Dizziness When You Turn Your Head: The Neck Blood Flow Screen

You look over your shoulder to back out of the driveway and the room seems to tilt. Or you tip your head back to reach a top shelf and feel light, woozy or off balance for a few seconds. You mention it at your next physio visit, and suddenly your physiotherapist has a lot of questions.

That is on purpose. Most dizziness comes from the inner ear or the neck, and both usually respond well to treatment. But a small number of people have dizziness because the blood supply to the back of the brain is not keeping up. Telling these apart is one of the first jobs in any dizziness or neck assessment.

What is vertebrobasilar insufficiency?

The back of your brain, including the brainstem and the balance centre called the cerebellum, gets its blood from two vertebral arteries that run up through the bones of your neck. They join to form the basilar artery. Doctors call this the posterior circulation.

Vertebrobasilar insufficiency (VBI) means blood flow through these arteries drops for a short time. Physiotherapists often use the wider term cervical arterial dysfunction for any problem with the neck arteries that could cause symptoms.

Most cases of VBI are caused by hardening and narrowing of the arteries (atherosclerosis), the same process behind many heart attacks and strokes. Other causes include a tear in an artery wall, clots travelling from the heart, and, less often, an artery being pinched when the head is turned. Risk factors include:

• Smoking
• High blood pressure
• Diabetes
• High cholesterol
• Older age
• Heart or circulation problems, including an irregular heartbeat called atrial fibrillation
• A family history of vascular disease

Warning signs to know

Clinicians often remember the main signs as the "5 Ds and 3 Ns":

• Dizziness or vertigo
• Diplopia: double vision or other vision changes
• Dysarthria: slurred speech
• Dysphagia: trouble swallowing
• Drop attacks: your legs suddenly give way without warning
• Nausea or vomiting
• Numbness or tingling, especially around the face or lips
• Nystagmus: jumpy, flickering eye movements

Clumsiness, unsteady walking, feeling close to fainting and headache can also happen.

Here is the important part. Dizziness on its own is very common and is usually not caused by blood flow. One medical review notes that inner ear problems account for 80% to 90% of emergency visits for vertigo, and that vertigo alone cannot confirm VBI. What raises concern is dizziness that comes together with other signs from the list above, especially in someone with vascular risk factors.

When to call 911

Call 911 if dizziness comes with any of these: slurred speech, double vision or sudden vision loss, trouble swallowing, weakness or numbness in the face, arm or leg, or sudden trouble walking or keeping your balance. These can be signs of stroke. Do not drive yourself, and do not wait to see if it passes. Symptoms that settle quickly still need emergency care.

See your family doctor soon if you have dizziness that keeps coming back, dizziness with headaches or ringing in the ears, or dizziness that started with a new medication. It is also a good time to have your blood pressure, cholesterol and blood sugar checked.

Why your physiotherapist asks about this

An international consensus framework for physiotherapists (the IFOMPT Cervical Framework) asks clinicians to keep problems with the neck arteries in mind during every neck assessment. They are rare, but the framework stresses picking them up through careful questions and a physical exam adapted to what we hear. At VPC, a dizziness or neck assessment usually includes:

• Questions about exactly what "dizzy" means for you: spinning, light-headed, off balance or something else
• What brings it on, how long it lasts, and whether it happens with head position, standing up or neck movement
• Screening for the 5 Ds and 3 Ns and for vascular risk factors
• Checking your blood pressure when it is relevant
• Watching your eye movements, checking sensation and coordination, and testing your balance

Physiotherapists used to rely on neck positioning tests to "clear" the arteries. Research reviews have found these tests have limited value, so we lean on your full history and exam instead. If anything points toward a blood flow problem, we do not treat your neck. We either call 911 or send you to the emergency department, or write to your family doctor so they can investigate further.

What physiotherapy can and can't do

Physiotherapy cannot fix a narrowed or damaged artery. Diagnosis needs medical imaging, and treatment is medical: managing blood pressure, cholesterol and other risk factors, and sometimes procedures or medication. If you have questions about medication, talk to your doctor or pharmacist.

What we can do is help with the causes of dizziness that we do treat once serious causes have been ruled out. That includes inner ear conditions such as BPPV, dizziness linked to the neck, and balance problems. After a stroke, physiotherapy also plays a big part in recovery. Staying active is good for your blood vessels too, and we can help you build a safe exercise plan that your doctor supports.

Key takeaways

• Most dizziness comes from the inner ear or the neck, not blood flow.
• Dizziness together with double vision, slurred speech, trouble swallowing, drop attacks, numbness or unsteadiness needs urgent care. Call 911.
• Risk factors like smoking, high blood pressure, diabetes and high cholesterol make a blood flow cause more likely.
• Your physiotherapist screens for these signs before treating your neck and refers you if anything does not fit.

If your doctor has ruled out a serious cause and your dizziness seems linked to your neck, learn more about how we assess and treat cervicogenic dizziness, or read about our approach to vertigo and dizziness.

Call: 905-669-1221

Visit: 398 Steeles Ave W #201, Thornhill, ON

Book online: vaughanphysiotherapy.com

Sources

Heart and Stroke Foundation of Canada. (n.d.). FAST signs of stroke... are there other signs? https://www.heartandstroke.ca/stroke/signs-of-stroke/fast-signs-of-stroke-are-there-other-signs

Kerry, R., Taylor, A. J., Mitchell, J., & McCarthy, C. (2008). Cervical arterial dysfunction and manual therapy: A critical literature review to inform professional practice. Manual Therapy, 13(4), 278 to 288. https://doi.org/10.1016/j.math.2007.10.006

National Health Service. (n.d.). Dizziness. https://www.nhs.uk/symptoms/dizziness/

Rushton, A., Carlesso, L. C., Flynn, T., Hing, W. A., Rubinstein, S. M., Vogel, S., & Kerry, R. (2023). International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic & Sports Physical Therapy, 53(1), 7 to 22. https://doi.org/10.2519/jospt.2022.11147

StatPearls. (2025). Vertebrobasilar insufficiency. In StatPearls. StatPearls Publishing. https://www.statpearls.com/point-of-care/31123

This article is for general information and isn't medical advice. If you have any of the warning signs above, call 911 or contact your doctor right away.