Vertigo is NOT mainly caused by the vertebral arteries.
By far the most common causes are peripheral vestibular disorders of the inner ear, with benign paroxysmal positional vertigo (BPPV) being the single most frequent etiology overall, followed by other peripheral disorders and central causes such as vestibular migraine. Vertebral artery compression or vertebrobasilar insufficiency is a comparatively uncommon cause, though a posterior circulation stroke/TIA is the critical “cannot-miss” central cause.
Epidemiologic distribution. In large dizziness/vertigo cohorts, roughly 56% are peripheral vestibular, ~17% central vestibular, ~10% psychiatric/functional, and the remainder other/unknown. The most common specific diagnoses are BPPV (the leading cause across sexes and especially in those >60, up to ~46%), Ménière disease, unilateral peripheral vestibulopathy, vestibular migraine, and — among central causes — vascular vertigo/dizziness (brainstem/cerebellar infarcts) and vestibular migraine.
On vertebral artery compression specifically. Symptomatic mechanical compression (e.g., rotational “bow hunter’s” syndrome) is rare, and MRA has not shown significant differences in vertebral artery stenosis between symptomatic patients with vertebrobasilar insufficiency and asymptomatic controls — so attributing vertigo to vertebral artery compression should be a diagnosis of exclusion after more common causes and stroke are addressed.
Additionally, dizziness can persist as a neuroplastic symptom after the structural cause has been resolved. The latest cutting edge treatment involves utilizing virtual reality retraining for the brain. I went through that treatment protocol (8 weeks) at UCSF and resolved the remaining post-surgical dizziness.
, Youcai Bi 1,B,C, Yunbo Chen 1,A,B
