Dizziness and Vertigo in London 2026. What Is Causing It, When It Is Serious and the Treatment That Works in Minutes
Dizziness is one of the commonest reasons adults see a doctor, and the word covers several different experiences that have entirely different causes. Vertigo is a false sense that you or the room is spinning. Lightheadedness is a feeling of being about to faint. Disequilibrium is unsteadiness on your feet. Separating them is most of the diagnosis, and the commonest cause of true vertigo has a cure that takes minutes and is almost never offered.
Key points
The commonest cause of true vertigo is benign paroxysmal positional vertigo, diagnosed at the bedside with the Dix-Hallpike test and usually cured in a single appointment with the Epley manoeuvre.
Trials show the Epley manoeuvre resolves symptoms in a large majority of people after 1 or 2 treatments, yet many people are given suppressant tablets instead, which treat nothing and slow recovery.
A small proportion of dizziness is a posterior circulation stroke mimicking an inner ear problem, and specific features distinguish it.
Lightheadedness has a different cause list entirely, including postural blood pressure drops, dehydration, anaemia, low blood sugar and medication effects.
Want your dizziness properly assessed? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
When is dizziness an emergency
Sudden dizziness or vertigo with any of the following needs 999 or an emergency department now, because it may be a stroke. New weakness or numbness of the face, arm or leg. Slurred speech or difficulty finding words. Double vision or loss of vision. Difficulty swallowing. Severe unsteadiness where you cannot walk or stand unaided. A sudden severe headache. Loss of coordination in the arms or legs.
Strokes in the back of the brain, the posterior circulation, can present with vertigo that looks like an inner ear problem, and they are the diagnosis most important not to miss. They are commoner in older people and in those with high blood pressure, diabetes, atrial fibrillation or smoking. A specialist examination called HINTS, assessing eye movements and alignment, helps distinguish an inner ear cause from a central one in continuous vertigo, and it needs to be performed by somebody trained in it.
Dizziness with chest pain, palpitations, breathlessness or fainting points to a heart cause, including an abnormal rhythm, and needs urgent assessment.
Everything outside those categories is the large majority, and most of it is treatable.
What causes dizziness and vertigo
Benign paroxysmal positional vertigo is the commonest cause of true vertigo. Brief intense spinning, usually under a minute, triggered by head position changes such as rolling over in bed, lying down, looking up at a shelf or bending forward. It becomes commoner with age and after head injury.
Vestibular neuritis and labyrinthitis cause sudden continuous vertigo lasting days, often after a viral illness, with nausea and difficulty walking. Labyrinthitis adds hearing loss. Most settle over weeks, and early vestibular rehabilitation speeds recovery.
Ménière's disease causes recurrent attacks of vertigo lasting 20 minutes to several hours, with fluctuating hearing loss, tinnitus and a sense of fullness in one ear. Vestibular migraine causes episodes of vertigo in people with a migraine history, often without a headache at the time, and is under-recognised.
Lightheadedness has a different list. Low blood pressure on standing, known as orthostatic hypotension, particularly in older people and those on blood pressure medication. Dehydration. Anaemia. Low blood sugar. Abnormal heart rhythms. Anxiety and hyperventilation. And medication, which is among the commonest causes in older adults, including blood pressure drugs, diuretics, sedatives and some antidepressants.
Not sure what's causing yours? Ask on WhatsApp or email team@thewellnesslondon.com.
The treatment that works in minutes
Benign paroxysmal positional vertigo is diagnosed with the Dix-Hallpike test, a quick bedside manoeuvre in which the head is turned and the patient is laid back so the affected ear is lowered. It reproduces the vertigo and a characteristic flicking eye movement that identifies which ear and which canal is involved.
It is then treated with the Epley manoeuvre, a sequence of head positions that uses gravity to move the displaced crystals out of the canal and back to where they cause no symptoms. It takes a few minutes, can make you feel briefly dizzy while it is done, and trials show it resolves symptoms in a large majority of people after 1 or 2 treatments. Where it recurs, which happens in a proportion of people over time, it can be repeated, and some people learn to perform a version at home.
This matters because the alternative most people receive is medication. Vestibular suppressants such as prochlorperazine and antihistamines can ease severe nausea in the first day or 2 of an acute attack, but they do not treat positional vertigo and they slow the brain's natural compensation if taken for longer, which delays recovery. Many people take them for weeks for a condition that a few minutes of repositioning would have cured.
For vestibular neuritis and persistent imbalance, vestibular rehabilitation exercises retrain the balance system and have good evidence. For Ménière's disease, salt reduction, specific treatment and ENT input. For vestibular migraine, migraine management.
How the assessment works
A careful history, because the type of dizziness, what triggers it, how long each episode lasts and what accompanies it do most of the diagnostic work.
Examination including blood pressure lying and standing to detect a postural drop, a full neurological examination, eye movement assessment, ear examination, the Dix-Hallpike test where positional vertigo is suspected, and a cardiac examination.
Blood tests at an accredited partner laboratory where lightheadedness points there, including full blood count for anaemia, glucose and HbA1c, kidney function and electrolytes, and thyroid function. An ECG and rhythm monitoring where a heart cause is possible.
A medication review, since drug effects are among the commonest and most correctable causes, particularly in older adults on several medications.
Then treatment. The Epley manoeuvre performed in the room for positional vertigo. Vestibular rehabilitation arranged where balance needs retraining. Audiometry, MRI of the brain and internal auditory canals at a specialist centre with consultant reporting where hearing loss is asymmetric or features are atypical. And ENT, neurology or cardiology referral to a named consultant with the appointment booked where needed.
Where we are
Portman Square, Marylebone
The Wellness is at 10 Portman Square, London W1H 6AZ, adjacent to Harley Street and 3 minutes from Baker Street.
Belgravia
Our second clinic is at the Light Centre, 9 Eccleston Street, London SW1W 9LX, close to Victoria.
What dizziness assessment costs
Consultant ENT and neurology appointments in the Harley Street district run £250 to £500 for a first consultation, with audiometry, balance testing and MRI charged separately. Private MRI of the brain and internal auditory canals commonly runs £500 to £1,000. Specialist vestibular assessment and rehabilitation run several hundred pounds more. Comprehensive imaging programmes at the top of the market exceed £32,000.
At The Wellness the examination, the diagnosis and the first-line treatment are handled in the appointment. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Heart Health programme where dizziness may have a cardiac cause, with echocardiography and a cardiometabolic panel, from £3,495.
Comprehensive Blood Panel including full blood count, glucose, HbA1c, kidney function, electrolytes and thyroid, with consultation and interpretation, from £495.
Extended 45-minute consultation for recurrent or complex dizziness, with full examination and a written plan, from £395.
In-person consultation with full examination, Dix-Hallpike testing and the Epley manoeuvre where indicated, from £220.
Same-day video consultation for advice and triage, from £150. Mini consultation from £59.
Home, hotel or office visit from £495 daytime and £695 evenings and weekends, which suits anyone too unsteady to travel.
Audiometry, vestibular rehabilitation, MRI and ENT, neurology or cardiology referral arranged with named consultants.
Same-day appointments 7 days a week at 10 Portman Square, Marylebone.
Ask what your plan would cost. Message us on WhatsApp.
Why The Wellness is the best place in London for dizziness and vertigo
Because positional vertigo is treated rather than medicated. The Dix-Hallpike test and the Epley manoeuvre take minutes in a proper examination, cure most cases in 1 or 2 treatments, and are the reason many people leave the appointment feeling better than when they arrived. The weeks of suppressant tablets most people are given instead delay recovery.
Because the dangerous causes are looked for deliberately. The features of a posterior circulation stroke and of a cardiac rhythm problem are checked in every assessment, and where they are present you are sent to the right place immediately rather than scheduled.
Because the whole differential is available in one place. Blood pressure lying and standing, bloods for anaemia and glucose, a medication review, rhythm monitoring and imaging where needed, so lightheadedness is investigated as properly as vertigo.
And because home visits are available for anyone too unsteady to travel, which is precisely when dizziness makes getting to a clinic hardest.
Related reading
Headaches and migraine covers vestibular migraine and its overlap with dizziness, palpitations and heart symptoms covers cardiac causes, high blood pressure covers postural drops and medication effects, and ear wax removal covers ear causes of imbalance.
Book an appointment. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about dizziness and vertigo
When is dizziness a sign of a stroke?
Sudden dizziness or vertigo with new weakness or numbness of the face, arm or leg, slurred speech, double vision or loss of vision, difficulty swallowing, inability to walk or stand unaided, or a sudden severe headache needs 999 immediately. Strokes in the back of the brain can mimic an inner ear problem.
What is the commonest cause of vertigo?
Benign paroxysmal positional vertigo, where tiny calcium crystals drift into the wrong part of the inner ear. It causes brief intense spinning, usually under a minute, when you roll over in bed, lie down, look up or bend forward. It is benign and usually curable in a single appointment.
What is the Epley manoeuvre?
A sequence of head positions that uses gravity to move displaced crystals out of the inner ear canal, treating benign paroxysmal positional vertigo. It takes a few minutes and trials show it resolves symptoms in a large majority of people after 1 or 2 treatments.
Do tablets help vertigo?
Only briefly. Vestibular suppressants can ease severe nausea in the first day or 2 of an acute attack, but they do not treat positional vertigo and they slow the brain's natural compensation if taken for longer, which delays recovery.
Why do I feel lightheaded when I stand up?
Most often a drop in blood pressure on standing, known as orthostatic hypotension, particularly in older people and those on blood pressure medication. Dehydration, anaemia, low blood sugar, heart rhythm problems and medication are other causes.
Can a doctor visit if I am too dizzy to travel?
Yes. Home, hotel and office visits are available from £495 in the daytime and £695 in the evening or at weekends, and the examination and Epley manoeuvre can be performed at home where positional vertigo is the cause.
This article is for information and does not replace personal medical advice. Sudden dizziness with weakness, speech disturbance, visual loss, inability to walk or chest pain needs 999 immediately. All treatments at The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The Wellness. Last updated September 2026.
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