Vertigo and Dizziness Treatment in Redmond, WA

Dizziness and vertigo are among the most common patient complaints in all of medicine — and among the most confusing to sort out. "Dizziness" means different things to different people: a true spinning sensation (vertigo), lightheadedness, imbalance, or disorientation. Each has different causes and different appropriate treatments. True vertigo from inner ear problems (BPPV, Meniere's disease, vestibular neuritis) requires specific interventions and typically ENT or neurology evaluation. Cervicogenic dizziness — dizziness originating from upper cervical dysfunction — is often overlooked but responds well to NUCCA upper cervical care. For patients whose dizziness workup has been inconclusive, or whose symptoms persist after inner ear treatments, evaluating the upper cervical spine is often worthwhile.

Understanding Vertigo vs Dizziness

Clinical distinction matters here because treatment approaches differ dramatically:

• Vertigo — the artificial perception of movement. True vertigo is a sensation that you or your surroundings are spinning or rotating, even when stationary. This specific sensation points toward vestibular (inner ear) or central nervous system causes
• Dizziness — a broader term covering lightheadedness, feeling faint, or feeling "off"
• Disequilibrium — a sense of imbalance or unsteadiness, often felt in the body rather than the head
• Presyncope — feeling like you might pass out; typically indicates cardiovascular causes

Accurately describing which sensation you're experiencing helps providers identify the likely cause. The question "do you feel like YOU are spinning or like the ROOM is spinning?" is less helpful than describing the actual sensation.

Common Symptoms Associated with Vertigo and Dizziness

• Spinning sensation (true vertigo)
• Lightheadedness or feeling faint
• Imbalance or unsteadiness when standing or walking
• Nausea and vomiting
• Difficulty focusing eyes (nystagmus — rapid eye movements)
• Hearing changes (tinnitus, hearing loss) — suggests inner ear involvement
• Headache
• Neck pain or stiffness
• Difficulty walking or performing complex movements
• Blurred vision
• Weakness
• Difficulty talking or thinking clearly during episodes
• Episodes triggered by head position changes (classic BPPV)
• Episodes triggered by neck movement or sustained posture (suggests cervicogenic)
• Fatigue, anxiety, or depression (common with chronic cases)

Red Flag Symptoms — Seek Emergency Care

Certain presentations indicate potentially serious conditions requiring immediate evaluation:

• Dizziness with sudden severe headache — possible stroke or hemorrhage, call 911
• Dizziness with any FAST signs — Face drooping, Arm weakness, Speech difficulty, Time to call 911
• Dizziness with new neurological symptoms — weakness, numbness, double vision, difficulty swallowing
• Dizziness with chest pain or shortness of breath — possible cardiac emergency
• Dizziness following head trauma — concussion evaluation needed
• Severe persistent vertigo lasting hours with hearing loss — possible labyrinthitis or stroke affecting inner ear circulation
• New dizziness with history of cancer — workup for metastasis
• Progressive dizziness getting worse over days to weeks — requires workup
• Loss of consciousness during episodes — requires cardiac evaluation

These require ER or urgent medical evaluation — NUCCA is not appropriate as the initial response.

Common Types of Vertigo and Dizziness

Different causes require different treatments:

• Benign Paroxysmal Positional Vertigo (BPPV) — the most common cause of true vertigo. Caused by displaced calcium carbonate crystals (otoconia) in the inner ear. Brief episodes triggered by head position changes. Treated effectively with specific repositioning maneuvers (Epley maneuver) performed by trained providers. NOT a NUCCA condition — see an ENT, neurologist, or vestibular PT trained in canalith repositioning
• Meniere's Disease — episodes of vertigo, hearing loss, tinnitus, and ear fullness. Underlying cause involves inner ear fluid pressure. Managed by ENT with dietary changes, diuretics, and sometimes procedural interventions
• Vestibular Neuritis / Labyrinthitis — inflammation of the vestibular nerve (neuritis) or inner ear (labyrinthitis), often following viral illness. Causes severe acute vertigo lasting days to weeks. Managed medically; vestibular rehabilitation PT helps recovery
• Vestibular Migraine — vertigo associated with migraine (may occur with or without typical migraine headache). Common and often misdiagnosed. See our Migraines page. NUCCA has evidence for migraine patients
• Cervicogenic Dizziness — dizziness originating from upper cervical dysfunction. Often associated with neck pain, triggered by neck movement or sustained posture. This is the primary NUCCA indication. Often misdiagnosed as inner ear problems
• Post-Concussion Dizziness — common after concussion/TBI; often has multiple contributors including vestibular, cervical, and visual components. See our Post-Concussion Syndrome page
• Orthostatic Hypotension — lightheadedness on standing from blood pressure drop. Cardiovascular cause, not vestibular
• Persistent Postural-Perceptual Dizziness (PPPD) — chronic dizziness without clear peripheral cause; often involves anxiety amplification
• Acoustic Neuroma — rare benign tumor on the vestibular nerve; produces progressive hearing loss and dizziness. Requires neurosurgical evaluation
• Medication side effects — many medications can cause dizziness (antihypertensives, sedatives, some antibiotics, certain antidepressants)

Cervicogenic Dizziness: The NUCCA Fit

Cervicogenic dizziness is dizziness originating from upper cervical spine dysfunction. The upper cervical region provides substantial proprioceptive input to the brain's balance centers. When upper cervical function is disrupted — through injury (whiplash), chronic postural strain, or atlas misalignment — the brain receives faulty information about head position, producing dizziness that often feels like true vertigo.

Features suggesting cervicogenic dizziness:

• Dizziness often triggered by neck movement or sustained neck posture
• Associated neck pain or stiffness
• History of head/neck trauma (whiplash, concussion)
• Dizziness that persists after normal inner ear workup
• Response to cervical treatment including NUCCA
• Often misdiagnosed as "inner ear problems" that don't respond to inner ear treatments

For cervicogenic dizziness specifically, there is direct research evidence supporting manual therapy of the upper cervical spine. Our Reid 2008 and Reid 2014 citations below are specifically on cervicogenic dizziness.

How Dizziness Is Properly Evaluated

Appropriate dizziness workup typically includes:

• Clinical history — detailed description of the dizziness sensation, triggers, duration, associated symptoms
• Physical examination — neurological screening, vestibular testing (Dix-Hallpike for BPPV, head impulse test), orthostatic blood pressure measurement, cervical range of motion
• ENT or neurology evaluation for persistent cases
• Audiology testing — if hearing changes are present
• MRI — if central cause is suspected
• Cardiac workup — for lightheadedness/presyncope presentations
• Vestibular function testing — electronystagmography (ENG), videonystagmography (VNG), rotary chair testing in specialized settings

If you have persistent dizziness without a clear diagnosis, see a physician — ideally one with experience in dizziness (ENT, neurologist, or neurotologist). Chiropractic should not be the first stop for undiagnosed dizziness.

Why NUCCA Is Different for Dizziness Care

Traditional chiropractic manipulation can be particularly problematic for dizziness patients — forceful rotation of a dizzy patient's neck often triggers or worsens symptoms. NUCCA takes a fundamentally different approach:

This gentle approach is appropriate for patients with vestibular sensitivity, post-traumatic symptoms, or craniocervical instability where traditional cervical manipulation would be inappropriate.

What to Expect: Your NUCCA Dizziness Care

Working With Your Broader Care Team

Dizziness care often requires multiple providers:

• ENT (otolaryngologist) — PRIMARY specialist for inner ear causes of vertigo. Essential for BPPV diagnosis and treatment, Meniere's disease management, and vestibular neuritis
• Neurologist — for central vertigo, vestibular migraine, and complex cases. Neurotologists specialize specifically in vestibular disorders
• Vestibular physical therapist — specialized PT for vestibular rehabilitation (VRT). Highly effective for BPPV (canalith repositioning), vestibular neuritis recovery, and PPPD. Look for providers with vestibular rehabilitation certification
• Primary care physician — initial evaluation, coordination of care
• Cardiologist — for presyncope presentations or suspected cardiovascular causes
• Audiologist — for hearing evaluation when inner ear involvement is suspected
• Mental health provider — for anxiety-amplified dizziness (PPPD) or significant impact on quality of life
• Physical therapist — for balance training and fall prevention

Standard medical treatments depend on cause: Epley maneuver for BPPV, vestibular suppressants (meclizine) for acute symptoms, diuretics and dietary changes for Meniere's, migraine prevention for vestibular migraine, vestibular rehabilitation PT. NUCCA addresses the cervicogenic component and does not replace indicated medical treatments for other causes.

When NUCCA May Not Be the Right Fit

NUCCA is NOT appropriate as initial care for:

• Red flag symptoms (see list above) — require medical evaluation
• Undiagnosed dizziness without basic medical workup
• BPPV — needs canalith repositioning, not NUCCA
• Acute vestibular neuritis — needs medical management
• Suspected central causes (stroke, tumor, MS)
• Cardiac causes of dizziness
• Severe acute vertigo requiring immediate symptom management

If your dizziness is one of these, medical evaluation comes first. If cervicogenic components are present alongside other causes, NUCCA can be part of a broader care plan.

What the Research Shows

The evidence base for upper cervical care specifically in cervicogenic dizziness is reasonable. For other causes of dizziness (BPPV, Meniere's, vestibular neuritis), appropriate medical and vestibular therapy approaches have stronger evidence than NUCCA.

Frequently Asked Questions

Related Conditions

• Migraines (vestibular migraine)
• Headaches
• Post-Concussion Syndrome
• Auto Injuries
• Neck Pain
• Craniocervical Instability
• TMJ and Jaw Pain
• Chronic Pain

Ready to Evaluate Whether Cervical Factors Are Contributing?

If you've been through dizziness workup without clear answers, or your symptoms haven't responded to inner ear treatments, evaluating the upper cervical spine is often worthwhile. Your initial consultation is complimentary.