Have you recovered from COVID-19, influenza or another viral illness, only to find that your dizziness, vertigo or balance problems haven’t gone away?
Perhaps the infection itself has resolved, but you still feel unsteady when walking. You may feel as though you are swaying, floating or walking on uneven ground. Turning your head quickly might make you dizzy, supermarkets may suddenly feel overwhelming, or you may notice that your balance is much worse in the dark.
For some people, the symptoms are more dramatic. They may experience a sudden episode of severe spinning vertigo during or shortly after an illness, followed by weeks or months of residual imbalance.
Others never experience true spinning vertigo at all. Instead, they are left with a vague but persistent feeling that their balance system simply hasn’t returned to normal.
Dizziness is a recognised symptom during and following COVID-19, although dizziness after an infection can have many different causes and should not automatically be attributed to the virus itself. Research has reported dizziness, vertigo and other audio-vestibular symptoms in people with COVID-19, although estimates vary considerably between studies and the precise mechanisms remain under investigation.
Importantly, post-viral dizziness is not one single diagnosis.
A viral illness can potentially be associated with or followed by several different vestibular presentations, including:
- Vestibular Neuritis
- Labyrinthitis
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular Migraine
- Persistent Postural-Perceptual Dizziness (PPPD)
- Persistent vestibular hypofunction
- Visual motion sensitivity
- Post-COVID Condition/Long COVID
- Non-vestibular causes such as cardiovascular, neurological, medication-related or autonomic problems
Determining which of these is responsible for your symptoms is important because the treatment can be very different.
Is dizziness common after COVID-19?
Dizziness has been repeatedly reported in studies examining neurological symptoms associated with COVID-19.
However, the term “dizziness” is extremely broad.
One person may use the word dizziness to describe spinning vertigo, while another means light-headedness, faintness, imbalance, rocking, visual disorientation or brain fog.
This is why simply knowing that someone is “dizzy after COVID” doesn’t tell us what is actually happening.
A detailed vestibular assessment aims to determine what type of dizziness you are experiencing and what is provoking it.
What can dizziness after a viral illness feel like?
Post-viral vestibular symptoms can present in many different ways.
You may experience:
- Spinning vertigo
- A rocking or swaying sensation
- Feeling as though you are walking on a boat
- Unsteadiness when walking
- Veering to one side
- Feeling pulled in one direction
- Dizziness when turning your head
- Dizziness when looking up or down
- Vertigo when rolling over in bed
- Difficulty walking in the dark
- Unsteadiness when closing your eyes in the shower
- Dizziness in supermarkets or shopping centres
- Difficulty looking at moving screens
- Sensitivity to scrolling
- Nausea
- Motion sensitivity
- Headaches
- Brain fog
- Fatigue
- A feeling of being disconnected or spatially disorientated
- Difficulty concentrating while walking or moving
The pattern of symptoms provides important clues about the underlying diagnosis.
For example, brief spinning when rolling over in bed suggests something very different from constant rocking that becomes worse in supermarkets.
Vestibular Neuritis after a viral illness
One of the most recognised vestibular conditions associated with viral illnesses is Vestibular Neuritis.
Vestibular Neuritis involves dysfunction of the vestibular portion of the eighth cranial nerve, which carries balance information from the inner ear to the brain.
The classic presentation is quite dramatic.
A person may suddenly develop severe, continuous rotational vertigo lasting hours to days. They may experience significant nausea or vomiting and have difficulty standing or walking.
Unlike BPPV, the dizziness isn’t simply triggered for a few seconds by rolling over in bed. During the acute phase of Vestibular Neuritis, the vertigo is generally present continuously, although movement can make it feel significantly worse.
Vestibular Neuritis typically does not cause hearing loss or tinnitus. When acute vestibular symptoms occur together with hearing symptoms, other diagnoses—including labyrinthitis—need to be considered.
Vestibular neuritis and labyrinthitis are commonly associated with viral infections, including illnesses such as colds and influenza.
Why am I still dizzy after the severe vertigo has stopped?
This is an extremely common question.
The initial severe vertigo from Vestibular Neuritis may settle, but that doesn’t necessarily mean the balance system has fully recovered.
If one vestibular system is functioning differently from the other, the brain receives asymmetrical information.
Fortunately, the brain is remarkably adaptable.
Through a process called vestibular compensation, the central nervous system gradually learns to recalibrate and use the altered vestibular information more effectively.
This process is one of the reasons many people improve substantially after Vestibular Neuritis.
However, compensation is not always complete.
Some people are left with:
- Dizziness during quick head movements
- Difficulty walking while turning their head
- Reduced balance in darkness
- Difficulty on uneven surfaces
- Visual blurring during movement
- Motion sensitivity
- Fatigue in visually complex environments
- Generalised unsteadiness
These symptoms may indicate residual vestibular hypofunction.
Vestibular rehabilitation may be considered in this situation.
What is vestibular hypofunction?
Vestibular hypofunction simply means that one or both vestibular systems are providing reduced or altered information to the brain.
If only one side is affected, this is called unilateral vestibular hypofunction.
When both sides are affected, it is called bilateral vestibular hypofunction.
Someone with vestibular hypofunction may feel relatively comfortable sitting still but become symptomatic when walking or moving their head.
One particularly characteristic complaint is:
“I’m okay during the day, but I feel really unsteady when I’m walking in the dark.”
This happens because vision normally provides valuable information about your position in space.
When visual information is removed, such as when walking in darkness or closing your eyes in the shower, your brain has to rely more heavily on the vestibular and proprioceptive systems.
If vestibular function is impaired, balance can deteriorate.
Could COVID-19 affect the vestibular system?
Research has reported vertigo, dizziness, tinnitus and hearing symptoms in association with COVID-19.
However, this needs to be interpreted carefully.
The presence of dizziness during or after COVID-19 does not automatically mean that SARS-CoV-2 has directly damaged the inner ear.
COVID-19 can affect multiple systems capable of producing dizziness, and early studies examining audio-vestibular symptoms have had significant limitations.
Therefore, rather than assuming:
“COVID damaged my vestibular nerve,”
a more useful clinical question is:
“What is causing my dizziness now?”
That is something a vestibular assessment can help investigate.
BPPV after illness
Another possibility is Benign Paroxysmal Positional Vertigo (BPPV).
BPPV occurs when small calcium carbonate crystals called otoconia become displaced from their usual location within the inner ear and enter one of the semicircular canals.
The result is typically brief episodes of rotational vertigo triggered by changes in head position.
Common triggers include:
- Rolling over in bed
- Getting into or out of bed
- Looking upward
- Bending down
- Lying flat
- Tilting the head backwards
The vertigo generally lasts for seconds rather than hours.
If you recovered from a viral illness and subsequently noticed:
“Every time I roll onto my right side, the room spins for 10 seconds,”
that warrants assessment for BPPV rather than simply assuming you have ongoing post-viral dizziness.
BPPV may be managed using a canalith repositioning manoeuvre, such as the Epley manoeuvre, when the affected canal and side have been correctly identified.
Could it be Vestibular Migraine?
A viral illness can also coincide with or potentially trigger an exacerbation of Vestibular Migraine in susceptible individuals.
Vestibular Migraine is an important cause of recurrent dizziness and vertigo.
One common misconception is that Vestibular Migraine always causes a severe migraine headache.
It doesn’t.
Some patients experience prominent vestibular symptoms with little or no headache during an episode.
Symptoms may include:
- Episodic vertigo
- Rocking or swaying
- Motion sensitivity
- Head pressure
- Headaches
- Nausea
- Sensitivity to light
- Sensitivity to sound
- Visual aura
- Dizziness in supermarkets
- Sensitivity to scrolling or screens
- Difficulty with busy visual environments
If your positional testing and peripheral vestibular examination are normal but you continue experiencing episodic dizziness with migraine-associated features, Vestibular Migraine may need to be considered.
What if the dizziness becomes constant?
Sometimes the original illness or vestibular event resolves, but the nervous system doesn’t fully return to its previous way of processing balance information.
The person may transition from an acute vestibular condition into Persistent Postural-Perceptual Dizziness (PPPD).
PPPD typically produces persistent non-spinning dizziness, unsteadiness or rocking/swaying sensations.
Symptoms are generally worse with:
- Standing
- Walking
- Movement
- Head movements
- Supermarkets
- Shopping centres
- Crowds
- Scrolling
- Moving screens
- Driving
- Visually complex environments
Symptoms occur on most days for at least three months.
Importantly, PPPD can develop after a vestibular event or another medical illness.
This can create a confusing situation for patients.
You may have initially had a genuine acute vestibular disorder, but months later the original condition is no longer the primary reason you feel dizzy.
Your MRI may be normal.
Your BPPV may have resolved.
Your vestibular testing may have improved.
Yet you still don’t feel normal.
This does not mean the symptoms are imagined.
PPPD involves altered processing of balance and spatial information and can often respond to appropriately targeted rehabilitation.
Why are supermarkets suddenly difficult after being sick?
Another common post-vestibular symptom is visual motion sensitivity, sometimes called Visually Induced Dizziness or Visual Vertigo.
Patients often tell us:
“I was fine until I went back to the supermarket.”
There are long aisles, repetitive shelves, bright lights, patterned floors, people moving through your peripheral vision and constant head movements as you search for products.
Following a vestibular illness, some people become overly dependent on vision for balance.
When the visual environment subsequently becomes complex or moves around them, their brain has difficulty resolving the sensory information.
This can produce:
- Dizziness
- Swaying
- Nausea
- Disorientation
- Brain fog
- Unsteadiness
- A feeling of needing to escape the environment
Visual motion sensitivity can occur following vestibular neuritis and is also commonly associated with PPPD and Vestibular Migraine.
What about Long COVID?
Some people experience persistent symptoms following COVID-19, commonly referred to as Post-COVID Condition or Long COVID.
Dizziness and balance-related disability have been reported in people with Post-COVID Condition.
However, dizziness in this population can be complex.
Not every patient with Long COVID and dizziness has an inner-ear vestibular disorder.
Symptoms can potentially involve several interacting systems.
For this reason, someone experiencing persistent post-COVID dizziness may require assessment by more than one healthcare professional depending on the symptom pattern.
Vestibular Physiotherapy is particularly relevant when there is evidence of:
- Motion-provoked dizziness
- Impaired gaze stability
- Balance dysfunction
- Visual motion sensitivity
- Vestibular hypofunction
- Persistent movement sensitivity
Could it be something other than my inner ear?
Absolutely.
This is an important point.
Feeling dizzy after COVID-19 or another illness doesn’t automatically mean you have a vestibular disorder.
Other potential contributors can include:
- Dehydration
- Medication effects
- Anaemia
- Blood pressure changes
- Cardiovascular conditions
- Autonomic dysfunction
- Deconditioning
- Neurological disorders
- Anxiety and panic
- Metabolic conditions
- Persistent post-viral fatigue
The description “I feel dizzy” therefore isn’t enough to make a diagnosis.
Understanding when the symptoms occur is often much more useful.
What clues suggest a vestibular problem?
Certain patterns make us more suspicious of vestibular involvement.
For example:
“The room spins when I roll over in bed.”
This may suggest BPPV.
“I had three days of severe vertigo and now I’m unsteady whenever I move my head.”
This may suggest Vestibular Neuritis with residual vestibular hypofunction.
“I’m fine sitting down, but I lose my balance in the dark.”
This may indicate increased reliance on vision and possible vestibular dysfunction.
“Since I was sick, supermarkets and scrolling make me dizzy.”
This raises the possibility of visual motion sensitivity, PPPD or Vestibular Migraine.
“I have attacks of dizziness with headaches, light sensitivity and nausea.”
Vestibular Migraine should be considered.
The diagnosis comes from putting the entire pattern together rather than focusing on one symptom.
How is post-viral dizziness assessed?
A comprehensive Vestibular Physiotherapy assessment may examine several different components of the balance system.
This can include assessment of:
Eye movements
Smooth pursuit, saccades and other oculomotor functions may be assessed.
Vestibulo-Ocular Reflex
The Vestibulo-Ocular Reflex, or VOR, helps stabilise your vision when your head moves.
Testing such as the Head Impulse Test can help identify signs of peripheral vestibular hypofunction.
Positional testing
Dix–Hallpike and Supine Roll testing can help determine whether BPPV is present.
This is particularly important if your dizziness is triggered by rolling in bed, lying down or looking upward.
Balance
Balance can be assessed under different sensory conditions.
For example, you may be asked to stand on a firm or compliant surface with your eyes open and closed.
This helps determine how effectively your brain is using visual, vestibular and proprioceptive information.
Walking
Walking may be assessed normally and while moving your head or reducing visual input.
Motion sensitivity
We may assess whether repeated head or body movements provoke symptoms.
Visual motion sensitivity
If supermarkets, scrolling or moving screens are problematic, visually induced dizziness may also need to be assessed.
How does Vestibular Rehabilitation help?
Vestibular Rehabilitation Therapy is a form of physiotherapy used to manage dizziness, balance and visual stability.
The treatment program depends entirely on what is found during your assessment.
It may include:
Gaze-stability exercises
These exercises may help retrain the Vestibulo-Ocular Reflex and may be particularly useful following vestibular hypofunction.
A patient may practise maintaining focus on a stationary target while moving their head.
The exercise is then gradually progressed as the vestibular system adapts.
Balance retraining
Exercises can challenge the interaction between vision, proprioception and the vestibular system.
These might include standing or walking under progressively more challenging sensory conditions.
Habituation
If particular movements repeatedly provoke dizziness, carefully graded exposure may help reduce the nervous system’s response to those movements.
Walking with head movements
Walking while turning or nodding the head may help restore tolerance to the types of movements required in everyday life.
Visual-motion rehabilitation
If scrolling, supermarkets or moving environments provoke symptoms, visual exercises and graded exposure may be incorporated.
Treatment for BPPV
If assessment identifies BPPV, treatment is quite different.
Rather than repeatedly performing general balance exercises, the priority is usually to reposition the displaced crystals using an appropriate canalith repositioning manoeuvre.
Should I just rest until the dizziness goes away?
During the very acute phase of a severe illness, rest may obviously be necessary.
However, once medically safe, prolonged avoidance of movement can sometimes interfere with vestibular compensation.
The brain needs appropriate movement and sensory input in order to recalibrate.
This does not mean pushing through severe symptoms or forcing yourself to exercise excessively.
Vestibular rehabilitation is based on graded exposure.
The challenge needs to be sufficient to stimulate adaptation without repeatedly overwhelming the system.
For someone recovering from a post-viral illness—particularly where significant fatigue is also present—the appropriate dose of rehabilitation can be particularly important.
How long does recovery take?
There is no single timeframe.
Many people with Vestibular Neuritis experience substantial improvement over several weeks, although residual balance problems can persist longer in some individuals.
Recovery depends on factors including:
- The underlying diagnosis
- The degree of vestibular dysfunction
- Whether one or both vestibular systems are affected
- Migraine
- Visual dependency
- Physical activity
- General health
- Fatigue
- Anxiety and fear of movement
- Whether PPPD has developed
- Whether appropriate vestibular rehabilitation has commenced
The important point is that persistent symptoms don’t necessarily mean that nothing can be done.
Sometimes the diagnosis simply needs to be reconsidered.
When should dizziness be investigated urgently?
New dizziness isn’t always benign.
Seek urgent medical assessment for sudden or severe dizziness associated with symptoms such as:
- Facial weakness
- Weakness or numbness affecting an arm or leg
- New difficulty speaking
- New severe difficulty walking
- Double vision
- Difficulty swallowing
- Sudden severe headache
- Loss of consciousness
- New significant neurological symptoms
- Chest pain or significant shortness of breath
A sudden new hearing loss should also be assessed urgently.
If you’re unsure whether a new episode of severe dizziness is vestibular or neurological, seek medical assessment rather than assuming it is the same as a previous episode.
When should I see a Vestibular Physiotherapist?
Consider a Vestibular Physiotherapy assessment if you have recovered from COVID-19 or another viral illness but continue experiencing:
- Persistent dizziness
- Vertigo
- Unsteadiness
- Difficulty walking
- Dizziness with head movement
- Vertigo when rolling over in bed
- Difficulty balancing in the dark
- Visual motion sensitivity
- Dizziness in supermarkets
- Problems with scrolling or screens
- Swaying or rocking sensations
- Reduced confidence with walking
- Persistent symptoms following Vestibular Neuritis
- Ongoing imbalance despite otherwise recovering from your illness
The aim of an assessment is not simply to label everything “post-viral dizziness.”
The more useful question is:
What has the viral illness left you with?
Is it BPPV?
Vestibular hypofunction?
Vestibular Migraine?
Visual Vertigo?
PPPD?
Or does the symptom pattern suggest that further medical investigation is required?
Once the underlying problem is identified, treatment can become much more targeted.
Dizziness after COVID-19 treatment in Melbourne
At The Vertigo Co, we assess patients experiencing persistent dizziness, vertigo and balance problems following COVID-19 and other viral illnesses.
A comprehensive Vestibular Physiotherapy assessment can help determine whether your ongoing symptoms are consistent with BPPV, vestibular hypofunction, Vestibular Neuritis, Vestibular Migraine, PPPD, visual motion sensitivity or another vestibular presentation.
Depending on the findings, treatment may include:
- Vestibular Rehabilitation
- Gaze-stability exercises
- Balance retraining
- Habituation exercises
- Visual-motion rehabilitation
- Canalith repositioning manoeuvres for BPPV
- Graded return to movement and everyday activities
If you have recovered from COVID-19 or another viral illness but are still saying:
“I just haven’t felt steady since I was sick.”
“The infection is gone, but the dizziness isn’t.”
“I feel fine sitting down, but movement makes me dizzy.”
“Since COVID, supermarkets and screens make me feel awful.”
“I had severe vertigo when I was sick and my balance has never completely recovered.”
it may be worth having your vestibular system assessed.
Persistent dizziness after an illness can have several different causes. Identifying the specific pattern is the first step towards determining the most appropriate treatment.
The Vertigo Co – Vestibular Physiotherapy
If you’re experiencing persistent dizziness or imbalance following COVID-19 or another viral illness, consider booking a comprehensive Vestibular Physiotherapy assessment with The Vertigo Co.
This article provides general information only and is not a substitute for individual medical assessment. The relationship between COVID-19 and specific vestibular disorders continues to be studied, and dizziness following COVID-19 should not automatically be assumed to represent direct injury to the vestibular system. New, sudden or severe dizziness, particularly when accompanied by neurological symptoms, sudden hearing loss, chest pain or significant shortness of breath, requires prompt medical assessment.
