If you have been told you have vertigo, there is a good chance someone also told you it was “crystals in your inner ear.” You may have been handed a printout of exercises, or had a provider tip your head back on an exam table and roll you to one side. For many people, that is exactly the right answer. For others, the dizziness keeps coming back, the maneuvers stop helping, and every scan comes back normal.
If that second group sounds familiar, the problem may not be your inner ear at all. Two conditions, benign paroxysmal positional vertigo (BPPV) and cervicogenic vertigo, can sound nearly identical when you describe them, but they start in different places in the body and respond to different care. Knowing which one you are dealing with is often the difference between months of frustration and a clear plan.
Why “Vertigo” Is Not a Diagnosis
Vertigo describes a symptom: the sensation that you or the room is moving when nothing is. It tells us something is disrupting the way your brain calculates where your head is in space. It does not tell us why.
Your brain builds that picture from three streams of information: the inner ear (your vestibular system), your eyes, and position sensors in your neck. When any one of those streams sends inaccurate data, the result can feel like dizziness. BPPV is a problem in the first stream. Cervicogenic vertigo is a problem in the third.
We covered the broader picture of recurring dizziness in Why Do I Keep Getting Vertigo. This article narrows in on the two causes that are most often confused with each other.
What Is BPPV?
Benign paroxysmal positional vertigo is the most common cause of vertigo that originates in the inner ear. Your inner ear contains tiny calcium carbonate crystals called otoconia, which normally sit in a structure called the utricle. In BPPV, some of those crystals break loose and drift into one of the semicircular canals, most often the posterior canal. When you move your head relative to gravity, the loose crystals shift and send a false signal that your head is still moving.
What BPPV Typically Feels Like
- A true spinning sensation, often intense, that starts a few seconds after a change in head position
- Episodes that usually last under a minute
- Common triggers: rolling over in bed, lying down, sitting up, tipping the head back to look up, or bending forward
- Nausea during episodes, with a lingering sense of being “off” afterward
- No neck pain required; many BPPV patients have perfectly comfortable necks
How BPPV Is Identified and Treated
BPPV is diagnosed with a positional test called the Dix-Hallpike maneuver. The examiner moves your head into a specific position and watches your eyes for a characteristic involuntary movement called nystagmus. If that pattern appears, the diagnosis is well supported.
Treatment is a canalith repositioning maneuver, such as the Epley maneuver, which uses a sequence of head positions to guide the crystals back where they belong. When BPPV is the true cause, repositioning is highly effective, often within one to a few sessions.
BPPV can recur, and recurrence is fairly common. But maneuvers that never produce lasting relief, or dizziness that never matched the classic positional pattern in the first place, are signals to look elsewhere.
What Is Cervicogenic Vertigo?
Cervicogenic vertigo, often called cervicogenic dizziness in the research literature, is dizziness that originates in the upper neck. The small muscles and joints at the top of the cervical spine, particularly around the atlas (C1) and axis (C2), are packed with proprioceptors: sensors that continuously report the position and movement of your head relative to your body. The suboccipital muscles at the base of the skull contain some of the highest densities of these sensors anywhere in the body.
When the upper neck is injured, misaligned, or moving abnormally, those sensors can send distorted position information. Your brain then receives one version of reality from your inner ears and eyes and a different version from your neck. That sensory mismatch can produce dizziness, imbalance, and disorientation, even when the inner ear itself is healthy.
What Cervicogenic Vertigo Typically Feels Like
- Unsteadiness, lightheadedness, or a floating or rocking sensation, more often than a violent spin
- Symptoms that follow neck movement or sustained neck postures, such as long hours at a computer or behind the wheel
- Episodes that can last minutes to hours rather than seconds
- Neck pain, stiffness, or reduced range of motion that rises and falls with the dizziness
- Frequent companions: headaches starting at the base of the skull, visual strain, and difficulty concentrating
- A history of whiplash, a fall, a sports injury, or a concussion, sometimes years before the dizziness started
Why It Is So Often Missed
There is no single definitive test for cervicogenic vertigo, and it does not show up on a standard MRI. It is usually identified by ruling out other causes and then finding objective evidence that the neck is sending poor position information. Because of that, it remains a debated diagnosis in parts of the medical literature, and many patients are never evaluated for it at all.
Instead, they hear that their imaging is normal, their inner ear tests are normal, and the dizziness may be stress. If you have been down that road, Why Can’t Anyone Tell Me What’s Wrong With My Neck explains why a normal scan does not always mean a normally functioning neck.
BPPV vs. Cervicogenic Vertigo at a Glance
| BPPV | Cervicogenic Vertigo | |
|---|---|---|
| Where it starts | Inner ear: loose crystals in a semicircular canal | Upper neck: distorted position signals from joints and muscles |
| What it feels like | True spinning, often intense | Unsteadiness, lightheadedness, floating or rocking |
| Typical triggers | Changing head position relative to gravity: rolling over, lying down, looking up | Neck movement or sustained neck postures |
| Episode length | Usually under a minute | Minutes to hours |
| Neck pain | Not required | Usually present |
| Common history | Often no clear cause; more common with age; can follow head trauma | Whiplash, concussion, falls, sports injuries, chronic posture strain |
| Key clinical test | Dix-Hallpike maneuver | Ruling out other causes, plus neck position sense and neck torsion testing |
| Care that matches | Canalith repositioning, such as the Epley maneuver | Addressing the upper cervical spine and restoring accurate position sense |
The Question That Helps Separate Them: Did Your Head Move, or Did Your Neck?
BPPV responds to the position of your head relative to gravity. Cervicogenic vertigo responds to the position of your head relative to your body. That distinction sounds subtle, but clinically it is very useful.
Rolling over in bed moves your whole head relative to gravity, which can trigger BPPV. Now picture keeping your head perfectly still while your body rotates underneath it, as if you were sitting in a swivel chair and someone held your head in place. Your head has not moved relative to gravity, so loose crystals have no reason to shift. Your neck, however, is now fully rotated. If that position reproduces dizziness or disrupts smooth eye tracking, it points toward the neck.
This is the logic behind clinical tests such as the smooth pursuit neck torsion test. These are exam tools, not self-tests. Please do not try to provoke your symptoms at home, especially after a recent neck injury.
Why the Distinction Matters
Getting the category right changes everything that follows.
- Repositioning maneuvers treat crystals, not necks. If your dizziness is cervicogenic, repeated Epley maneuvers are unlikely to produce lasting change, because there are no displaced crystals to reposition.
- Neck care does not reposition crystals. If you have true BPPV, the right next step is a repositioning maneuver with a qualified provider. Upper cervical care is not a substitute for it.
- Both can happen at once. Head and neck trauma is a known cause of BPPV, and the same whiplash or concussion that loosened crystals can also injure the upper neck. Treating only one leaves patients partly better and still searching for answers.
- Other conditions belong on the list. Meniere’s disease, vestibular migraine, and vestibular neuritis each have their own patterns. Our Meniere’s disease page and Can a Chiropractor Help With Meniere’s Disease explain how the upper neck can factor into that condition.
The goal is not to argue for one explanation over another. It is to match the care to the cause. For more of the overlooked factors behind persistent dizziness, read What Nobody Has Told You About Your Vertigo.
When Dizziness Is an Emergency
Some dizziness is neither an inner ear nor a neck problem. Call 911 or go to the nearest emergency room if dizziness comes on suddenly along with any of the following:
- Slurred speech, facial drooping, or difficulty finding words
- Weakness or numbness in the face, arm, or leg, especially on one side
- Double vision or sudden loss of vision
- A sudden, severe headache unlike any you have had before
- Inability to walk or stand without falling
- Dizziness after a significant head injury, particularly with confusion, repeated vomiting, or loss of consciousness
These can be signs of a stroke or another serious event, and they need immediate medical evaluation.
How We Evaluate Dizziness at Keystone Chiropractic
Most of our vertigo patients arrive after seeing several providers. Many have already tried the Epley maneuver, vestibular therapy, medication, and imaging. Our role is to answer a question those evaluations often leave open: is the upper neck contributing, and can we measure it?
We use three diagnostic tools together, because each one shows something the others cannot:
- CBCT cone beam CT scanning: 3D imaging of the upper cervical spine and craniocervical junction, showing the precise position and structure of the atlas and axis. Keystone Chiropractic is one of very few chiropractic practices in Central Illinois using CBCT.
- Infrared thermography: a noninvasive scan that identifies nervous system stress patterns along the spine.
- The NeckCare System: an FDA-listed functional assessment backed by over 20 years of peer-reviewed cervical spine research, capturing more than 120 positional data points per second. It includes three tests: Cervical Range of Motion, which measures precise degrees of movement in all six directions; the Joint Position Error Test, which measures how accurately you return your head to neutral with your eyes closed; and the Butterfly Test, which measures sensorimotor coordination between your neck, eyes, and nervous system.
The NeckCare System is especially relevant here. Cervicogenic vertigo is fundamentally a problem of inaccurate position sense, and the Joint Position Error and Butterfly tests measure exactly that, then compare your results to normative data. Instead of guessing whether your neck is involved, we can show you. Learn more on our NeckCare System page.
If the findings point toward the upper neck, care follows the Blair upper cervical technique: no twisting, no cracking, and a gentle, low-force correction specific to your individual anatomy as shown on your CBCT images. After each adjustment, patients rest in a zero gravity chair for approximately 30 minutes to allow the correction to settle. You can read more about the approach on our Blair upper cervical page and our vertigo care page.
The aim is to correct a structural problem so your nervous system can receive accurate information again, not to promise a cure. And if the findings suggest your dizziness is not coming from your neck, you deserve to hear that plainly, along with where to turn next.
Because dizziness often varies from week to week, we retest objectively over time. Measurable changes frequently appear before symptoms fully settle. How We Track Your Progress explains how that works.
About Dr. Frederick Schurger
Dr. Frederick Schurger, DC, DCCJP, has practiced in Springfield since 2007. Before chiropractic, he earned a BS in Mechanical Engineering from Rose-Hulman Institute of Technology, a background that shapes how he analyzes the mechanics of the upper neck. He earned his Doctor of Chiropractic from Palmer College of Chiropractic in 2006.
He holds the Diplomate in Chiropractic Craniocervical Junction Procedures (DCCJP), a three-year post-doctoral program involving approximately 300 hours of advanced coursework, original research, and a three-day board examination covering upper cervical anatomy, neuroscience, comparative upper cervical techniques, and craniocervical junction procedures. It is held by very few practitioners nationwide.
In 2011 he was named Blair Chiropractor of the Year. The award is selected annually by the President and senior board members of the Blair Chiropractic Members Association, is open to any member of the society, and recognizes outstanding contributions to promoting and advancing the Blair technique. He is also a Blair Advanced Instructor and has taught neurology and upper cervical anatomy at Logan University College of Chiropractic and to practitioners in the Gonstead organization. Read his full background on our About page.
Frequently Asked Questions
Can you have BPPV and cervicogenic vertigo at the same time?
Yes. Head and neck trauma, including whiplash and concussion, is a known cause of BPPV and can also injure the upper cervical spine. When both are present, treating only one often leaves patients partly improved. A thorough evaluation looks for both.
Why didn’t the Epley maneuver fix my vertigo?
The Epley maneuver is designed to move displaced inner ear crystals. If your dizziness is coming from another source, such as the upper neck, there may be nothing for the maneuver to correct. BPPV can also recur, so ongoing symptoms deserve a fresh evaluation rather than repeated guesswork.
Will cervicogenic vertigo show up on an MRI?
Usually not. A standard MRI shows anatomy, not how accurately your neck reports head position to your brain. Functional testing, such as the Joint Position Error Test and Butterfly Test in the NeckCare System, measures that directly.
Can a car accident cause cervicogenic vertigo?
Yes. Whiplash is one of the most common histories among people with cervicogenic dizziness, and symptoms can appear weeks or even months after the injury. Our whiplash and concussion pages cover these injuries in more detail.
Is it safe to see a chiropractor if I have vertigo?
Blair upper cervical care uses no twisting and no cracking. Corrections are gentle, low-force, and based on your individual anatomy as measured on 3D CBCT imaging. Sudden dizziness with warning signs such as slurred speech, weakness, or double vision needs emergency medical care first.
Get a Clear Answer About Your Dizziness
If you have spent months or years being told your tests are normal while the dizziness continues, you deserve an evaluation that looks at the upper neck with objective measurements. Keystone Chiropractic is located at 450 S Durkin Drive, Ste B, in Springfield, IL, and sees patients from Chatham, Rochester, Sherman, Riverton, Taylorville, Jacksonville, Lincoln, and across Central Illinois. We are open Monday, Wednesday, and Thursday from 9:00am to 6:00pm.
Call (217) 698-7900 or visit our New Patients page to schedule your consultation.