Helping you find your balance and get back to steady ground
Vertigo is more than just feeling dizzy. For many people, it feels like the room is spinning or tilting, even when they’re standing still. This unsettling sensation can interfere with walking, driving, and everyday movement. It can also create fear and anxiety around when the next episode might strike. Apex Neurology provides expert, compassionate care for vertigo at multiple locations throughout New York, helping patients understand the cause and take back control of their lives.
What Is Vertigo?
Vertigo is a type of dizziness that creates the false sense that you or your surroundings are moving. It is typically caused by problems in the inner ear or the parts of the brain that control balance. The feeling can be sudden and intense or slow and steady, depending on the cause.
Vertigo is often confused with general lightheadedness, but it usually involves a spinning or swaying sensation that makes it difficult to stay upright. In some cases, vertigo is triggered by certain head movements or changes in position.
Common symptoms include:
- A spinning or tilting sensation
- Loss of balance or coordination
- Nausea or vomiting
- Sweating
- Headaches
- Ringing in the ears or hearing changes
- Eye movement abnormalities (nystagmus)
Episodes may last a few seconds, several minutes, or much longer. Some people have isolated events, while others experience ongoing symptoms that affect their quality of life.
Who Can Benefit?
If you’ve been experiencing balance problems or dizziness that feels like the world is moving around you, medical evaluation can help. You may benefit from vertigo treatment if you:
- Have repeated or unexplained episodes of spinning sensations
- Feel dizzy when turning your head, lying down, or standing up
- Experience nausea, motion sickness, or loss of balance
- Have a history of ear infections or inner ear disorders
- Recently had a head injury, concussion, or viral illness
- Notice hearing loss or ringing in one or both ears
- Are unsure what’s causing your dizziness and want answers
Even if your vertigo symptoms seem mild, they can be a sign of a deeper issue that needs to be addressed.
What to Expect
During your appointment, your provider will start by asking detailed questions about your symptoms. You’ll be asked when the vertigo started, how long it lasts, what makes it better or worse, and how it’s impacting your day-to-day life.
A physical and neurological exam will follow, focusing on:
- Eye movements
- Balance and walking
- Coordination and reflexes
- Head and neck positioning
- Hearing function
You may also be referred for:
- Videonystagmography (VNG) or ENG testing to track involuntary eye movements
- Audiometry to evaluate hearing loss
- MRI or CT scans, if neurological concerns are suspected
- Blood tests to rule out infection or metabolic issues
Once the cause is identified, a personalized treatment plan will be created. Your plan may include:
- Vestibular rehabilitation therapy (VRT), which includes balance and head movement exercises
- Canalith repositioning maneuvers, such as the Epley maneuver, for benign paroxysmal positional vertigo (BPPV)
- Medications, such as anti-nausea drugs, antihistamines, or anti-inflammatories
- Lifestyle changes, including hydration, rest, and avoiding triggers
- Hearing or ENT referrals, if needed for inner ear-related causes
Treatment is often very effective once the cause is known.
BPPV: How Inner Ear Crystals Cause Spinning
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and accounts for roughly half of peripheral vertigo cases seen in clinical practice. The inner ear contains tiny calcium carbonate crystals called otoconia, which normally sit in the utricle and help the brain sense head position. When otoconia become dislodged — often after a head injury, prolonged bed rest, or simply with age — they can migrate into one of the three semicircular canals.
The posterior semicircular canal is involved in roughly 85–95 percent of BPPV cases. When the dislodged crystals move with head position changes, they pull on the canal’s sensors and create brief but intense spinning episodes, typically lasting less than a minute. Common triggers include lying down in bed, rolling over, looking up at a high shelf, or tilting the head back at the sink.
The Epley Maneuver: A Five-Minute In-Office Treatment
The canalith repositioning procedure — often called the Epley maneuver after Dr. John Epley, who first described it in 1980 — is the standard treatment for posterior canal BPPV. The procedure uses a sequence of guided head and body positions to move the loose otoconia out of the semicircular canal and back into the utricle, where they no longer cause symptoms.
Most patients experience significant improvement after a single Epley maneuver session, and Cochrane review data show response rates of roughly 80 percent after one treatment, with the vast majority of remaining patients responding after a repeat session. The procedure takes about five to ten minutes, requires no anesthesia, and can be performed during the same office visit as your initial vertigo consultation. See our canalith repositioning page for more detail on what to expect.
Other Causes of Vertigo Worth Knowing
While BPPV is the most common cause, vertigo has several other recognized origins our neurologists evaluate during workup:
- Meniere’s disease — episodic vertigo lasting 20 minutes to several hours, accompanied by tinnitus, fluctuating hearing loss, and a sensation of fullness in the affected ear.
- Vestibular neuritis — sudden, severe vertigo lasting days, typically following a viral illness, without hearing changes.
- Labyrinthitis — similar to vestibular neuritis but with associated hearing loss, since the entire inner ear is inflamed.
- Vestibular migraine — recurrent vertigo episodes that may or may not coincide with headache; closely related to migraine physiology and often responds to migraine preventive treatment.
- Acoustic neuroma (vestibular schwannoma) — a rare benign tumor on the vestibulocochlear nerve, more often presenting with asymmetric hearing loss than vertigo, but it should be considered when symptoms are one-sided.
When Vertigo Is a Medical Emergency
Most vertigo is benign and treatable, but a small subset of cases reflects central nervous system causes — including stroke, multiple sclerosis, or brainstem lesions — that require urgent evaluation. Seek emergency care immediately if vertigo is accompanied by any of the following:
- Sudden severe headache, especially with neck stiffness
- Weakness, numbness, or loss of coordination on one side of the body
- Difficulty speaking, slurred speech, or trouble understanding others
- Double vision or new vision loss
- Difficulty walking or standing that is markedly worse than your usual vertigo
- Sudden hearing loss combined with severe vertigo
At the bedside, neurologists and emergency providers use a focused exam called HINTS — head-impulse, nystagmus pattern, and test-of-skew — to help distinguish peripheral causes (inner ear) from central causes (brain). When red flags are present, imaging such as an MRI is typically needed.
Diagnosing Vertigo: Dix-Hallpike and VNG Testing
Two tests carry most of the diagnostic weight in vertigo evaluation. The Dix-Hallpike maneuver is a positional test performed in the office: your provider rapidly moves you from sitting to a head-hanging position while observing for characteristic eye movements (nystagmus). A positive Dix-Hallpike strongly confirms posterior canal BPPV and often points directly to the Epley maneuver as treatment.
For more complex cases — or when central causes are on the differential — we use videonystagmography (VNG). VNG uses infrared goggles to precisely record eye movements during a series of vestibular challenges, including position changes, caloric stimulation, and visual tracking. The results help differentiate peripheral from central vertigo, identify which inner ear is affected, and guide treatment. Audiometry and, when indicated, MRI imaging complete the workup for patients whose history or exam raises concern.
Where This Service Is Often Used
Vertigo care is often included in several areas of healthcare, including:
- Neurology clinics, where specialists evaluate balance and brain function
- Ear, nose, and throat (ENT) referrals, for inner ear disorders
- Physical therapy programs, especially for vestibular rehab exercises
- Post-concussion care, where dizziness is a common lingering symptom
- Fall prevention and senior care, when balance problems increase the risk of injury
Vertigo often overlaps with other health concerns, so treatment is best delivered by a team that sees the full picture.
Why Clients Choose This Service
- Clear answers: Get a real diagnosis and a treatment plan that makes sense
- Effective therapies: Hands-on techniques and exercises can improve balance quickly
- Compassionate care: Your symptoms are taken seriously, even when others haven’t understood
- Trusted specialists: Apex Neurology brings years of experience in diagnosing and treating vertigo
- Convenient care: Multiple New York locations make access to support easier for you or your loved one
How Apex Neurology Can Help
Vertigo can be disorienting and, for many, deeply unsettling. The good news is that most causes of vertigo are treatable, especially with early evaluation. Apex Neurology provides expert care tailored to the underlying cause of your symptoms. Whether your vertigo is triggered by a condition like BPPV, vestibular migraine, Meniere’s disease, or another neurological issue, your provider will create a thoughtful plan to help you regain balance and confidence.
Each clinic is equipped with the tools needed for accurate diagnosis and therapy. From advanced imaging to vestibular assessments, your care is comprehensive and collaborative. Providers work closely with audiologists, ENT specialists, and physical therapists when needed to ensure you get the full support you deserve.
Patients consistently share how much better they feel after receiving care that is specific to their condition. You are never treated like a general case. Your experiences are heard, respected, and addressed in ways that feel manageable and reassuring.
Ready to Take the Next Step?
If you’ve been struggling with dizziness, imbalance, or that spinning feeling that just won’t go away, now is the time to get the answers you deserve. Vertigo may be common, but that doesn’t mean it should control your life. Apex Neurology offers trusted, supportive care for vertigo at multiple locations across New York. Schedule a consultation today and take your first step toward steady ground.
Related Diagnostics and Treatments
Diagnostic and treatment options at Apex Neurology include VNG testing for vestibular evaluation and canalith repositioning (Epley maneuver) for BPPV vertigo.
Further Reading from Apex Neurology
- Dizziness treatment
- Vertigo disrupts your day: finding
- The vng test for vertigo
- Positional dizziness and BPPV
Frequently Asked Questions
Vertigo duration depends on the cause. BPPV (the most common type) lasts 30 seconds to 2 minutes per episode, triggered by head movement. Vestibular neuritis can cause continuous vertigo for several days. Meniere’s disease episodes last 20 minutes to 24 hours. Vestibular migraine vertigo lasts hours to days. Vertigo lasting longer than a week, or accompanied by hearing loss, severe headache, or weakness, requires immediate evaluation by a neurologist.
Yes, stress can both trigger and worsen vertigo. Chronic stress affects the vestibular system through cortisol and inflammation, can trigger vestibular migraine, and disrupts the inner ear’s balance regulation. Anxiety can also cause persistent postural-perceptual dizziness (PPPD), a real condition where the vestibular system stays in a heightened state. If your vertigo correlates with stressful periods, treatment should address both the vestibular cause and stress management together.
Vertigo feels like the room is spinning around you, or that you yourself are spinning even when stationary. It’s different from lightheadedness or feeling faint. Patients often describe it as being on a boat, motion-sickness-like nausea, sudden imbalance with head movement, or a tilting/swaying sensation. Severe episodes can include vomiting and inability to walk. The spinning sensation is the hallmark — if you don’t feel that, you may have a different type of dizziness.
A neurologist or vestibular specialist uses Video Nystagmography (VNG) testing to identify which ear is causing vertigo. The test tracks involuntary eye movements (nystagmus) in response to head positions. The Dix-Hallpike maneuver specifically identifies which side has BPPV by triggering nystagmus when the affected ear is positioned downward. The direction and speed of the eye movement tell the clinician which inner ear canal is involved.
Vertigo itself is rarely dangerous, but the underlying cause sometimes is. Most vertigo is from inner ear issues like BPPV — uncomfortable but benign. However, vertigo can also be a symptom of stroke, tumor, multiple sclerosis, or severe ear infection. Red flags requiring immediate attention include sudden severe vertigo with new headache, weakness, slurred speech, vision changes, or hearing loss. New vertigo over age 50 should always be evaluated by a neurologist to rule out vascular causes.
The most common cause is BPPV — calcium crystals dislodging in the inner ear, often after head trauma, viral illness, or aging. Other causes include vestibular neuritis (viral inner ear inflammation), Meniere’s disease (excess inner ear fluid), vestibular migraine, ear infections, head injury, certain medications, and rarely, stroke or tumor. Women over 50 are most prone to BPPV. A neurological exam plus VNG testing identifies the specific cause and points to the right treatment.