Over the years I have wondered if vestibular rehabilitation programs worked. My experience was that a lot of our patients that underwent vestibular rehabilitation would feel better but would digress when they stopped doing the exercises. The one thing that was consistently missing was an answer to a simple but powerful question. Why?


We need to ask ‘why’


This question has led me on a journey to understand dizziness in greater depth.  There are 3 main systems that can cause dizziness, our eyes, our inner ear and our neck. Assessing each system is important in addressing an underlying cause to dizziness. The tests that I have found most useful in screening for problems in each system are convergence for vision and eye coordination, the Dix Hallpike with imaging or video oculography for vertigo, and upper cervical C1-2 motion testing to screen for neck involvement.


3 best tests to assess for the cause of dizziness


Convergent Gaze Testing

Dix Hallpike with Imaging

Upper cervical C1-2 Testing


Convergence testing


Looking for eye coordination for convergent and divergent gaze is important to assess muscle and nerve function of the eyes. Neck issues can create muscle trigger points in ocular muscles pulling an eye way from midline and creating blurred vision and occasionally double vision. And yes, dizziness.


Symptoms to look for…


Blurred vision that changes

Double vision that is intermittent

Headache pain around the eyes

Eye fatigue and overall fatigue with cognitive function


Tips for testing


  • Go slowly and do 3 repetitions looking at convergent and divergent gaze.
  • Look for blinking and closing of the eyes. Look for eye drift.
  • See if your testing reproduces dizziness or other symptoms.



On our next post we will be looking at the vestibular system and gaining a better understanding of how our vestibular system works and best practices for testing and treatment. You will get some ‘tools’ for immediate treatment of your vertigo patients that have positional vertigo.


For more on convergent gaze testing and headaches check this link out.