Dizziness is your nervous system
asking for help it hasn’t received.

Dizziness is a broad term for any disturbance in spatial orientation or balance. Vertigo is a specific subtype: a false sense of spinning or rotation, either of the environment or of yourself. Vertigo typically indicates a vestibular system problem, either in the inner ear or in the central vestibular pathways of the brainstem and cerebellum. Other forms of dizziness (lightheadedness, floating, chronic unsteadiness) may arise from different mechanisms including cervicogenic disruption or autonomic dysfunction. The distinction matters because the type determines the treatment.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of episodic vertigo in adults. It occurs when calcium carbonate crystals (otoconia) from the utricle become displaced into one of the semicircular canals of the inner ear, generating false movement signals when the head changes position. The brief, intense spinning this produces (typically lasting less than a minute) is triggered by specific movements like lying down or rolling over. The evidence-based first-line treatment is canalith repositioning maneuvers, most commonly the Epley maneuver. Dr. Silver performs positional testing to identify which canal is affected, then applies the appropriate maneuver. BPPV often resolves in one to three treatment sessions.

Cervicogenic dizziness arises from disrupted proprioceptive input from the upper cervical spine to the vestibular nuclei in the brainstem. The suboccipital muscles and facet joints of C1 and C2 contain a high density of mechanoreceptors that project directly to these nuclei. When these structures are injured (often through whiplash or cervical trauma), or when atlas misalignment alters normal joint mechanics, the brainstem receives inaccurate position information, producing persistent dizziness and spatial disorientation. Cervicogenic dizziness is a recognized clinical entity that responds to upper cervical correction and cervical proprioceptive rehabilitation.

Central vestibular dysfunction refers to dizziness and balance disruption originating in the vestibular processing pathways of the brainstem and cerebellum. The peripheral vestibular organs of the inner ear are not the source in this presentation. It can follow concussion, neurological injury, or result from functional neurological impairment. Eye movement abnormalities are a key clinical indicator. The cerebellum and brainstem exert precise control over the vestibulo-ocular reflex and smooth pursuit, and VNG testing reveals disruptions in those controls. Central vestibular dysfunction is addressed through targeted functional neurology rehabilitation.

This depends significantly on the type and cause. BPPV often responds in one to three repositioning sessions. Cervicogenic dizziness typically improves over several weeks of upper cervical correction and proprioceptive rehabilitation. Central vestibular dysfunction, particularly following concussion or neurological injury, may require a longer course of targeted rehabilitation. Dr. Silver assesses the specific mechanism at the first appointment and gives an honest estimate of expected trajectory based on what the examination reveals.

Assessment begins with a full vestibular and functional neurological examination, including videonystagmography for quantified eye movement analysis, computerized balance assessment, positional testing for BPPV, and cervical evaluation. These tools map whether the dysfunction is peripheral, central, or cervicogenic. Treatment is then built entirely from those findings: repositioning maneuvers for BPPV, vestibular rehabilitation for central dysfunction, and upper cervical correction for cervicogenic involvement. The goal is a specific answer to a specific problem.