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Dizziness & Vertigo: Causes, Assessment & Treatment in Toronto

Feeling dizzy, off-balance or as though the room is spinning can be unsettling—and the word “dizziness” can describe many different sensations with many possible causes.

Some people experience spinning when they roll over in bed. Others feel unsteady when walking, lightheaded when standing, sensitive to movement or overwhelmed in busy visual environments such as grocery stores. The pattern of your symptoms can provide important clues about what may be contributing to them.

At Physiomobility Health Group in Don Mills, North York, our vestibular physiotherapists assess dizziness, vertigo and balance problems to help determine whether the vestibular system, balance system, neck or other factors may be contributing—and whether physiotherapy is appropriate.

Book a Dizziness & Balance Assessment

What Does Your Dizziness Feel Like?

“Dizziness” is not a diagnosis. It is a symptom that people use to describe several different sensations.

Understanding what you feel, when it happens and how long it lasts is often more useful than the word dizziness itself.

Does the room spin when you roll over in bed?

Brief spinning triggered by rolling over, lying down, sitting up, looking upward or bending over can occur with Benign Paroxysmal Positional Vertigo (BPPV).

BPPV occurs when tiny calcium carbonate crystals become displaced into part of the inner-ear balance system where they do not belong.

A vestibular physiotherapist can perform positional testing to determine whether BPPV is present and, when appropriate, treat it with a canal-specific repositioning manoeuvre.

Learn more about BPPV and positional vertigo treatment →

Did severe dizziness start suddenly and last for hours or days?

A sudden onset of prolonged vertigo or dizziness can have several possible causes.

One peripheral vestibular cause is vestibular neuritis, which affects vestibular nerve function and can result in intense initial vertigo followed by ongoing imbalance, motion sensitivity or difficulty stabilizing vision.

However, sudden severe dizziness can also have non-vestibular and potentially serious causes.

New, sudden or severe dizziness—particularly when accompanied by neurological symptoms—requires appropriate medical assessment.

Learn more about Vestibular Neuritis →

Do you feel dizzy with migraine or visual stimulation?

Vestibular migraine can cause dizziness, vertigo, motion sensitivity, imbalance and sensitivity to light or visually complex environments.

A headache does not necessarily occur during every episode.

People may notice symptoms when:

  • Walking through grocery stores or shopping centres
  • Watching fast-moving images
  • Scrolling on a screen
  • Driving or riding in a vehicle
  • Moving their head quickly
  • Being exposed to bright lights or visually busy environments

Vestibular rehabilitation may be one component of management when vestibular, balance or visual-motion impairments are present.

Learn more about Vestibular Migraine →

Do you feel constantly off-balance, rocking or swaying? Could it be PPPD?

Some people describe feeling as though they are:

  • Rocking
  • Swaying
  • Floating
  • Walking on a boat
  • Unsteady despite not actually falling
  • Worse when standing or walking
  • Worse in busy visual environments
  • Vestibular tests can be normal

Persistent symptoms like these can occur for different reasons, including vestibular dysfunction and conditions such as Persistent Postural-Perceptual Dizziness (PPPD).

Assessment is important because similar sensations can occur with several different conditions. Vestibular rehabilitation plays an important role in managing PPPD and assisting patients to return to normal life and activities. A multideciplinary approach to treatment is essential involving CBT providers such as psychotherapists.

Are you dizzy after a concussion?

Dizziness and balance problems are common after concussion, but there is no single cause of “post-concussion dizziness.”

Symptoms may involve vestibular function, eye movements, balance, visual-motion sensitivity, the cervical spine or other factors.

A detailed assessment helps determine which systems appear to be contributing so that rehabilitation can be individualized.

Learn more about Concussion Rehabilitation →

Cervicogenic dizziness is dizziness or a sense of imbalance that is associated with neck pain, stiffness, or restricted neck movement. Persistent dizziness after automobile, work related or sport injuries should be assessed for a possible relation between neck injury and dizziness.

Cervical dizziness is thought to result from altered sensory information from the muscles and joints of the upper neck, which can interfere with how the brain integrates signals from the neck, eyes, and inner ear to maintain balance and spatial orientation. Symptoms may include unsteadiness, lightheadedness, or a feeling of disorientation rather than true spinning vertigo, and they may worsen with certain neck movements or prolonged postures. Because similar symptoms can occur with inner-ear, neurological, and other conditions, cervicogenic dizziness is generally considered a diagnosis of exclusion after other potential causes of dizziness have been assessed.

When the clinical presentation is consistent with cervicogenic dizziness, treatment may include rehabilitation of cervical and balance-related impairments.

Because there is no single definitive test for cervicogenic dizziness, other potential causes need to be considered.

Do you mainly feel unsteady when walking?

Not everyone with a balance disorder experiences spinning.

You may notice:

  • Unsteadiness while walking
  • Difficulty turning quickly
  • Reduced confidence on stairs
  • Difficulty walking in the dark
  • Problems on uneven ground
  • Needing to hold walls or furniture
  • Increasing fear of falling
  • Recurrent falls or near-falls

Balance depends on information from several systems, including vision, the vestibular system and sensation from the body.

A balance assessment can help identify which situations are difficult and guide an individualized rehabilitation program.

Learn more about Balance & Falls Prevention →

What Is the Difference Between Dizziness and Vertigo?

The terms are often used interchangeably, but they do not mean exactly the same thing.

Dizziness is an umbrella term that may describe lightheadedness, unsteadiness, floating, rocking, disorientation or other altered sensations of balance and orientation.

Vertigo is the false sensation that you or your surroundings are moving when they are not. People commonly describe spinning, although other sensations of movement can occur.

Vertigo is therefore a type of dizziness—not a diagnosis itself.

Determining the cause requires looking at the pattern, duration, triggers and associated symptoms.

What Can Cause Dizziness and Vertigo?

Dizziness can arise from many different conditions.

Potential contributors include:

  • BPPV
  • Vestibular neuritis
  • Vestibular hypofunction
  • Vestibular migraine
  • Ménière’s disease and other inner-ear disorders
  • Persistent Postural-Perceptual Dizziness (PPPD)
  • Concussion
  • Cervical dysfunction in appropriate presentations
  • Medication effects
  • Cardiovascular causes
  • Neurological conditions
  • Vision problems
  • Other medical conditions

More than one factor may also contribute to someone’s symptoms.

This is why treatment should be based on assessment rather than treating every episode of dizziness as an inner-ear problem or BPPV.

Do you experience episodes of vertigo with hearing changes or ringing in the ear?

Ménière’s disease is an inner-ear disorder that can cause recurring episodes of vertigo along with fluctuating hearing loss, tinnitus (ringing or buzzing in the ear), and a feeling of pressure or fullness in the affected ear.

Vestibular physiotherapy does not treat Ménière’s disease itself and cannot prevent or stop an acute Ménière’s attack. Diagnosis and medical management should be provided by a physician, typically an ENT or other appropriate medical specialist.

However, some people with Ménière’s disease continue to experience imbalance, unsteadiness, motion sensitivity, or reduced confidence with walking between attacks. In these situations, vestibular rehabilitation may help the brain compensate for changes in inner-ear balance function and improve day-to-day stability.

Depending on the findings of a vestibular assessment, rehabilitation may include:

  • Balance and walking exercises
  • Gaze-stabilization exercises when appropriate
  • Exercises to improve vestibular compensation
  • Gradual exposure to movements or environments that provoke symptoms
  • Strategies to improve confidence and reduce fall risk

The goal of physiotherapy is therefore symptom management and functional recovery—not treatment of the underlying Ménière’s disease. Vestibular rehabilitation is generally most useful when dizziness or imbalance persists between acute episodes.

When Is Dizziness an Emergency?

Most dizziness seen in a physiotherapy clinic is not a medical emergency. However, new or sudden dizziness can occasionally be associated with a serious medical or neurological condition.

Seek urgent medical attention for new dizziness or vertigo accompanied by symptoms such as:

  • New weakness or numbness of the face, arm or leg
  • New difficulty speaking or understanding speech
  • New severe difficulty walking or inability to stand
  • New double vision or significant vision changes
  • Sudden severe or unusual headache
  • Loss of consciousness
  • Chest pain or significant breathing difficulty
  • Other sudden neurological symptoms

If symptoms are severe, sudden, unusual for you or concerning, seek appropriate medical assessment rather than assuming they are caused by the inner ear.

How Is Dizziness Assessed?

There is no single “dizziness test.”

At Physiomobility, assessment begins by understanding what the dizziness feels like, when it occurs, how long it lasts and what triggers it.

Depending on your presentation, a vestibular physiotherapy assessment may include:

Symptom and Medical History

The timing and triggers of dizziness provide important diagnostic information.

Your physiotherapist may ask about:

  • When symptoms began
  • Duration of episodes
  • Head and body movements that trigger symptoms
  • Hearing symptoms
  • Migraine history
  • Falls
  • Concussion or head injury
  • Neck symptoms
  • Medications and relevant medical history

Eye Movement Assessment

The vestibular and visual systems work closely together.

Eye movement examination may provide information about vestibular function and help determine whether further assessment or referral is appropriate.

Infrared Video Goggles

Physiomobility uses infrared/video goggles when clinically appropriate to observe eye movements and nystagmus with reduced visual fixation.

Positional Testing

If your symptoms suggest BPPV, tests such as the Dix-Hallpike test or supine roll test may be performed.

The pattern of symptoms and eye movements helps determine whether BPPV is present and which canal may be involved.

Vestibular and Visual-Stability Testing

Testing may examine how your eyes respond to head movement and whether head movement affects visual stability or reproduces symptoms.

Balance and Walking Assessment

Balance may be assessed under different sensory conditions and during functional activities such as walking and turning.

Cervical Assessment

When neck involvement is suspected, examination of the cervical spine may form part of the assessment.

Screening and Referral

Physiotherapists do not treat every cause of dizziness.

If your assessment identifies findings that require medical investigation or another healthcare professional’s expertise, appropriate referral may be recommended.

Can Physiotherapy Help Dizziness and Vertigo?

It depends on the cause.

Physiotherapy can be particularly helpful when dizziness, vertigo or imbalance is related to conditions that respond to vestibular rehabilitation, repositioning manoeuvres, balance rehabilitation or appropriate cervical treatment.

For example:

BPPV
May respond to canal-specific repositioning manoeuvres.

Vestibular hypofunction or vestibular neuritis
May benefit from vestibular rehabilitation addressing visual stability, motion tolerance and balance.

Balance impairment
May benefit from progressive balance and gait training.

Concussion-related vestibular dysfunction
May benefit from targeted vestibular and balance rehabilitation when appropriate.

Vestibular migraine or persistent dizziness
Vestibular rehabilitation may be one component of a broader management approach for selected patients.

The important first step is determining whether physiotherapy is appropriate for your particular presentation.

What Is Vestibular Physiotherapy?

Vestibular physiotherapy is specialized rehabilitation for people experiencing dizziness, vertigo, imbalance or visual-motion problems associated with vestibular and balance-system dysfunction.

Treatment may include:

  • Repositioning manoeuvres
  • Gaze stabilization
  • Vestibular adaptation exercises
  • Habituation
  • Balance and gait training
  • Visual-motion exercises
  • Functional rehabilitation
  • Individualized home exercises

Physiomobility has a dedicated page explaining how vestibular assessment and rehabilitation work.

Learn more about Vestibular Physiotherapy & Rehabilitation →

Why Choose Physiomobility for Dizziness and Balance Assessment?

Experienced Vestibular Physiotherapists

Physiomobility has physiotherapists with a clinical focus on dizziness, vertigo, balance and vestibular rehabilitation.

Our approach begins with assessment rather than assuming that all dizziness is caused by BPPV.

Assessment Beyond Positional Vertigo

When appropriate, assessment may include positional testing, eye movements, vestibulo-ocular function, balance, gait and cervical screening.

Infrared Video Goggles

Infrared/video goggles can assist with observation of nystagmus and other eye movements during vestibular and positional testing.

BPPV and Complex Vestibular Presentations

Our vestibular physiotherapists assess BPPV as well as people experiencing persistent dizziness, vestibular hypofunction, balance problems and other vestibular presentations within the scope of physiotherapy.

Multidisciplinary Rehabilitation

Physiomobility is a multidisciplinary rehabilitation clinic, allowing care to be coordinated when dizziness occurs together with issues such as neck pain, concussion-related problems or mobility limitations.

Convenient North York Location

Physiomobility Health Group is located at CF Shops at Don Mills in North York, Toronto.

Frequently Asked Questions About Dizziness and Vertigo

Why do I get dizzy when I roll over in bed?

One possible cause is BPPV, particularly when rolling over or changing head position produces a brief spinning sensation. Other conditions can also cause positional dizziness, so assessment is important before assuming BPPV is the cause.

Why do I feel dizzy when I move my head?

Head-movement-related dizziness can occur with several vestibular conditions, including vestibular hypofunction, but the symptom alone does not identify the diagnosis.

A vestibular assessment can help determine whether vestibular dysfunction is contributing.

Can you have vertigo without an inner-ear problem?

Yes. Vertigo describes a sensation rather than a diagnosis. Although many causes involve the vestibular system, migraine, neurological conditions and other problems can also produce vertigo or dizziness.

Why do grocery stores make me dizzy?

Large stores and other visually complex environments can be challenging for people with visual-motion sensitivity.

This can occur with conditions including vestibular migraine, persistent dizziness, concussion and some vestibular disorders.

Why am I still dizzy after BPPV treatment?

Some people experience temporary residual unsteadiness after successful BPPV treatment. Persistent symptoms can also indicate unresolved BPPV or another contributing condition.

If symptoms continue, reassessment can help determine the next step.

Can anxiety cause dizziness?

Anxiety can contribute to or amplify dizziness in some people, and persistent dizziness itself can also cause anxiety.

However, dizziness should not automatically be attributed to anxiety without considering other possible causes.

Should I see a doctor or a vestibular physiotherapist for dizziness?

New, severe or unexplained dizziness may require medical assessment, particularly when associated with neurological, cardiovascular, hearing or other concerning symptoms.

Vestibular physiotherapy is particularly appropriate when a vestibular or balance problem is suspected or when a healthcare provider has recommended vestibular rehabilitation.

Can dizziness be treated without medication?

Some causes of dizziness respond to non-medication approaches.

For example, BPPV may respond to repositioning manoeuvres, while vestibular rehabilitation may help selected patients with vestibular hypofunction, balance problems or motion sensitivity.

Treatment depends on the underlying cause.

Dizziness & Vertigo Assessment in Don Mills, North York

If you are experiencing dizziness, vertigo or unexplained balance problems, determining the likely source of your symptoms is an important first step.

Physiomobility Health Group provides vestibular and balance assessment at CF Shops at Don Mills in North York, Toronto.

If physiotherapy is appropriate, your treatment plan will be based on your assessment findings rather than a generic dizziness exercise program.

Book a Dizziness & Balance Assessment

Find Information About Your Symptoms

Clinical Review

Clinically reviewed by Gita Mikal, Registered Vestibular Physiotherapist

Gita Mikal is a physiotherapist at Physiomobility Health Group with a clinical focus on vestibular rehabilitation, dizziness and balance disorders.

Last clinically reviewed: August 2026

This page provides general educational information and is not intended to diagnose the cause of dizziness. New, severe, unusual or rapidly worsening symptoms should receive appropriate medical assessment.

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