When the GP mentions vertigo and starts talking about crystals, it's fair to be confused. Vertigo doesn't sound like an ear problem; it sounds like a balance one, and most people leave that appointment more puzzled than when they walked in.

Here's the thing though: vertigo isn't one condition. It's an umbrella term for a symptom that can come from several different places in the body, and treating it well starts with working out which one you've actually got.

In clinic, the two I see confused most often are BPPV, which is an inner ear problem, and cervicogenic dizziness, which comes from the neck. They can feel similar enough on a bad day that people assume they're the same thing, but they're triggered differently and they respond to completely different treatment. This is why neck stretches can be a lifesaver for one and do absolutely nothing for the other.

Honestly, a good chunk of the patients who come in convinced they have BPPV turn out, once we dig a little, to have something coming from the neck instead. So let's go through how to actually tell the two apart, and what helps with each.

What is vertigo, really?

Vertigo is a false sense of movement, usually a spinning sensation, either of yourself or the room around you. It's different from lightheadedness, general unsteadiness, or feeling faint, even though most people reach for "dizzy" to describe all four. Getting specific about which one you actually experience matters, because it's the sensation itself, along with what triggers it, that points us towards the cause.

BPPV or the neck: how to tell them apart

BPPV tends to be brief, over in a few seconds to under a minute, and it's a genuine spinning sensation. It's triggered by a specific change in head position: rolling over in bed, looking up to a high shelf, tipping your head back to wash your hair. Because it's coming from the balance organs in the inner ear, it's often accompanied by nystagmus, a rhythmic involuntary eye movement we can see during assessment.

Cervicogenic dizziness feels different. It's vaguer, more of an unsteady or floaty sensation than a true spin, and it's triggered by neck movement or by holding a position for a while, think desk work or a long drive. It also tends to hang around longer, minutes to hours rather than seconds, and often comes with neck stiffness or a headache. It settles with a change of posture more than with any particular head movement.

Where each one comes from

BPPV happens when tiny crystals, otoconia, become displaced into one of the semicircular canals in the inner ear. Most of the time there's no obvious trigger for this, though it can follow a head injury or a viral illness.

Cervicogenic dizziness comes from altered feedback travelling from the joints and muscles of your upper neck up to your brain. It's often linked to posture or a whiplash-type injury, where the neck loses some of its accuracy in sensing its own position, and the brain interprets that faulty signal as movement.

It's also worth knowing vestibular migraine and a handful of other causes exist. If what you're experiencing doesn't fit neatly into either pattern above, that's usually when we start considering those.

What actually helps

If BPPV is what's going on, the treatment that works is a crystal repositioning manoeuvre, most commonly the Epley manoeuvre, which physically guides the displaced crystals back out of the semicircular canal. It looks a lot scarier than it is, and for true BPPV it's usually genuinely effective. What it isn't, though, is forgiving of guesswork. Doing it in the wrong direction, or for the wrong canal, won't help and can leave you feeling worse, so it's worth getting it assessed and performed properly the first time rather than winging it from a video.

If it's coming from the neck, the approach looks much like managing ordinary neck pain, because the underlying trigger, usually a sustained posture, is the same.

• Chin tucks. Sitting tall with your eyes forward, draw your head straight back and tuck your chin slightly, as though making a double chin, without tipping your head down. Hold for two seconds.
• Upper trapezius stretch. Bring your ear towards your shoulder, keeping your eyes forward, and hold for 10 seconds.
• Levator scapulae stretch. Rotate your nose towards your armpit on the same side, eyes down towards the floor, and hold for 10 seconds.
• Change position. Stand up and actually move, rather than stretching while still glued to your chair.

Do this a few times through the day, particularly around long stretches at a screen.

A simple self-test: if a change in head position is what settles things, that points towards BPPV. If it's a change in posture or neck movement that settles things, that points towards the neck.

When it doesn't fit either picture

If vertigo comes on suddenly alongside other neurological symptoms, a new and severe headache, or a change in hearing, or if it simply doesn't match either pattern above, that needs to be looked at the same day rather than waiting to see a physio.

Questions I get asked a lot

Is it dangerous to move my head if I have BPPV?

No. It's unpleasant, but not harmful, and the treatment itself involves deliberately moving your head through specific positions.

Do I need a scan?

Rarely at this stage. Both BPPV and cervicogenic dizziness are diagnosed clinically, through your history and specific positional tests, rather than imaging. Scans come into the picture when something doesn't fit the usual pattern, or when there are red flags alongside it.

How long until this improves?

BPPV often resolves within one to a few sessions once it's repositioned correctly. Cervicogenic dizziness tends to follow a similar timeline to neck pain generally: several weeks of consistent postural change, longer if it's been going on for a while.

Can I just do the Epley manoeuvre myself from a video?

You can, but the manoeuvre is specific to which canal and which side is affected. It's worth getting that confirmed first; otherwise, you might be doing the right exercise on the wrong ear, which won't get you anywhere.

If you're not sure which of these you're dealing with, pay attention over the next few days to exactly what sets it off, a head position or a sustained posture, and how long it lasts each time. That's genuinely useful information to bring in with you, because it often tells us which mechanism we're dealing with before we've even started testing.

You're welcome to book an assessment with me to confirm which one this is, so it gets treated properly from the first session rather than guessed at.