Struggling with dizziness and looking for help in Amsterdam? At Wijs, you can visit our clinics in Amsterdam North and Amsterdam West for vestibular physiotherapy: targeted treatment for dizziness and balance problems. On this page you can learn how your balance works, which forms of dizziness exist, and how our vestibular-trained physiotherapists can help.
Dizziness is often described as the feeling that your relationship with the space around you is disturbed. The experience varies greatly from person to person. It might be a spinning sensation, light-headedness, a floating feeling when you move, or the sense of standing on a boat. Losing your orientation and the feeling that you could fall at any moment are also common.
Dizziness is a common complaint: for 3 to 14% of people who visit their GP, it is even the main reason for the appointment. Age plays a large role. The biggest group is 65 and over, but dizziness is common below that age too. The experience of dizziness can be frightening or limiting, throwing you off balance both literally and figuratively, so the impact on daily life is often considerable.
Your balance organ sits in the inner ear and has two parts: three semicircular canals that register rotational movements of the head, and two otolith organs containing tiny crystals that sense linear movement and the position of the head. The brain combines this information with what you see and with the feedback from your muscles and joints. This is how you stay balanced and keep a stable image during head movements. The hearing organ and the balance organ form one whole, which is why hearing problems and dizziness can sometimes occur together.
Important to know: dizziness can be properly assessed and, in many cases, treated effectively. Even so, many people live with it far longer than necessary, because the symptoms feel vague or are hard to describe. Below we cover the five most common forms of dizziness in which a vestibular-trained physiotherapist can contribute to treatment.
| Type of Dizziness | Symptoms | Duration | Cause |
|---|---|---|---|
| BPPV | Brief spinning dizziness on changes of position (turning over in bed, bending, looking up) | Seconds (< 1 minute) | Loose crystals in the balance organ |
| Vestibular hypofunction (vestibular neuritis) | Intense, ongoing spinning dizziness with nausea, followed by unsteadiness and sensitivity to movement | Acute: days. Recovery: weeks to months | Loss of the balance nerve (likely virus or inflammation) |
| Vestibular migraine | Recurring attacks of spinning or rocking dizziness, often without headache | 5 minutes to 72 hours | Migraine mechanism in the brain |
| Meniere’s disease | Attacks of spinning dizziness with hearing loss, ringing in the ear and ear pressure | 20 minutes to 12 hours | Fluid build-up in the inner ear |
| PPPD | Continuous unsteady, floating or hazy feeling; worse when standing, moving and in busy visual environments | Most days, at least 3 months | Disturbed processing of balance information in the brain |
| Orthostatic hypotension | Light-headedness when standing up (quickly) | Seconds | Temporary drop in blood pressure |
BPPV is the most common form of dizziness originating in the balance organ: around 20 to 30% of all people with dizziness have BPPV. The name says exactly what it is: benign, paroxysmal (in short attacks), position-dependent vertigo. The cause is mechanical. Small crystals (otoliths) come loose from the otolith organ and end up in one of the semicircular canals, usually the rear canal. When the head changes position, these crystals move with it and send a false rotation signal to the brain.
The result is a short, intense spinning sensation, usually lasting less than a minute, triggered by movements such as turning over in bed, lying down, bending or looking up. Between attacks people often feel fine, though an uncertain or light feeling can linger. BPPV is two to three times more common in women, increases with age and raises the risk of falls in older people. Does the spinning last longer than a minute? Then BPPV is actually unlikely.
The diagnosis is made using positional tests (such as the Dix-Hallpike test), in which the head is moved into specific positions to set the crystals in motion. The therapist or doctor watches for characteristic eye movements (nystagmus). The direction of these eye movements reveals which ear and which canal the crystals are in, and that determines the treatment.
The most important thing: do not delay treatment and do not start avoiding movements out of fear of the dizziness. BPPV can be treated quickly and effectively. If BPPV returns several times a year, a vitamin D deficiency may play a part; discuss supplementation with your GP.
Treatment consists of repositioning manoeuvres (such as the Epley or Semont manoeuvre), in which the head is moved through a series of positions so the crystals roll back to where they belong. This treatment is highly effective: in more than 95% of people the symptoms disappear, often after just one to three sessions. Medication does not resolve BPPV; it is and remains a mechanical problem.
Vestibular neuritis is a sudden loss of the balance nerve on one side, probably caused by a virus or inflammatory reaction. The result is acute, intense spinning dizziness that lasts for days, often with nausea, vomiting and significant loss of balance. Standing and walking are barely possible in this phase. An important difference from Meniere’s disease, for example: hearing stays normal. The condition is most common between the ages of 30 and 50 and is almost always a one-off.
After the acute phase (usually two to three days, sometimes a week) a reduced function of the balance organ remains: a vestibular hypofunction. This shows up as unsteadiness, a light feeling during (quick) head movements and sensitivity to busy visual environments such as a supermarket. These residual symptoms can last for weeks to months.
In the acute phase the diagnosis is usually made by the GP or neurologist, partly on the basis of spontaneous eye movements (nystagmus) and the head impulse test. Because the symptoms can resemble those of a stroke, this must first be carefully ruled out. After the acute phase, the function of the balance organ can be mapped further with balance testing.
Once the acute phase has passed, the rule is: return to moving your head and body normally as soon as possible. It is precisely through movement that the brain learns to compensate for the loss. Be cautious with anti-dizziness medication after the acute phase, as it slows natural recovery.
Vestibular rehabilitation is the treatment of choice here: exercise therapy focused on gaze stabilisation, balance and gradually building up movement, so the brain learns to compensate for the affected side. The sooner you start, the faster the recovery. Good guidance also matters to prevent the symptoms from becoming chronic: without the right approach, around 25% of people with vestibular neuritis go on to develop PPPD (see below).
Vestibular migraine is the most common cause of recurring, spontaneous dizziness attacks. The attacks last from 5 minutes to 72 hours and feel different for each person (and even from attack to attack): spinning dizziness, a rocking or swaying feeling, or dizziness triggered by head movements or visual stimuli. Notably, around 30% of attacks come with no headache at all. That makes the diagnosis tricky and means this form is often missed.
Most people have a history of migraine, sometimes going back years. Women are affected around five times more often than men. During attacks there is often sensitivity to light and sound, nausea and sensitivity to movement. Motion sickness, now or in childhood, is also common in this group.
There is no test that proves vestibular migraine. The diagnosis is made on the basis of international criteria (Barany Society and ICHD-3): at least five attacks of 5 minutes to 72 hours, a history of migraine, and migraine features such as one-sided throbbing headache, sensitivity to light and sound, or aura in at least half of the attacks. Investigations mainly serve to rule out other causes, usually via the neurologist.
As with ordinary migraine, it comes down to recognising and limiting your triggers. Keep a diary of sleep, activities, food and drink for six weeks. Common triggers are stress, poor or irregular sleep, skipping meals, hormonal fluctuations and busy visual environments. Regularity in sleep, eating and movement demonstrably helps most people.
Together with the physiotherapist, you can look at physical triggers such as neck and shoulder tension, and at calmly building up your capacity and fitness. Vestibular rehabilitation can improve balance and residual symptoms, but only once the attacks are under control; exercising too early or too intensively can actually make the symptoms worse. Coordinating with the GP or neurologist about (preventive) medication is part of a complete approach.
Meniere’s disease is a condition of the inner ear in which hearing, as well as balance, is involved. It is characterised by attacks of intense spinning dizziness lasting 20 minutes to 12 hours (usually a few hours), together with hearing loss in the low tones, ringing in the ear (tinnitus) and a feeling of pressure in one ear. Between attacks there are often few or no symptoms. The disease is chronic and variable: periods with many attacks can alternate with years of calm. Hearing can gradually deteriorate over time.
The disease is most common between the ages of 30 and 60. The exact cause is unknown; the most widely accepted explanation is a build-up of fluid in the inner ear (endolymphatic hydrops).
The diagnosis is made by the ENT specialist on the basis of criteria: at least two spontaneous dizziness attacks of 20 minutes to 12 hours, demonstrated hearing loss on a hearing test (audiometry) and fluctuating ear symptoms in the affected ear. Additional testing mainly serves to rule out other conditions.
There is no cure (yet), but you can learn to cope with the attacks: during an attack, lie down on a firm surface, keep your head still and fix your gaze on a fixed point. Many people benefit from regularity and from limiting salt, caffeine and stress, although the scientific evidence for this is limited. Let those around you know what they can do during an attack.
The physiotherapist cannot prevent the attacks themselves, but can do a great deal for the balance problems that arise between and after attacks. Vestibular rehabilitation improves balance, reduces the risk of falls and restores confidence in moving. General fitness and stability training is also important to preserve your overall capacity, and with it your day-to-day wellbeing, as much as possible.
PPPD is the most common cause of chronic dizziness. It is not spinning dizziness, but an ongoing unsteady, floating or hazy feeling (“not clear in the head”) that is present most days, for at least three months. The symptoms typically worsen when standing and sitting, during movement and in busy visual environments: the supermarket, scrolling on your phone, heavy traffic.
PPPD usually develops after a period of dizziness, for example following vestibular neuritis, BPPV, vestibular migraine or a panic attack. Instead of recovering fully, the brain stays in a heightened state of alertness: it leans too heavily on visual information and judges normal balance signals as threatening. This creates a vicious circle in which fear of falling and avoidance keep the symptoms going. It is important to stress that the symptoms are real and not imagined, even though there is often nothing (any longer) to find in the balance organ itself.
PPPD is diagnosed on the basis of clinical criteria and is emphatically not a diagnosis of exclusion (“we can’t find anything, so it must be PPPD”). The criteria: dizziness or unsteadiness most days for at least three months, worsening with an upright posture, movement and visual stimuli, a clear triggering onset, and a clear impact on daily functioning.
The first and most important step is understanding what is happening: the dizziness is an over-protective response of the brain, not a sign of damage. Do not avoid the triggering situations, but gradually and in measured steps seek them out again. Enough sleep, relaxation and calm movement support recovery.
The core of treatment is vestibular rehabilitation with a calm, step-by-step build-up: the brain is, in effect, retrained to process balance information normally. Doing too much too soon actually worsens the symptoms, so good dosing and guidance are essential. Where needed, treatment is combined with cognitive behavioural therapy and/or medication via the GP. There is no quick fix, but with time, explanation and the right build-up the symptoms can be treated well, especially when started early.
Do you recognise yourself in one of the forms of dizziness above? Our vestibular-trained physiotherapists investigate where your symptoms come from and work with you to create a targeted treatment plan. You can visit us at two locations in Amsterdam:
Bercylaan 807 A, 1031 KP Amsterdam
Tweede Hugo de Grootstraat 45 A, 1052 LB Amsterdam
Want to know whether vestibular physiotherapy is right for you? Book an appointment or explore our physiotherapy in Amsterdam.
Brief spinning dizziness when turning over in bed, bending or looking up often points to BPPV, where loose crystals in the balance organ send a false rotation signal. This form can usually be resolved quickly with repositioning manoeuvres.
The acute, intense phase usually lasts two to three days, sometimes a week. After that, residual symptoms such as unsteadiness and sensitivity to movement can linger for weeks to months. Vestibular rehabilitation speeds up recovery.
Yes. For many forms of dizziness, including BPPV, vestibular hypofunction, vestibular migraine, Meniere’s disease and PPPD, a vestibular-trained physiotherapist can play an important role in diagnosis and treatment. At Wijs, this is available in Amsterdam North and West.
Spinning dizziness (vertigo) is the sense that you or your surroundings are turning, and more often points to the balance organ. A light or floating feeling, especially when standing up quickly, can also be caused by a temporary drop in blood pressure (orthostatic hypotension). The nature and duration of the symptom help identify the cause.
Contact your GP with a first intense, ongoing attack, with dizziness alongside neurological signs (speech, strength, vision), or with dizziness accompanied by new hearing loss. These symptoms should be assessed medically before physiotherapy is considered.
