Several conditions can drive maladaptive changes in your brain’s balance and sensory-processing systems. Specific causes, symptoms, and treatments may differ, but they all share a common thread: Your brain is struggling to recalibrate after a destabilizing event. These five conditions can all correspond to chronic dizziness.

Persistent Postural Perceptual Dizziness (PPPD or Triple-PD)

PPPD typically develops after an illness or injury that affects balance. These include vestibular neuritis (inflammation of the vestibulocochlear nerve of the inner ear), concussion, and benign paroxysmal positional vertigo. It can also be triggered by acute stress, a migraine or panic attack, or a fainting episode.

Research suggests that patients with long COVID may be more susceptible. Functional neurologist J­eremy Schmoe, DC, DACNB, often sees patients with PPPD-like symptoms after they’ve experienced immune stressors, including mold exposure, Lyme disease, and chronic gut infections.

With PPPD, the brain is stuck in a heightened state of vigilance, misinterpreting normal movement and visual input as a threat. You may feel unsteadiness, motion sensitivity, lightheadedness, or nonspinning dizziness. Symptoms often get worse when standing or walking. Visually busy environments, like grocery stores or crowded places, can also be a trigger.

Treatment may include vestibular ­rehabilitation therapy, which is ­designed to help you regain control of gaze stability, physical stability, and balance. Cognitive behavioral therapy can retrain your brain and reduce symptoms. Medication may also be beneficial.

Schmoe often recommends an anti-inflammatory diet to support treatment. “If you’re doing these things and you’re still not feeling well, there could be something underlying going on that’s causing inflammation in the nervous system,” he says.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV occurs when calcium crystals called otoconia become dislodged from their usual location in your inner ear and move into the semicircular canals that help control balance. When you move your head, the dislodged crystals shift, sending signals to your brain that trigger sudden, intense vertigo. You may also feel nausea, unsteadiness, or a sense that the room is spinning.

BPPV is more common in older adults, people with head injuries, and people with a history of inner-ear infections.

BPPV itself is not chronic: It can be treated using physical therapy techniques, including the Epley maneuver, to return the crystals to the otolith organs in your inner ear. Sometimes it even resolves on its own.

But because it can cause hypervigilance and a sensitization to triggers, BPPV can lead to PPPD. “In that case, it’s not the physical problem that’s making dizziness chronic. It’s because the brain has taken over,” says vestibular audiologist Yonit Arthur, AuD.

Post-Concussion Syndrome (PCS)

Up to 80 percent of mild traumatic brain injuries lead to post-concussion syndrome, which can involve head­aches, brain fog, fatigue, and dizziness. Persistent PCS is diagnosed when post-concussion symptoms persist for more than three months after an initial concussion.

People with PCS may rely more on their vision than their vestibular and proprioceptive systems. Such reliance can overstimulate their nervous system, says Schmoe. “You may also have a sensation called vection, when you feel like you’re moving but you’re not.”

Anyone can develop PCS after a concussion, but it’s more common in those who have had multiple concussions, a history of migraine, or previous neurological conditions. “The concussion research is clear that psychosocial factors, including preexisting anxiety, are major risk factors for people developing chronic symptoms,” adds Arthur.

Recovery is typically nonlinear and takes time. Treatment may include physical therapy, vestibular therapy, cognitive therapy, or life­­style adjustments.

Visually Induced Dizziness (VID)

Rather than a diagnosis itself, VID is a constellation of symptoms caused by dysfunction in the vestibular system and triggered when your brain struggles to process complex visual environments. Sometimes called visual vertigo, VID can be caused by a range of conditions, including head injury, BPPV, and vestibular migraine. It’s often a symptom of PPPD.

The mismatch between what you’re seeing and your body’s sense of movement and balance can make you feel dizzy, lightheaded, or unsteady. It can also cause nausea, headaches, brain fog, and a feeling of being “off” even when you’re sitting still. Common triggers include grocery-store aisles, busy or moving patterns, fluorescent lighting, and scrolling on your phone. Hypervigilance and anxiety perpetuate symptoms.

VID is more common in people with vestibular disorders, like vestibular ­migraine, or a history of concussions. If you are prone to motion sickness or spend extended time on digital screens, you may also be more vulnerable.

Treatment may include vestibular rehabilitation therapy and exposure training. Schmoe has found virtual reality can help desensitize some people.

Vestibular Migraine

Vestibular migraine can cause dizziness symptoms with or without a headache. Rather than reflecting a problem with the vestibular system, it affects the vestibular-associated processing systems in the brain, says Arthur.

Symptoms may include sudden or prolonged dizziness, vertigo, an off-balance feeling, or unsteady walking. You may also have other migraine symptoms, including nausea and vomiting, light sensitivity, and sound sensitivity. Symptoms can last minutes to days and occur with or without pain.

Anyone can suffer vestibular migraine, though people with a history of migraine headaches, motion sensitivity, or inner-ear disorders are most susceptible, says Arthur. It often runs in families and can be triggered by hormonal shifts, bright lights, and disrupted sleep. Stress is a big factor, as well.

Treatment may include vestibular therapy, medication, and migraine-management strategies. “With vestibular migraine, there’s a change in blood flow into the neurological ­circuitry of the brain as well as changes in inflammatory mediators, so people respond well to anti-inflammatory dietary approaches,” says Schmoe.

Unlike many practitioners, Arthur doesn’t recommend migraine diets and trigger diaries, which she has found cause people to focus too much on their symptoms.

“Having a healthy diet overall is important,” she says, “but people don’t need to be sitting around being vigilant. What they need is to stop being as afraid of their symptoms.”

If you’ve seen a doctor and your chronic dizziness can’t be explained medically, check out the American Institute of Balance and the Vestibular Disorders ­Association to find a vestibular therapist or functional neurologist either near you or who offers telehealth services.

Meanwhile, there are several ways you can support your own healing, including with these expert recommendations:

1. Learn more. “The No. 1 thing you can do once you’ve got medical clearance is educate yourself on why this is just a software issue in your brain,” says Arthur. With some brain retraining, your neural circuitry can be rebooted.

2. Engage in gentle movement. Schmoe has designed a neurobic workout that helps activate your cerebellum and rewire neurons. It can also help with balance, coordination, and physical control. (Find Schmoe’s neurobic workout at “The Neurobic Workout.”)

3. Try somatic tracking. This mindfulness practice teaches your brain that your dizziness is not dangerous to you. Arthur offers guided practices on her YouTube channel, The Steady Coach.

4. Tend to your stress. Stress can trigger sustained chronic dizziness. To break the cycle, find a practice to ground yourself in the present and create emotional space from your stressors so you can respond more calmly. (For a helpful stress-relief technique, visit “What is EFT and How Does it Work?“)

5. Reduce brain inflammation. For many of his dizziness patients, Schmoe recommends nutritional supplements to help reduce brain inflammation and improve blood flow to the head. He suggests magnesium L-threonate, glutathione, vinpocetine, fatty acids, and ginkgo, as well as curcumin and resveratrol, which may support blood-brain barrier integrity.

6. Manage your blood sugar. Your inner ear responds to fluctuations in blood sugar, says Schmoe. Hypo­glycemia (low blood sugar), hyperglycemia (high blood sugar), and insulin resistance are among the most frequent causes of balance disorders.

7. Get sufficient ­vitamin D. Chronic dizziness is sometimes correlated with vitamin D deficiency. In one study, ­vitamin D–deficient patients with BPPV who received 50,000 IU of weekly supplemental vitamin D3, combined with physical therapy, experienced reduced symptoms that were sustained for at least six months.

8. Give your eyes a break. Completely avoiding visually stimulating environments can perpetuate the cycle of anxiety and symptoms, but taking occasional breaks from screens and other visually overwhelming stimuli can be helpful.

9. Try the home Epley maneuver. If you have been diagnosed with BPPV, your practitioner can teach you a method called the Epley maneuver to treat yourself at home. Both Arthur and Schmoe recommend against performing it without a diagnosis and training.

See David’s Top 3 Takeaways

By the time I applied to compete on NBC’s American Ninja Warrior (ANW) in 2022, I’d faced health problems nearly my entire life. I’d dreamed of being on the show since I started watching it at 8 years old, but for a long time, no one could have ­believed I’d be able to realize this dream.

Significant health challenges prevented me from physically maturing and participating at school and in sports. Yet when I was 13, I discovered a simple treatment method that allowed me to break away from nearly constant pain and step into my strength.

It changed the course of my life.

 

Seeing the Future

When I was 2 years old, doctors discovered I was legally blind in my left eye and at risk of retinal detachment. For the next eight years, I wore a patch over my right eye for four hours every day to force the weak eye to see. While remarkably effective — I now have 20/40 corrected vision — I spent those hours in almost complete blindness.

That was just the beginning of my health issues. Shortly after starting kindergarten, I began experiencing severe migraine attacks. Each one caused excruciating pain in my temples, and I would vomit dozens of times. I visited doctors all over the country, but the medications they prescribed were usually ineffective and came with nasty side effects.

Because my symptoms kept me mostly at home, I wasn’t developing in all the ways a “normal” kid would. I didn’t have many chances to connect or build friendships with kids my age. I also couldn’t commit to playing team sports because I’d have to miss too many games and practices.

So I became obsessed with ANW. When I felt well, I’d construct and navigate mini obstacle courses with my brother. On bad days, I’d try to watch the show from bed, gaining ­inspiration from the athletes conquering ­obstacles on and off the course.

 

Finding Relief

In fifth grade, my migraine attacks were so frequent and severe that I missed the last 55 days of school and had to be homeschooled the following year.

Medications made me feel awful, so I tried alternatives. I used ice packs, heat packs, and various types of pillows. I tried reforming my diet, avoiding artificial sweeteners, MSG, and red dye. Nothing seemed to work.

When I was 13, my parents took me to a chiropractor, who explained how tension in the suboccipital muscles at the base of the skull often cause tension-induced headaches. He suggested my mom use her thumbs to apply pressure to these muscles the next time I felt symptoms. At the next sign of a headache, my mom did as he instructed — and I felt relief almost instantly!

Because my mom couldn’t always be with me, I wanted to be able to do this for myself. I searched online for a self-serve trigger-point-release product but found nothing. So I decided to make my own.

For my first prototype, I attached two bicycle kickstands to a piece of metal and used the contraption to massage the muscles on my head and neck. It didn’t really work, so I tried again, using a pool noodle as a base for neck support.

This model combined gravity and the weight of my head to put pressure on my suboccipital muscles. I used it at the onset of a migraine attack and felt immediate relief. When I started using it daily for prevention, the frequency and intensity of the attacks dropped dramatically.

Finding relief for myself was incredible, but I quickly turned to the possibility of helping others. In a couple of months, I found a designer to help advance my prototype. Within a few years, I’d developed more than 100 prototypes, acquired four U.S. patents, and come up with a name: Releevum.

I’ve always had high aspirations, but with my health issues, I’d sometimes worry that I’d never be successful. The obstacles seemed insurmountable. But developing this product allowed me to pour my pent-up ambition into a project, and I finally felt like I could shape my future rather than be stymied by my health.

 

Upward Swing

I was 14 when I returned to in-person schooling in 2018. I was only 4 feet, 11 inches tall and weighed 75 pounds. I wasn’t athletic. But later that fall, a ninja warrior training gym opened near my home in Boca Raton, Fla. I started attending open gym sessions, where I could practice obstacle courses on my own.

I was terrible, but I loved the variety of obstacles and how people cheered for each other. With my ANW dream in mind, I kept going back.

The next spring, I competed in recreational leagues. I placed last in my first few competitions, but I progressed rapidly. By the following year, I was ready for more.

I pursued my school PE requirement through an independent study at the ninja warrior gym, and I started strength training with a friend. He showed me his lifting routine and shared his nutrition strategy. I began eating more whole foods, largely abstained from sugar, and ratcheted up my protein intake.

By my senior year of high school, I’d shot up to 5 feet, 9 inches, and I weighed nearly double what I had four years prior. I’d also developed from a social outlier into my school’s student-body president and obtained admittance to Yale University. I was thrilled by my progress, but I wasn’t going to stop there.

 

Dream Come True

At the start of my freshman year of college, I applied to be on ANW. I was one of some 250 athletes — out of more than 100,000 applicants — selected to participate.

I flew to Hollywood the following spring for taping. The experience was brief: I fell during qualifying rounds. Although I was grateful for the opportunity, part of me felt like I’d ruined my one chance at living my dream.

Within 30 minutes of landing back in my hometown, I received a phone call. For the first time in its history, the show was filming two seasons at ­roughly the same time, and the ­producers wanted to offer me a second chance.

This time, I meant business. More determined than ever, I made it to the second-to-last obstacle. Even though I couldn’t complete the course, I went far enough to advance to the semifinals. There, I raced against one of my childhood heroes, Joe “The Weatherman” Moravsky.

He beat me, but I left Hollywood enriched by the opportunity and honored to compete on the show that had inspired me in my darkest days. It was a full-circle moment — the best experience of my life.

I’m hopeful that I can go back and compete again soon.

 

Future Goals

These days, I strive to do something physical each day. I also try to stay curious, maintain a positive attitude, and grow in my spirituality. I’m still attending Yale, majoring in economics and minoring in data science.

In addition to my personal pursuits, I always make sure to join friends for lunch or dinner. Having spent most of my childhood at home, I’m blessed to surround myself with inspiring people and engage in deep conversations.

When I graduate in 2026, I plan to work in management consulting and continue my pursuits with Releevum. I received a $10,000 prize from Entrepreneur Elevator Pitch in November 2023, and I’m excited to release Releevum into the world.

I created a solution for my own problem years ago when I made my first successful prototype, but there’s a long way to go. Millions of people with migraine continue to suffer, and I can’t wait to make a difference in their lives too.

David’s Top 3 Takeaways

1) Obstacles are inevitable in both ninja and life. “Success is determined by how you handle them,” David says.

2) Dream big. Never let the fear of failure stop you from trying, he advises. We can accomplish a lot more than we think when we commit to making progress.

3) Life is a team sport. “True success can’t be achieved alone,” David notes. “Surround yourself with others who encourage you to drive for greatness.”

 

This article originally appeared as “Rising to the Challenge” in the September/October 2025 issue of Experience Life.

Susan Gearhart sat up in bed one morning and found the room spinning. “I thought I was having a stroke,” she recalls. Whenever she turned her head, she experienced overwhelming vertigo. “All I could do was cry.”

Gearhart’s doctor diagnosed her with benign paroxysmal positional vertigo, or BPPV, a condition in which crystals in the inner ear migrate to one of the ear’s semicircular canals and trigger a sensation of spinning. (Spinning is the hallmark of vertigo; dizziness is defined by feeling lightheaded or unsteady.) With the help of physical therapy, the BPPV gradually subsided, but an around-the-clock, wobbly sensation plagued her for two years.

“I couldn’t cook dinner or do dishes for more than five minutes before I’d have to sit down. I’d open the refrigerator and feel like I was going to faint. I went to the emergency room three, maybe four times,” she says.

Her symptoms didn’t make sense. Gearhart hadn’t had a stroke, nor did she have an infection or disease. Even though her BPPV had resolved by then, the disorientation persisted and was severe enough to put much of her life on hold.

In search of solutions, Gearhart came across a series of videos by vestibular audiologist Yonit Arthur, AuD. She learned that dizziness without a medical explanation can be a sign that the brain is in a state of hypervigilance — associating countless harmless triggers with danger.

Arthur calls this phenomenon “neuroplastic dizziness” or “neural-circuit dizziness.” She describes it as a programming error affecting the brain’s ability to process information it receives from the body’s sensory systems. Symptoms may begin with a head injury, trauma, infection, or stress, but they persist after the original injury has resolved.

In Gearhart’s case, the trigger was her initial vertigo episode.

Injury, illness, and stress can cause neurological changes, explains functional neurologist Jeremy Schmoe, DC, DACNB. These can affect your brain’s ability to locate your body in space. The resulting dizziness, lightheadedness, motion sickness, or vertigo can, in turn, activate your sympathetic, fight-or-flight nervous system. Soon, your body has entered a self-perpetuating cycle of perceived threat, anxiety, and symptoms.

What Arthur calls neuroplastic dizziness is not a psychosomatic condition. Instead, it’s an indication that your brain’s neuroplasticity — its ability to learn and change — is temporarily working against you. It often means your brain is caught in a pattern of anticipating and experiencing dizziness after the original issue has been resolved.

Fortunately, this is a software, rather than a hardware, problem, says Arthur. That means you can harness your brain’s plasticity to work for you again. One primary way to break free of the cycle, she suggests, is to learn how to react to symptoms in a new way.

Your Body in Balance

Under normal circumstances, your body’s ability to achieve and maintain balance is the result of multiple systems working together to recognize your position in space.

One of these is the vestibular system. Housed in your inner ear, it comprises three semicircular canals that detect whether your head is turning or changing direction. It also includes two small chambers called otolith organs; these detect backward and forward movement, as well as gravitational pull. Incoming information is sent to your brainstem, where a group of nerve cells called vestibular nuclei coordinate reflexes in your eyes and muscles to help stabilize your vision to prevent falling.

Yet balance involves more than the inner ear, explains Schmoe. “The inner ear itself can’t 100 percent detect all of the motion and movement that a complex human being can do.”

The visual system also plays a role in balance. Your eyes send out signals about your environment to different areas of your brain, via the optic nerve, such as whether the ground is level or, if you’re in motion, where you are relative to objects around you.

Finally, there’s the body’s proprioceptive system, composed of receptors in the muscles, joints, tendons, and skin. These provide sensory feedback about gravitational load, how your musculoskeletal system is handling that load, and your body’s position in space. The cervical spine provides input that helps coordinate the movements of your head and body.

[People] may also consciously adapt their behavior, such as by steering clear of crowded places, escalators, or visually busy environments to avoid triggering symptoms. Arthur cautions that extreme avoidance can feed the perceived threat-anxiety-symptom loop. “People become hyperfocused on the symptoms. Their nervous system is sensitized to triggers. These perpetuate the mismatch.”

All three systems — vestibular, visual, and proprioceptive — are integrated in the brainstem and cerebellum. Together they act as your brain’s command center for balance.

Chronic dizziness is a sensory-integration problem in this command center, says Schmoe. When the brainstem and cerebellum start to misinterpret signals from the vestibular, visual, or proprioceptive systems, you get a mismatch between what your brain predicts and what you experience.

We typically find ways to compensate. Someone might rely more on their visual system for balance if their inner ear is offline. Or they may instinctively keep their head still or unconsciously adopt postural or gait changes to find stability.

They may also consciously adapt their behavior, such as by steering clear of crowded places, escalators, or visually busy environments to avoid triggering symptoms. Arthur cautions that extreme avoidance can feed the perceived threat-anxiety-symptom loop. “People become hyperfocused on the symptoms. Their nervous system is sensitized to triggers. These perpetuate the mismatch.”

Finding Your Feet

Dizziness and vertigo are among the most common reasons people in the United States visit a healthcare provider, but these visits can be exercises in frustration if providers can’t find a structural explanation.

Chronic dizziness that can’t be explained medically is a prime candidate for a mind-body approach. Depending on the original trigger and what’s perpetuating it, this can involve physical, vestibular, or neurological rehabilitation, as well as coaching or cognitive behavioral approaches. The goal is to dial down the body’s threat response.

“Your body and your mind and your brain are in constant contact, and what affects one is going to affect the other,” Arthur emphasizes.

When Schmoe treats a case of chronic dizziness, he first looks for any potential physiological or neurological root of dysfunction, such as neuroinflammation, imbalances in the gut microbiome, or compensatory strategies that may be making symptoms worse.

Arthur’s treatment approach focuses on vestibular rehabilitation, as well as addressing the psychological and social forces that perpetuate a dizziness cycle. She teaches an exercise called somatic tracking, training her patients to observe sensations with curiosity and without reacting. The goal of this technique is to retrain the brain to recognize safety. This can help reduce the reactivity that can trigger symptoms.

With the help of Arthur’s coaching, Gearhart was able to connect the dots between past trauma, emotions, and dizziness. After about 18 months of work, she was free of dizziness and anxiety. Gearhart now helps others as a mentor in Arthur’s program.

“Knowledge is power,” says Arthur. “Once people understand this is just [their] brain making an error here, they can reduce their fear. Since fear is one of the foundational problems in these cases, that in and of itself can really help with symptoms.”

Supporting Yourself

If you’ve seen a doctor and your chronic dizziness can’t be explained medically, check out the American Institute of Balance and the Vestibular Disorders ­Association to find a vestibular therapist or functional neurologist either near you or who offers telehealth services.

Meanwhile, there are several ways you can support your own healing, including with these expert recommendations:

Learn more. “The No. 1 thing you can do once you’ve got medical clearance is educate yourself on why this is just a software issue in your brain,” says Arthur. With some brain retraining, your neural circuitry can be rebooted.

Engage in gentle movement. Schmoe has designed a neurobic workout that helps activate your cerebellum and rewire neurons. It can also help with balance, coordination, and physical control. (Find Schmoe’s neurobic workout at “The Neurobic Workout.”)

Try somatic tracking. This mindfulness practice teaches your brain that your dizziness is not dangerous to you. Arthur offers guided practices on her YouTube channel, The Steady Coach.

Tend to your stress. Stress can trigger sustained chronic dizziness. To break the cycle, find a practice to ground yourself in the present and create emotional space from your stressors so you can respond more calmly. (For a helpful stress-relief technique, visit “What is EFT and How Does it Work?“)

Reduce brain inflammation. For many of his dizziness patients, Schmoe recommends nutritional supplements to help reduce brain inflammation and improve blood flow to the head. He suggests magnesium L-threonate, glutathione, vinpocetine, fatty acids, and ginkgo, as well as curcumin and resveratrol, which may support blood-brain barrier integrity.

Manage your blood sugar. Your inner ear responds to fluctuations in blood sugar, says Schmoe. Hypo­glycemia (low blood sugar), hyperglycemia (high blood sugar), and insulin resistance are among the most frequent causes of balance disorders.

Get sufficient ­vitamin D. Chronic dizziness is sometimes correlated with vitamin D deficiency. In one study, ­vitamin D–deficient patients with BPPV who received 50,000 IU of weekly supplemental vitamin D3, combined with physical therapy, experienced reduced symptoms that were sustained for at least six months.

Give your eyes a break. Completely avoiding visually stimulating environments can perpetuate the cycle of anxiety and symptoms, but taking occasional breaks from screens and other visually overwhelming stimuli can be helpful.

Try the home Epley maneuver. If you have been diagnosed with BPPV, your practitioner can teach you a method called the Epley maneuver to treat yourself at home. Both Arthur and Schmoe recommend against performing it without a diagnosis and training.

Common Dizziness Disorders

Several conditions can drive maladaptive changes in your brain’s balance and sensory-processing systems. Specific causes, symptoms, and treatments may differ, but they all share a common thread: Your brain is struggling to recalibrate after a destabilizing event. These five conditions can all correspond to chronic dizziness.

Persistent Postural Perceptual Dizziness (PPPD or Triple-PD)

PPPD typically develops after an illness or injury that affects balance. These include vestibular neuritis (inflammation of the vestibulocochlear nerve of the inner ear), concussion, and benign paroxysmal positional vertigo. It can also be triggered by acute stress, a migraine or panic attack, or a fainting episode.

Research suggests that patients with long COVID may be more susceptible. Functional neurologist J­eremy Schmoe, DC, DACNB, often sees patients with PPPD-like symptoms after they’ve experienced immune stressors, including mold exposure, Lyme disease, and chronic gut infections.

With PPPD, the brain is stuck in a heightened state of vigilance, misinterpreting normal movement and visual input as a threat. You may feel unsteadiness, motion sensitivity, lightheadedness, or nonspinning dizziness. Symptoms often get worse when standing or walking. Visually busy environments, like grocery stores or crowded places, can also be a trigger.

Treatment may include vestibular ­rehabilitation therapy, which is ­designed to help you regain control of gaze stability, physical stability, and balance. Cognitive behavioral therapy can retrain your brain and reduce symptoms. Medication may also be beneficial.

Schmoe often recommends an anti-inflammatory diet to support treatment. “If you’re doing these things and you’re still not feeling well, there could be something underlying going on that’s causing inflammation in the nervous system,” he says.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV occurs when calcium crystals called otoconia become dislodged from their usual location in your inner ear and move into the semicircular canals that help control balance. When you move your head, the dislodged crystals shift, sending signals to your brain that trigger sudden, intense vertigo. You may also feel nausea, unsteadiness, or a sense that the room is spinning.

BPPV is more common in older adults, people with head injuries, and people with a history of inner-ear infections.

BPPV itself is not chronic: It can be treated using physical therapy techniques, including the Epley maneuver, to return the crystals to the otolith organs in your inner ear. Sometimes it even resolves on its own.

But because it can cause hypervigilance and a sensitization to triggers, BPPV can lead to PPPD. “In that case, it’s not the physical problem that’s making dizziness chronic. It’s because the brain has taken over,” says vestibular audiologist Yonit Arthur, AuD.

Post-Concussion Syndrome (PCS)

Up to 80 percent of mild traumatic brain injuries lead to post-concussion syndrome, which can involve head­aches, brain fog, fatigue, and dizziness. Persistent PCS is diagnosed when post-concussion symptoms persist for more than three months after an initial concussion.

People with PCS may rely more on their vision than their vestibular and proprioceptive systems. Such reliance can overstimulate their nervous system, says Schmoe. “You may also have a sensation called vection, when you feel like you’re moving but you’re not.”

Anyone can develop PCS after a concussion, but it’s more common in those who have had multiple concussions, a history of migraine, or previous neurological conditions. “The concussion research is clear that psychosocial factors, including preexisting anxiety, are major risk factors for people developing chronic symptoms,” adds Arthur.

Recovery is typically nonlinear and takes time. Treatment may include physical therapy, vestibular therapy, cognitive therapy, or life­­style adjustments.

Visually Induced Dizziness (VID)

Rather than a diagnosis itself, VID is a constellation of symptoms caused by dysfunction in the vestibular system and triggered when your brain struggles to process complex visual environments. Sometimes called visual vertigo, VID can be caused by a range of conditions, including head injury, BPPV, and vestibular migraine. It’s often a symptom of PPPD.

The mismatch between what you’re seeing and your body’s sense of movement and balance can make you feel dizzy, lightheaded, or unsteady. It can also cause nausea, headaches, brain fog, and a feeling of being “off” even when you’re sitting still. Common triggers include grocery-store aisles, busy or moving patterns, fluorescent lighting, and scrolling on your phone. Hypervigilance and anxiety perpetuate symptoms.

VID is more common in people with vestibular disorders, like vestibular ­migraine, or a history of concussions. If you are prone to motion sickness or spend extended time on digital screens, you may also be more vulnerable.

Treatment may include vestibular rehabilitation therapy and exposure training. Schmoe has found virtual reality can help desensitize some people.

Vestibular Migraine

Vestibular migraine can cause dizziness symptoms with or without a headache. Rather than reflecting a problem with the vestibular system, it affects the vestibular-associated processing systems in the brain, says Arthur.

Symptoms may include sudden or prolonged dizziness, vertigo, an off-balance feeling, or unsteady walking. You may also have other migraine symptoms, including nausea and vomiting, light sensitivity, and sound sensitivity. Symptoms can last minutes to days and occur with or without pain.

Anyone can suffer vestibular migraine, though people with a history of migraine headaches, motion sensitivity, or inner-ear disorders are most susceptible, says Arthur. It often runs in families and can be triggered by hormonal shifts, bright lights, and disrupted sleep. Stress is a big factor, as well.

Treatment may include vestibular therapy, medication, and migraine-management strategies. “With vestibular migraine, there’s a change in blood flow into the neurological ­circuitry of the brain as well as changes in inflammatory mediators, so people respond well to anti-inflammatory dietary approaches,” says Schmoe.

Unlike many practitioners, Arthur doesn’t recommend migraine diets and trigger diaries, which she has found cause people to focus too much on their symptoms.

“Having a healthy diet overall is important,” she says, “but people don’t need to be sitting around being vigilant. What they need is to stop being as afraid of their symptoms.”

This article originally appeared as “Restore Your Balance” in the September/October 2025 issue of Experience Life.

Physical Health

Cold has a dramatic effect on the body: Step into a cold shower or jump into an icy lake, and you’ll likely feel your heart race and your lungs gasp for air. Your blood vessels constrict (a process called vasoconstriction), and you may start shivering.

Your newly alert brain activates cold-shock proteins, which bind to nucleic acids and other proteins to help your body adapt to the cold. The molecules regulate various cellular processes, including metabolism and the stress response.

Specifically, cold shock stimulates the release of norepinephrine, a neurotransmitter that plays a key role in your body’s fight-or-flight stress response. Norepinephrine also functions as a hormone, and it signals brown adipose tissue (BAT), or brown fat, to burn calories and produce heat to regulate body temperature in cold environments.

BAT is rich in mitochondria, which are responsible for its brown color. (Mitochondria are essential to energy, focus, vitality, and metabolism. And yet most of us have no idea how our mitochondria work. Learn how to tune up your body’s quadrillions of “energy factories” at “The Care and Feeding of Your Mitochondria.”) Brown fat generates heat by burning calories through a process called nonshivering thermogenesis, which involves breaking down glucose and fat molecules.

Unlike white fat, which stores energy, brown fat’s primary function is to maintain body temperature by burning energy. Researchers have been studying BAT’s potential to improve glucose metabolism and insulin sensitivity.

A growing body of research suggests cold exposure may be one way to increase the amount of brown fat your body produces.

Mental Health

Cold-water therapy may ease depression. To understand how this works, it helps to know what happens in the body during depressive cycles, says Claudia Skowron, MS, LCPC, CADC, a mental healthcare provider who recommends cold-water immersion to her patients.

“When someone is actively ­depressed, they may have low energy levels, low levels of serotonin or dopamine in the brain, high cortisol levels, and low metabolic functioning,” she explains.

Immersion in cold water increases endorphins, which can elevate energy and improve mood. “Endorphins help lower cortisol, which plays a significant role in managing depressive symptoms,” Skowron says.

Cold-water immersion can also spike dopamine, the so-called feel-good neurotransmitter. “Cold-water exposure has been remarkably helpful for clients battling substance use disorder,” she notes. “Its ability to boost dopamine helps manage cravings and impulsivity, making it a valuable tool in addiction recovery programs.”

There’s not enough research to prove indisputably that cold-water immersion improves mental health, Minson says. But one small study he conducted showed a decline in participants’ cortisol levels three hours after spending 15 minutes in cold water. Their moods got better, too.

He believes at least some of the mental health benefits of cold therapy come from the sense of accomplishment it offers, which can create a positive upward spiral.

Skowron adds that “submerging yourself in cold water is always unpleasant, but doing so regularly builds mental resilience. It teaches us that we can push through discomfort, which translates into being better equipped to handle stressful situations in life.” (For more on the benefits of cold conditioning, visit “The Health Benefits of Cold Conditioning.”)

Optimize Your Cold Exposure

Research has shown that the therapeutic benefits of cold-water immersion start with a single exposure. This is how to build a healthy tolerance for cold.

Take care. If you have cardio­vascular issues or Raynaud’s phenomenon, check with your healthcare provider before you begin. Cold exposure is likely to exacerbate ­Raynaud’s symptoms. When cold plunging outdoors, go with a friend or a group for safety.

Keep it brief. Begin with a 10-­second cold shower or plunge and work up to one to two minutes in ­water temperatures around 50 degrees F. Extend the time as your body adapts.

Breathe deep. When you first submerge yourself in cold water, your body’s shock response is activated. Practicing controlled-breathing techniques can help.

“Breathwork plays a critical part in cold-water therapy,” Skowron says. “Learning how to control breathing, such as with the Wim Hof Method (learn more about this breathing technique here), reduces the panic in the body and subsequently increases alpha brain waves, which aid in calmness and relaxation.”

Recover. Allow ample time for your body to warm up and repair. If you’re doing plunges outside in cold weather, be sure to dry off and get dressed immediately afterward. And take a moment to relish your sense of accomplishment.

Physical Health

Exposing your body to intense heat can initiate a host of adaptive ­responses. An increased heart rate triggers greater blood flow to the skin and helps you cool off, and sweat can help the body excrete small amounts of heavy metals, pollutants, and other toxins.

The body responds to a higher core temperature by producing heat-shock proteins, which enhance your ability to manage stress and build resilience.

“Heat-shock proteins play a crucial role in cellular repair by addressing misfolded proteins caused by mutations in gene sequencing, translation errors, or environmental changes,” D’Adamo explains. Scientists are examining how misfolded proteins contribute to Alzheimer’s, Parkinson’s, and other neurodegenerative diseases.

A Finnish cohort study linked frequent, consistent sauna use with a 50 percent reduction in the risk of cardiovascular disease mortality and a 40 percent reduction in all-cause mortality compared with less ­frequent use. Some researchers argue the benefits may stem from improved vascular function, reduced blood pressure, and better heart-rate variability, all of which reduce strain on the cardiovascular system.

Another Finnish study found that, compared with those who used a ­sauna once a week, individuals who used saunas two or three times weekly lowered their stroke risk by 14 percent. Those who visited four to seven times per week saw a 61 percent reduction.

Heat exposure can improve cellular function in the lining of the blood vessels and decrease blood pressure, two major risk factors for stroke.

Heat therapy can even produce some of the same effects as exercise, a potential game-changer for people with mobility issues.

Environmental physiologist Christopher Minson, PhD, codirector of the Exercise and Environmental Physiology Labs at the University of Oregon, studies the effects of heat therapy on vascular health in sedentary individuals.

“The increase in body temperature, heart rate, and increased blood flow caused by heat therapy mimics the physiological effects of moderate exercise, such as improved blood flow and stress tolerance,” he explains.

Mental Health

Heat therapy can also have a powerful effect on depressive disorders. “Heat therapies boost neurotransmitter levels and have shown significant benefits for people with depression,” Minson says.

These are vividly illustrated by a 2024 study published in the International Journal of Hyperthermia. Researchers used heat beds to induce “whole-body hyperthermia” (high body temperature) in study subjects with major depressive disorder. The treatments were paired with cognitive behavioral therapy (CBT), a therapeutic approach that cultivates awareness of negative thinking (learn more about this gold standard in psychotherapy here).

Twelve participants completed the eight-week study; they had an average symptom reduction of 15.8 points in the Beck Depression Inventory. (A three-point reduction is clinically significant.) Eleven of them no longer met the criteria for major depressive disorder.

“We observed reductions in depressive symptoms that were much higher than we would have expected from receiving CBT without heat treatment,” notes lead study author Ashley Mason, PhD, in a news release.

Researchers are unsure of the exact mechanism at work, but some speculate that heat’s effect on the production of the mood-enhancing neurotransmitters serotonin and norepinephrine may be a factor. ­Additionally, once the body cools down from heat exposure, it remains cooler longer. This may benefit people with depression, whose baseline body temperatures tend to be higher.

Optimize Your Heat Exposure

If you’re new to heat therapy, start with shorter sessions — a few minutes in the sauna at most — and lower temperatures. Infrared saunas tend to be cooler, so they’re a good place to begin. Increase time and temperature as your body adapts.

Use regularly. There are competing viewpoints about what frequency, duration, and temperature provide maximum benefits. Both Minson and D’Adamo say the sweet spot seems to be about three to five sessions per week, 15 to 20 minutes at a time, in temperatures around 170 degrees F. Infrared saunas typically heat to about 120–150 degrees F, so you can stay in one for up to 40 minutes.

Hydrate. During heat therapy sessions, drink water like it’s your job. Hydrating before, during, and after helps maintain electrolyte balance and prevent dehydration.

Recover. After a heat session, allow ample time for your body to cool down. Wait until you’ve stopped sweating to get dressed. Follow with rest and proper nutrition to help maximize your body’s adaptation and repair.

Use caution. If you’re pregnant, have cardiovascular issues, or tend toward low blood pressure, consult a healthcare provider before beginning heat therapy. If you experience dizziness or intense fatigue during a session, seek cooler temperatures immediately.

If you know you’re sensitive to heat or prone to fainting, consider using an infrared sauna because they run slightly cooler. D’Adamo recommends sitting in the middle of an infrared sauna, away from heating elements, to avoid any potential ­exposure to electromagnetic fields.