Why are you still dizzy even though your MRI didn't show anything?

According to the National Institutes of Health, nearly 40% of adults experience dizziness at some point in their lifetime. Dizziness accounts for 2–5% of unplanned primary care visits, and up to 30% of adults over 65 report that it interferes with daily life.

If you are dizzy, you are not alone.

But one of the most frustrating experiences is this:

• You feel miserable

• You push through a car ride that makes your symptoms worse.

• You undergo imaging.

• Your MRI comes back normal.

Now what...?

First, a Normal MRI Is Often Good News

An MRI is designed to detect structural abnormalities such as tumors, strokes, bleeding, or major tissue damage. With a few exceptions (such as benign paroxymal positional vertigo or BPPV, where the issue is a physical dislodging of the crystals in your ear that detect gravity and your body's position in relation to it), most causes of dizziness are not structural problems. They are functional problems.

In other words, the system is irritated, misfiring, or poorly coordinated, but not damaged in a way that shows up on imaging.

A normal MRI does not mean your symptoms are imaginary. It just means your brain and inner ear structures are intact.

That is actually a positive finding.

What Actually Causes Most Dizziness?

Dizziness is not one single sensation. The type of dizziness matters.

• Lightheadedness or “wooziness” is often related to blood pressure regulation or autonomic dysfunction.

  
  

• Vertigo (spinning) is commonly linked to inner ear dysfunction.

  
  

• Rocking or swaying sensations are frequently related to central processing or sensory integration issues.

  
  

• Imbalance or unsteadiness often reflects a multi-system coordination problem.

Most dizziness comes from dysfunction within the vestibular system, your body’s motion and balance detection system. This system includes the inner ear and its connections to the brain.

But here is the key: The vestibular system can malfunction without being damaged.

Think of it like a software issue rather than a hardware issue. The wiring is intact. The processing is just off.

Your Balance Is a Team Effort

Your sense of balance depends on three systems working together:

1. The Vestibular System

Your inner ear and brainstem detect head motion, acceleration, and gravity.

2. Vision

Your eyes tell your brain where you are in space.

3. Proprioception

Sensors in your muscles and joints tell your brain where your body is positioned.

If even one of these systems becomes slightly inaccurate, the brain can struggle to reconcile the mismatch, and that mismatch often feels like dizziness. An MRI will not show that mismatch. It cannot show timing errors, reflex dysfunction, or sensory integration problems.

Common Functional Causes of Dizziness With Normal Imaging

Some of the most common diagnoses that produce normal imaging include:

• Benign paroxysmal positional vertigo (BPPV)

• Vestibular neuritis after viral illness

• Vestibular migraine

• Persistent postural perceptual dizziness (3PD)

• Post-concussion vestibular dysfunction

• Cervicogenic dizziness

• Autonomic dysfunction

  
  

All of these are very real, and all frequently produce normal imaging.

So What Do You Do?

If your dizziness is new and accompanied by any of the following, go to the emergency room immediately:

• Sudden severe headache

• Double vision

• Weakness or numbness

• Slurred speech

• Difficulty walking

• Fainting

• Chest pain

• Sudden hearing loss in one ear

  
  

If those symptoms are not present, vestibular physical therapy is often the next appropriate step.

A trained vestibular physical therapist can:

• Identify which system is misfiring

• Reduce symptom sensitivity through habituation (slowly exposing your system to triggering stimuli)

• Teach you eye exercises that improve innate ocular reflexes that integrate with your vestibular system

• Restore balance confidence by improving strength and proprioception

• Improve sensory integration with dual tasking exercises that incorporate different components of balance and the vestibular system

  
  

Because most dizziness is functional, it is highly treatable!

The Bottom Line

A normal MRI does not invalidate your symptoms. It usually means the problem is one of coordination, timing, or sensory processing, not structural damage.

That is good news.

If you are tired of feeling off balance, foggy, or motion sensitive, specialized vestibular rehabilitation can help recalibrate your system.

Headway Physical Therapy is a locally owned clinic in downtown Raleigh. Dr. Casey Roy specializes in vestibular disorders and helps patients regain clarity, confidence, and stability.

If you’re ready to stop spinning and start winning, make Headway today towards your goals and a higher quality of life.