Cervicogenic Dizziness vs. BPPV (Vertigo): How to Tell the Difference
By Upper Cervical Chiropractic Encinitas (serving North County San Diego + greater San Diego)
Dizziness can be frustrating—and honestly a little scary—because it’s hard to describe and even harder to pin down.
In my Encinitas office at Upper Cervical Chiropractic Encinitas, I frequently see people from all over North County San Diego (and greater San Diego) who were told, “It’s probably your inner ear”… but their symptoms don’t fully match a classic inner-ear pattern—especially when neck pain, stiffness, headaches, or a whiplash history are also in the mix.
Two of the most common causes people confuse are:
BPPV (Benign Paroxysmal Positional Vertigo) – an inner ear issue
Cervicogenic dizziness – dizziness driven by the neck
Let’s break down how to tell the difference in a practical way.
Quick note: This article is educational and not a diagnosis. If your dizziness is new, worsening, or severe, make sure you’re evaluated by the appropriate medical provider.
First: “Dizziness” isn’t one thing
People use the word dizziness to describe different sensations:
Spinning / the room is moving (true vertigo)
Lightheaded / faint
Floating / woozy
Off-balance / unsteady
Visual disorientation (especially in busy environments)
Those details matter because BPPV and cervicogenic dizziness tend to have different “signatures.”
What is BPPV?
BPPV is one of the most common causes of vertigo. It happens when tiny calcium crystals (otoconia) in the inner ear get displaced into the wrong canal. When you change head position, those crystals move and trigger a spinning sensation.
BPPV tends to feel like:
Sudden spinning vertigo
Triggered by position changes, especially:
rolling in bed
getting in/out of bed
looking up
bending forward
Often lasts seconds (commonly under a minute)
May cause nausea
Often feels very “specific” and repeatable with the same movement
A classic BPPV clue
If you can say:
“When I roll to the right in bed, the room spins for 10–30 seconds.”
…that sounds very BPPV-ish.
What usually helps BPPV
Evaluation (often by ENT or vestibular physical therapy)
Repositioning maneuvers (like the Epley maneuver), performed correctly for the affected canal
What is cervicogenic dizziness?
Cervicogenic dizziness is dizziness that appears to be coming from the neck—typically related to irritation or dysfunction in the cervical spine and the sensory system around it.
Your brain builds balance from multiple inputs:
inner ear (vestibular)
vision
neck proprioception (position sense from joints/muscles)
If the upper neck is inflamed, stiff, or not moving well—especially after injury—those signals can become “noisy,” and the brain may interpret that as dizziness, imbalance, or disorientation.
Cervicogenic dizziness tends to feel like:
Off-balance / unsteady / foggy
Sometimes more “floaty” than spinning
Often worse with:
neck movement
sustained posture (driving, computer work)
turning to check blind spots
Frequently accompanied by:
neck pain and stiffness
headaches (often base-of-skull or behind the eyes)
tight upper traps / SCM tension
Can follow:
whiplash (even “minor”)
repetitive strain posture
prior neck injury history
A classic cervicogenic clue
If you can say:
“My dizziness gets worse when my neck flares up or when I turn my head, and my neck feels tight.”
…that points more toward a neck-driven component.
Quick comparison: cervicogenic dizziness vs BPPV
BPPV is more likely if:
The dizziness is spinning vertigo
It’s triggered by lying down, rolling in bed, looking up
It’s brief (seconds)
It’s very repeatable with a specific position
Cervicogenic dizziness is more likely if:
The dizziness feels like imbalance, disorientation, or light “wooziness”
It tracks with neck pain/stiffness
It’s triggered by turning the neck or prolonged posture
It’s more persistent (minutes to hours) or comes and goes with neck flare-ups
Can you have BOTH?
Yes—this is common.
Some people have a true inner ear component and a neck component at the same time. That’s one reason dizziness can be stubborn: you treat one piece, but the other piece is still adding noise to the system.
When dizziness should be treated as urgent
If you have dizziness plus any of the following, seek urgent medical evaluation:
sudden weakness, numbness, facial droop
trouble speaking, confusion
severe “worst headache of your life”
fainting, chest pain, shortness of breath
new vision loss
new severe difficulty walking
(These aren’t typical BPPV or typical cervicogenic dizziness patterns.)
What to do next (a practical plan)
Step 1: Get the right evaluation
If your symptoms match BPPV (especially positional spinning), consider:
ENT
vestibular physical therapy
a clinician trained in positional testing and maneuvers
If your symptoms are strongly tied to neck pain/stiffness (or a whiplash history), it’s reasonable to evaluate the cervical component too.
Step 2: Don’t ignore your neck if it’s clearly involved
If your neck is part of the pattern, you may benefit from:
cervical spine exam (mobility, muscle tone, provocation)
posture and movement assessment
proprioception/balance testing (when appropriate)
targeted rehab or manual care based on findings
Where upper cervical care may fit (North County San Diego + greater San Diego)
At Upper Cervical Chiropractic Encinitas, we focus on the upper neck (C1/C2) and how it can affect posture, movement, and sensory input.
Important: not every dizzy patient is an upper cervical case, and dizziness isn’t something you should “guess” on. The best outcomes happen when we:
rule out red flags
identify whether the pattern is inner ear, neck, or mixed
coordinate with ENT/vestibular PT when indicated
Because there are fewer upper cervical providers in this region, we often see people traveling in from Carlsbad, Solana Beach, Cardiff, Oceanside, Vista, San Marcos, Escondido, and even San Diego when they want a thorough upper cervical evaluation.
FAQs
If it’s BPPV, will neck treatment fix it?
Usually not. BPPV is an inner ear crystal problem and often responds best to repositioning maneuvers.
If it’s cervicogenic dizziness, will the Epley fix it?
Usually not. If dizziness is tied to neck movement and neck pain, repositioning maneuvers may not address the root driver.
How long does it take to improve?
It depends on the cause, duration, and whether it’s a single-source problem (just BPPV) or mixed (BPPV + neck + other factors). When the correct driver is identified, many people improve significantly.
Need help sorting this out?
If you’re dealing with dizziness and you’re not sure whether it’s BPPV, cervicogenic dizziness, or a mix of both, we can help you identify the pattern and choose the right next step.
Serving Encinitas, North County San Diego, and greater San Diego.
Book an initial exam on our website today.
