it to help (NCCIH), and the NIH found no evidence that ginger root helps Ménière’s disease (NIDCD). As a food or drink it is a gentle comfort; check with your provider before ginger supplements if you are pregnant or breastfeeding (NCCIH).

Supplements and dizziness. Tell your doctor about any herbal or alternative therapy you use, because some can change how well or how safely conventional medicines work (NIDCD). Bring vitamins, supplements and herbal remedies to every visit along with your prescriptions (NIDCD), and tell your provider if you feel dizzy after starting anything new (MedlinePlus). We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage doesn’t treat the causes of vertigo — inner-ear problems, migraine, blood pressure drops or medicines — and we found no good research showing it eases dizziness. It may help you relax, and for neck or shoulder pain it may give short-term relief (NCCIH).

If you have BPPV, lying back or rolling over can set off spinning (MedlinePlus), so tell your therapist, change position slowly, and sit for a moment before you stand up.

Safety

The risk of harm appears to be low, but rare serious problems — a blood clot, nerve injury or broken bone — have been reported, some with vigorous deep-tissue massage or in people at higher risk, such as older adults (NCCIH). MBHA suggests avoiding forceful neck work if you have new or unexplained dizziness, and seeing a doctor first.

What it costs

Private massage therapists charge about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Much of living with dizziness happens day to day. An MBHA Wellness Coach can help you turn your care team’s advice into habits — always alongside a medical diagnosis, never instead of one. For home safety and fall prevention, see our Balance guide.

During a spell

Getting up slowly and drinking enough

If you get lightheaded when you stand, avoid sudden changes in posture: get up slowly, stay seated for a few moments before standing, and have something to hold on to (MedlinePlus). Not drinking enough fluids can cause low blood pressure, and your provider may suggest drinking more (MedlinePlus). Ask your provider how much is right for you, especially if you have heart or kidney problems or Ménière’s.

Home exercises — only as prescribed

  • For BPPV, your provider may teach you repositioning exercises to do at home (MedlinePlus). One example is the Brandt-Daroff exercises, which an audiologist may recommend after an Epley maneuver. They are likely to bring on dizziness, so they should be done somewhere safe, preferably with another person present (NHS hospital leaflet). Do them only if a clinician has confirmed BPPV and shown you how.
  • Balance (vestibular) exercises are usually taught by a physical therapist (MedlinePlus); for BPPV, the U.S. guideline allows vestibular rehabilitation either self-administered or with a clinician (AAO-HNS guideline). A coach can help you keep up the routine your therapist sets.

Keep a dizziness diary

Write down when dizziness happens and what you were doing; it can help find triggers to avoid (MedlinePlus). If migraine may be involved, a headache journal noting the time, how long it lasted, sleep, stress, food and drink, weather and any medicines can help your doctor diagnose and treat it (NINDS). Common migraine triggers include too much or too little sleep, stress, skipped meals, too much alcohol and some medicines (NINDS); for vestibular migraine, certain foods such as aged cheese, deli meats and red wine, and fatigue (Cleveland Clinic).

Alcohol, caffeine and sleep

Stress and anxiety

Long-term dizziness is stressful. Relaxation methods such as guided imagery, progressive muscle relaxation, yoga, tai chi or meditation can help you cope (MedlinePlus). If panic or anxiety seem to come with your dizzy spells, talk to a health care provider; they will also check that a physical problem isn’t the cause (NIMH). Our Anxiety guide has more.

Driving and safety

Talk with your doctor about whether it is safe to drive (NIDCD). A sudden dizzy spell while driving, operating heavy machinery or climbing can be dangerous: MedlinePlus advises waiting one week after a severe spell of vertigo has gone, or asking your provider first (MedlinePlus). If you have recurring BPPV, avoid these activities while you have symptoms (MedlinePlus). MBHA coaching cost estimate being researched.

Another approach

BPPV and repositioning maneuvers

BPPV is the most common cause of vertigo and the easiest to treat (MedlinePlus). It can follow a head injury or simply come with age (NIDCD), and a past bout of labyrinthitis or a family history of BPPV may raise the risk (MedlinePlus).

What it feels like

Brief, intense spinning set off by a certain head movement — bending down, looking up or over your shoulder, or rolling over in bed (NIDCD). Each spell lasts seconds to minutes and may bring nausea or a feeling that things are jumping (MedlinePlus). Weakness, slurred speech or vision problems are not part of BPPV and need medical help right away (MedlinePlus).

Diagnosis and treatment

The Dix-Hallpike test confirms the most common type, and a “roll test” checks for another type if needed (AAO-HNS guideline). The Epley maneuver can be done by an ear specialist or an audiologist (NIDCD). Watching and waiting is also an option the guideline allows, with a recheck within a month (AAO-HNS guideline).

After treatment

Advice differs. MedlinePlus lists not bending over for the rest of the day and not sleeping on the side that triggers symptoms for a few days (MedlinePlus), while the 2017 guideline recommends against routine position restrictions after treatment (AAO-HNS guideline). Follow your own clinician’s instructions.

If it comes back

About half the time BPPV comes back at some point, and it can be treated again (MedlinePlus). Contact your provider if symptoms return, get worse, or home treatment doesn’t work (MedlinePlus).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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