The Biopsychosocial Approach to Dizziness

Overview

Dizziness is one of the most commonly reported symptoms in primary care, yet it remains persistently undertreated and misunderstood. While clinicians are trained to assess vestibular and musculoskeletal contributors, the broader physiological picture — including central sensitization, nociplastic pain mechanisms, and psychosocial drivers — is frequently missed entirely. The result is patients who cycle through assessments without answers, and clinicians who feel stuck. This course challenges that pattern directly.

In this course, Carolyn Vandyken, PT, guides clinicians through a rigorous biopsychosocial framework for understanding and treating dizziness. Drawing on current research in central sensitization, Persistent Postural-Perceptual Dizziness (PPPD), vestibular migraine, and chronic overlapping pain conditions, Carolyn makes the case that whole person care is not an afterthought — it is the clinical foundation. Clinicians will leave with concrete screening tools, assessment strategies, and a treatment framework grounded in Level 1 evidence.

This course is part of the Let's Talk Vestibular series on Embodia. It can be taken as a standalone course or as part of the full series.

Learning Objectives

By the end of this course, you will be able to:

1. Define central sensitization and nociplastic pain, and explain the physiological mechanisms that link them to dizziness and PPPD
   
   
2. Identify the diagnostic criteria and WHO-recognized classification for Persistent Postural-Perceptual Dizziness (PPPD)
   
   
3. Describe how chronic overlapping pain conditions (Central Sensitivity Syndromes) increase the prevalence and severity of dizziness symptoms
   
   
4. Differentiate vestibular migraine from episodic migraine using clinical features including cutaneous allodynia and the Central Sensitivity Inventory (CSI)
   
   
5. Apply a whole person biopsychosocial assessment framework including the CSI A and B, the OSPRO-YF, the Fremantle Awareness Questionnaire, and the Insomnia Severity Index (ISI)
   
   
6. Implement a targeted, evidence-based treatment approach addressing the five pillars of health — diet, exercise, water, sleep, and purpose/connection — for sensitized patients with persistent dizziness

Audience

This course is designed for physiotherapists, rehabilitation professionals, and any clinician working with patients experiencing persistent or complex dizziness. It is particularly relevant for practitioners in vestibular rehabilitation, chronic pain management, pelvic health, and primary musculoskeletal care who want to move beyond a purely structural model. No prior background in pain science is required, though familiarity with basic vestibular anatomy will be helpful.

Why This Course Matters

The numbers are hard to ignore. Up to 80% of patients presenting with dizziness have no identifiable organic cause despite thorough testing — a figure that points directly at how much central nervous system sensitization is being overlooked in clinical practice. Meanwhile, disability-adjusted life years for musculoskeletal conditions increased by over 60% between 1990 and 2016, and the healthcare system has not kept pace. Clinicians are seeing more complex, multi-system patients than ever before, and the biomedical model alone is not delivering outcomes.

This course closes a gap that most vestibular training leaves wide open. Central sensitization has been well-established in conditions like fibromyalgia and chronic fatigue syndrome for years — but its role in dizziness, PPPD, and vestibular migraine is less commonly taught. Patients with sensitized nervous systems who are treated only with peripheral vestibular techniques are likely to have poor outcomes; the research cited in this course makes that prediction explicit. Understanding how to screen for, identify, and treat central sensitization in dizzy patients is not a niche skill — it is an increasingly essential one.