Quick Answer
Dizziness has four distinct meanings, and separating them narrows the cause before any test. Vertigo specifically means a false sense of movement. CNS evaluates adult dizziness across Las Vegas and Henderson with in-office balance testing and, where positional vertigo is confirmed, repositioning treatment in the same visit.
Key Takeaways
- The first job is establishing which kind of dizziness you have. Spinning, faintness, unsteadiness on the feet, and a vague foggy detachment are four different symptoms with four different lists of causes, and the word dizzy covers all of them.
- Timing and triggers narrow it further. Seconds on turning over in bed, minutes to hours in episodes, days of constant spinning, or continuous unsteadiness for months each point to a different group of conditions.
- The commonest cause is mechanical and treatable in minutes. Benign paroxysmal positional vertigo comes from displaced particles in the inner ear, and a guided repositioning manoeuvre can resolve it in the same appointment it is confirmed.
- The dangerous causes are a small minority and identifiable. Sudden severe dizziness with double vision, slurred speech, weakness or inability to walk is an emergency, not an appointment, and the distinction is usually clear.
- Long-term suppressant medication is often the wrong answer. It masks the sensation while slowing the balance system’s own compensation, which is why establishing the cause matters more than controlling the symptom.
01 — OverviewFour different symptoms, one word
Dizziness is among the hardest complaints in neurology, and most of the difficulty is linguistic before it is clinical. Patients arrive saying they are dizzy, and that single word covers at least four experiences with almost entirely different causes. This page sits within the wider neurological conditions library at Clinical Neurology Specialists.
Vertigo, which means movement
A false sense that you or the room is moving, usually spinning. It implies the balance system, either the inner ear or the brainstem pathways it connects to, and it is the most specific of the four. When a patient says the room spins, the list of possible causes shortens considerably.
Presyncope, which means faintness
Feeling about to pass out, often with greying vision, sweating or a sense of warmth rising. This points toward blood pressure and the circulation rather than the balance system, and it belongs to a cardiac and vascular list. Standing up too quickly is the everyday version; a cardiac rhythm problem is the one that matters.
Disequilibrium, which means unsteadiness
Feeling unstable on your feet while your head feels clear. This points toward the sensory feedback the balance system depends on: the nerves in the feet, joint position sense, vision, and the cerebellum. It is common where a peripheral neuropathy has reduced feedback from the feet, described on the peripheral neuropathy page.
The fourth, which is the vaguest
A foggy, detached, lightheaded feeling that is neither spinning nor faintness nor unsteadiness. This is the least specific and most frequently dismissed, and it can reflect medication effects, anxiety, migraine, sleep disruption or a combination. Being vague does not make it unreal, and a consultation that stops trying to force it into one of the other three categories usually gets further.
Vertigo is the false sensation that you or your surroundings are moving, usually spinning, and it is a specific symptom rather than a synonym for dizziness, which also covers faintness, unsteadiness and a foggy detachment.
02Timing and triggers, which narrow it further than any test
Once the type of dizziness is established, when it happens and what brings it on does more diagnostic work than most investigations. This is why a careful history is not a preamble to the real assessment; it is the assessment.
Brief, on movement
Vertigo lasting under a minute, triggered by rolling over in bed, looking up or bending down. This pattern points strongly to positional vertigo, which is mechanical and treatable.
Episodic
Attacks with a beginning and an end, sometimes with hearing change, fullness in the ear or headache. This group includes inner-ear conditions and migraine-associated dizziness.
Continuous then settling
Severe constant vertigo over days that gradually improves, often after a viral illness, suggests an inflammatory process affecting one balance organ.
| How long an episode lasts | Typical trigger | Points toward |
|---|---|---|
| Under a minute | Head position, rolling over, looking up | Positional vertigo, mechanical and treatable |
| Minutes to hours | Often none identifiable | Inner-ear conditions, migraine-associated dizziness |
| Days, then improving | Often follows a viral illness | Inflammatory process affecting one balance organ |
| Months, continuous | Visual motion, fatigue, busy environments | Dysregulated compensation after an earlier event |
| Seconds, on standing | Getting up from sitting or lying | Blood pressure rather than the balance system |
Months of continuous unsteadiness
Persistent daily unsteadiness lasting months, often worse in visually busy environments such as supermarkets and worse when tired, is its own pattern. It frequently follows an initial vestibular event that has resolved while the symptoms have not, because the compensation process has become dysregulated rather than because the original problem persists. That distinction matters because the treatment is rehabilitation rather than medication.
What makes it worse is diagnostic too
Head position implicates the inner ear. Standing up implicates blood pressure. Visual motion and busy patterns implicate a compensation problem. Walking in the dark or on uneven ground implicates sensory feedback from the feet. Loud noise or pressure change implicates a specific and uncommon inner-ear condition. Each of these is a question worth answering precisely, and the Vestibular Disorders Association publishes patient material that helps people describe their own pattern more usefully.
Told it is just vertigo and left with tablets?
Which kind of dizziness, and what triggers it, narrows the cause more than any test. That is where a proper assessment starts.
03What the evaluation involves
A history establishing type, timing and triggers, then an examination directed at the balance system, then testing where the findings call for it.
The examination is more revealing than patients expect
Eye movements at rest and on gaze in each direction. Positional manoeuvres that can reproduce vertigo diagnostically. Assessment of the reflex holding gaze steady during head movement. Hearing checked at the bedside. Gait, balance with eyes closed, coordination, and sensation in the feet. Blood pressure lying and standing, because the presyncope group is missed if nobody measures it. Much of this requires nothing but time and a willingness to provoke the symptom deliberately, which is the part that distinguishes a thorough assessment.
When testing adds something
Where the examination cannot separate an inner-ear cause from a central one, videonystagmography records eye movement objectively and tests each balance organ independently, performed in our own offices and described on the VNG balance testing guide. Where a vascular question arises, cerebral blood flow can be assessed with transcranial Doppler. Where the pattern suggests a central cause, imaging is coordinated with an outside facility since the practice does not operate a scanner.
What is not usually needed
Imaging for classic positional vertigo, which is diagnosed by reproducing it on examination. Extensive blood work in the absence of a specific question. And an EEG, unless the episodes involve altered awareness rather than dizziness alone, in which case the question has changed and belongs with epilepsy and seizures. Over-testing dizziness is common and it generates incidental findings that create their own anxiety.
Why the medication list is examined closely
A great many commonly prescribed medications cause or worsen dizziness, and the effect accumulates when several are taken together. Blood pressure medications, some antidepressants, sedatives, certain antibiotics and anti-seizure medications all appear on that list, and so do over-the-counter sleep aids and antihistamines that patients rarely think to mention. Reviewing the whole list carefully is one of the highest-yield parts of a dizziness consultation, and it frequently identifies a contributor that can simply be changed.
Hearing, and when it changes the picture
Dizziness accompanied by new hearing loss, ringing or fullness in one ear shifts the assessment substantially and warrants prompt attention. The practice does not provide audiology, so formal hearing testing is arranged externally, and saying so is more useful than implying a service that is not here.
04Treatment, and why suppressant medication is usually the wrong long-term answer
Treatment depends entirely on the cause, which is the argument for establishing it. Three broad approaches cover most patients, and one common approach deserves a caution.
The mechanical fix
Where positional vertigo is confirmed, treatment is a sequence of guided head and body positions that moves displaced particles out of the affected canal. It takes minutes, it can often be done in the same appointment as the diagnosis, and the effect is assessed immediately rather than over weeks. Detail is on the canalith repositioning guide. It is the most satisfying treatment in this area precisely because the mechanism is physical and the result is quick.
Rehabilitation, which is the treatment for compensation problems
Where one balance organ is underperforming or where compensation has become dysregulated, vestibular rehabilitation drives the adaptation deliberately with graded exercises. It works by controlled exposure to the movements that provoke symptoms, which is counter-intuitive and is why it needs explaining properly: the exercises are meant to be mildly provocative, and avoiding them slows recovery. Local detail is on the vestibular rehabilitation guide.
Treating the underlying condition
Migraine-associated dizziness responds to migraine management rather than to vestibular treatment, which is why the headache and migraine page is sometimes the relevant one. Blood pressure and medication contributions are addressed directly. Reduced sensory feedback from a neuropathy is managed alongside falls-risk assessment. Where a central cause is identified, that condition is treated.
The caution about suppressants
Medications that suppress the sensation of dizziness have a place in the acute phase of severe vertigo, over days. Taken for months they present a problem: they blunt the very signal the brain uses to recalibrate, which slows the compensation that would otherwise resolve the symptoms. A patient maintained on them long-term can end up more persistently unsteady than one who was not, which is an uncomfortable thing to write and is the honest position. Nothing here promises an outcome, and responses vary between individuals.
05The small minority that are urgent, and how to tell
Most dizziness is not dangerous. A small proportion is, and the distinction is usually clearer than patients fear.
The features that mean emergency care
Sudden severe dizziness accompanied by any of: double vision, slurred speech, difficulty swallowing, facial or limb weakness or numbness, severe headache unlike previous headaches, or inability to walk or sit unsupported. Also sudden dizziness with new hearing loss. Those combinations belong at an emergency department rather than in a scheduling queue, and the reason is that a brainstem or cerebellar stroke can present as dizziness with very little else.
Why inability to walk is the most useful single sign
A patient with an inner-ear cause, however severe the spinning, can usually walk with support even if unwillingly. A patient who genuinely cannot stand or sit unsupported is more likely to have a central cause. That is not a rule to self-diagnose with, and it is the observation most worth passing on, because it is the one that most reliably separates the frightening-but-benign from the genuinely urgent.
What is not urgent, even when it feels catastrophic
Positional vertigo can be violent enough that patients believe they are having a stroke, and it is neither dangerous nor progressive. Severe vertigo from an inflammatory inner-ear process is miserable for days and improves. Feeling frightened by dizziness is universal and not itself a sign of anything sinister. The National Institute of Neurological Disorders and Stroke catalogues these as distinct disorders with distinct outlooks.
Falls, which is the risk that actually accumulates
For older adults the significant danger from chronic dizziness is not the underlying condition but falling. That makes assessment worth pursuing rather than accepting as part of ageing, and it makes the sensory contributors, medication review and home hazards part of the clinical plan rather than an aside. The American Academy of Neurology guidance treats falls risk as a neurological concern in its own right.
06Vertigo treatment across Southern Nevada
Both CNS offices evaluate dizziness, perform balance testing and deliver repositioning treatment, so care happens at whichever address is the shorter drive.
Vertigo treatment Henderson NV and Green Valley
Patients seeking vertigo treatment Henderson NV attend the West Horizon Ridge Parkway office, just off the 215 Beltway. Vertigo treatment Green Valley Henderson residents almost always find that address closest, and it offers the same testing and treatment as the Las Vegas site.
Vertigo treatment Summerlin and the west valley
Vertigo treatment Summerlin patients are usually closest to West Flamingo Road, which the 215 and Summerlin Parkway feed toward. Consultation, balance testing and repositioning are all available there.
Vertigo treatment North Las Vegas and the northwest
Vertigo treatment North Las Vegas patients attend whichever of the two offices is the shorter drive, following the consolidation into two fully equipped sites. We will not imply a third location exists.
Vertigo treatment Southern Nevada: why the drive matters for this condition specifically
Vertigo treatment Southern Nevada patients face a practical problem others do not. Someone with active vertigo should not be driving, and someone who has just had balance testing certainly should not, so almost every appointment involves a second person. A shorter journey therefore costs two people less time, and for a condition frequently needing several visits across testing, treatment and rehabilitation, that compounds. Choosing the closer office is part of the plan, and coverage is verified before your appointment, with detail on the insurance page. Where dizziness has followed a head injury, the relevant page is concussion and traumatic brain injury.
Dizziness and Balance Guides
7 in-depth guidesThis hub covers adult dizziness, vertigo and balance disorders at CNS. The guides below cover the objective balance study, the mechanical treatment for the commonest cause, rehabilitation for compensation problems, and the conditions dizziness is most often confused with. Start with the pattern that matches your own.
Start Here — Cornerstone Guides
VNG balance testing
Recording eye movement to separate an inner-ear cause from a central one.
Read the guide → TreatmentBPPV canalith repositioning
A mechanical fix for the commonest cause, often in the same visit it is confirmed.
Read more → RehabilitationVestibular rehabilitation
Graded exercises that drive the compensation medication slows down.
Read more →Browse by Category
Testing and treatment
When a vascular cause is suspected
Conditions that produce dizziness
Unsteadiness rather than spinning
The Complete Index — every guide in this hub
Five board-certified physicians
Leo Germin, M.D., FAANEM, founder and medical director, triple board-certified in Neurology and Vascular Neurology through the ABPN and Neuromuscular Medicine through the ABEM, with subspecialty certification in Neurosonology and Neuroimaging. Anup Panduranga, M.D., fellowship-trained in epilepsy. Eric Gutglueck, M.D., neuromuscular medicine and neuromuscular ultrasound. Jessica A. Knirk, M.D., general adult neurology with Botox for chronic migraine. William Lujan, M.D., broad general adult neurology.
Four advanced practice providers
Fara Tan, APRN, MSCN, a Multiple Sclerosis Certified Nurse through the Multiple Sclerosis Nurses International Certification Board. Lindsey Evans, PA-C, general neurology and electromyography. Terra Fonseca, PA-C, a surgical and vascular background applied to general adult neurology. Alissa Nakamura, PA-C, board-certified through the NCCPA, with three years in pain management that transfer directly to nerve-injury and neuropathy questions.
Spread, not headcount
A referral that lands somewhere without neuromuscular or epilepsy depth often becomes a second referral, and each handoff adds weeks. Here an ambiguous nerve study can be reviewed by a neuromuscular specialist and an ambiguous EEG by a fellowship-trained epileptologist without the patient leaving the practice. Full biographies are on the providers page.
The Bottom Line
Say which kind of dizzy, when it happens and what brings it on. Those three answers narrow the cause more than any test, and the commonest cause of true vertigo can be fixed mechanically in minutes once it is confirmed.
Frequently Asked Questions
What is the difference between dizziness and vertigo?
Vertigo specifically means a false sense of movement, usually spinning. Dizziness is a broader word that also covers faintness, unsteadiness on the feet, and a vague foggy detachment. Those four have largely different causes, which is why establishing which one you mean comes first.
What is the commonest cause of vertigo?
Benign paroxysmal positional vertigo, caused by displaced particles in the inner ear. It produces brief vertigo lasting under a minute, triggered by movements like rolling over in bed or looking up, and it can be treated mechanically in minutes once confirmed.
When is dizziness an emergency?
When it is sudden and severe with any of: double vision, slurred speech, difficulty swallowing, facial or limb weakness or numbness, severe unfamiliar headache, or inability to walk or sit unsupported. Also sudden dizziness with new hearing loss. Those need emergency care rather than an appointment.
Why might my dizziness medication be making things worse?
Suppressant medication has a place over days during severe acute vertigo. Taken for months it blunts the signal the brain uses to recalibrate, which slows the compensation that would otherwise resolve symptoms. Some patients end up more persistently unsteady as a result.
Do I need a scan for dizziness?
Usually not. Classic positional vertigo is diagnosed by reproducing it on examination, and over-testing dizziness generates incidental findings that create their own anxiety. Imaging is appropriate where the pattern suggests a central cause, and it is coordinated with an outside facility.
What is vestibular rehabilitation and why do the exercises provoke symptoms?
It is a programme of graded exercises that drives the brain to adapt to a balance problem. The exercises are meant to be mildly provocative, because controlled exposure is the mechanism. Avoiding the movements that cause symptoms slows recovery rather than protecting it.
I have been unsteady for months but tests were normal. What now?
That pattern is recognised. Persistent daily unsteadiness, often worse in visually busy places and when tired, frequently follows a vestibular event that has resolved while the compensation process has not. The treatment is rehabilitation rather than medication, and a normal test does not mean nothing is wrong.
Does CNS do hearing tests?
No. Audiology is arranged externally. Dizziness with new hearing loss, ringing or fullness in one ear does shift the assessment substantially and warrants prompt attention, so mention it when you book.
How this page was sourced
Practice facts here come from Clinical Neurology Specialists directly: that both offices evaluate dizziness, perform balance testing and deliver repositioning treatment, and that audiology and imaging are arranged externally rather than provided on site. Clinical context is sourced to the three organisations listed below, cited inline.
Symptom patterns described are typical and are not a self-diagnosis tool, since categories overlap and patients frequently have more than one contributor. The caution about long-term suppressant medication reflects the compensation mechanism rather than a claim about any specific product. No outcome is promised. Scope is adults 18 and older.
References
- Vestibular Disorders Association — patient information on balance and vestibular disorders.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
- American Academy of Neurology — clinical practice guidance and specialist supply.
This page is for general education about adult neurological care and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department. Speak with a qualified clinician about your own circumstances.