Pulsating dizziness typically indicates that the heartbeat is somehow involved. In this blog, we will discuss a few possible causes of pulsating dizziness and what type of healthcare providers may be able to help.
Pulsating dizziness may be fairly constant and can vary with head position. Whenever someone complains of pulsating dizziness, my first thought is their C1 (atlas bone) or C2 (axis bone) are out of proper alignment.
If the C1 or C2 bones are out of alignment, the blood flow through the vertebral arteries may be compressed causing pulsating dizziness. This may be why the pulsating dizziness is fairly constant but varies with head position.
Health Care Options for Pulsating Dizziness
If pulsating dizziness comes in short bursts occasionally, then a cardiology consult may be helpful to identify any abnormal heart rhythm or cardiac cause. Medical management may be beneficial if a cardiac cause if discovered.
If upper cervical issues are the root cause of pulsating dizziness, then neck care may be the appropriate treatment. Even though I assess for upper cervical dizziness during my initial exam, I don’t treat that problem as a vestibular physical therapist.
I have read case studies where the vestibular PT attempts to also treat the patient’s neck for cervicogenic dizziness and the patient does not achieve a full recovery. I want better results than that for my patients!
Therefore, I made a decision long ago to develop a team approach instead of trying to treat pulsating dizziness from the neck by myself. For patients with pulsating dizziness that show signs of upper cervical alignment issues during my exam, I typically refer them to an orthopedic manual physical therapist. I’ve had good results referring a few hundred people to this type of provider for dizziness related to their neck.
You can use this online directory to search for an orthopedic manual physical therapist if you suspect pulsating dizziness is linked with neck tension or neck pain.
Chiropractic Care
Some of my patients with pulsating dizziness prefer chiropractic care for their neck instead of orthopedic manual physical therapy. In that case, I refer them to upper cervical chiropractors trained in either NUCCA or the Blair technique.
NUCCA chiropractor typically only adjusts C1 bone, but may not address any other orthopedic issues. Whereas, upper cervical chiropractors who practice the Blair technique will typically adjust C1, C2, and the whole spine as needed.
Underlying Causes of Pulsating Dizziness from the Neck
Patients with pulsating dizziness from their neck often have neck pain, tension, or stiffness. Pulsating dizziness may occur in patients with a history of whiplash or other neck injury.
I have written other articles on these specific topics:
Who can Help with Upper Cervical Dizziness?
Root Causes of Upper Cervical Dizziness
Can Posture Cause Upper Cervical Dizziness
Certain occupations or hobbies can contribute to neck issues over time that can result in pulsating dizziness.
Pulsating dizziness can also develop over time in patients with low back pain or tailbone injury as the neck compensates for that misalignment on another spinal level. The head will always seek to align itself as “level” so the neck may develop misalignment over time to “level out” alignment issues elsewhere.
For example, this type of compensation can develop in response to scoliosis or an uncorrected leg length discrepancy.
For a more in depth discussion of potential deeper root causes of neck problems that can cause pulsating dizziness, click here.
Neck Stabilizing Exercises May Help
Once the spinal bones are properly aligned through manual therapy adjustment(s) by a skilled provider and the muscles re-balanced, exercises can stabilize your neck in place.
Restoration of proper alignment and stability in the neck will improve the blood flow through your neck to your brain and ears. This treatment approach can relieve pulsating dizziness.
Exercises for stretching or strengthening the neck muscles may be appropriate for long term relief of pulsating dizziness. Strengthening exercises can provide spinal stability to reduce the likelihood of recurring symptoms.
Neck exercises would be prescribed on a case-by-case basis after an evaluation.
Vestibular PT for Pulsating Dizziness
I’m not sure if vestibular physical therapy will offer any direct treatment that would provide relief from pulsating dizziness, especially if the neck is the root cause.
Pulsating dizziness may also occur in patients with a highly insufficient vestibulo-ocular reflex (VOR) due to heart beats disturbing gaze stability.
In those less common cases, the VOR training for gaze stabilization with a vestibular PT may reduce or resolve pulsating dizziness due to an unstable VOR triggering dizziness with the heart beat.
But keep in mind that if your C1 bone is not aligned properly, then doing a bunch of VOR eye exercises with your head moving quickly will not get you the results you want.
Ultimately, your C1 bone needs to be aligned, all BPPV needs to be cleared, and then you can get good results from vestibular eye exercises for VOR training.
For more information on upper cervical dizziness and vestibular rehab, such as how I sequence treatments when both types of care are needed, click here.
Can BPPV cause Pulsating Dizziness?
BPPV typically does NOT cause pulsating dizziness. I usually hear that specific complaint from patients with neck problems.
However, there are a few exceptions:
I have personally experienced pulsating dizziness while lying in bed from cupulolithiasis type BPPV. This type of pulsating dizziness is due to stuck crystals in one or more vestibular canal. A vestibular PT should be able to detect cupulolithiasis during a BPPV exam and treat it.
It is also possible (but uncommon) that patients with BPPV could perceive “visual pulsations” lasting for seconds to minutes. This could occur when the vertigo is triggered by certain positions or movements, due the symptom of oscillopsia caused by BPPV.
The patient may experience their visual world pulsating side to side or up and down. If that occurs, the nystagmus caused by BPPV would most likely be the reason for the short-lived visual pulsations.
Sometimes BPPV treatments or vestibular exercises can worsen neck problems. I discuss the considerations for co-occuring neck issues and BPPV treatment in this article.
I have found that many patients have both BPPV and upper cervical dizziness, so I recommend for those patients to address both problems for a full recovery from dizziness and vertigo. I treat the BPPV and refer to another specialist for the upper cervical care.
Can a Migraine Cause Pulsating Dizziness?
Migraines can cause a throbbing sensation, usually on one side of the head; however, the throbbing sensation from migraines is usually painful.
Throbbing pain on one side of the head can co-occur with dizziness and nausea during a migraine episode. Even so, I would not describe this symptom pattern as “pulsating dizziness.”
Vestibular migraines are a subtype of migraines that should be considered as a possible root cause of dizziness and vertigo in all migraine sufferers. To learn about vestibular migraines, check out tthis article.
Commit to the Treatment Plan
Keep in mind that jumping around to different health care providers without completing their treatment plan will limit your results in recovering from pulsating dizziness.
I suggest you decide which health care providers you like to work with and you trust.
You may ultimately need a team of providers to address each root cause in your case.
Then make a commitment to finish their treatment plan.
Disclaimer
This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
I have been having pulsing dizziness for the past week. It’s more behind my eyes than anything else, but it doesn’t feel like my migraines I’ve had before. I do have a history of tailbone pain, but that was a very long time ago. I’m not sure where to start exploring my dizzy spells, any tips are much appreciated!
Hi Heather,
I’m glad you found my blog on pulsating dizziness because that can be miserable!
I always suggest for people to notify their primary care provider of new dizziness symptoms.
For this problem, I usually refer to a provider who can assess both the upper cervical spine and the tailbone/ full spine, since the two issues may be linked.
I refer to an orthopedic manual physical therapy provider with an OCS credential who was trained at IPA. You can search for providers with similar training using this website.
If you prefer chiropractic care for your spine, you may want to look into the providers who offer the Blair technique.
The other chiropractic technique for upper cervical care is called NUCCA, but they don’t usually adjust anything besides the C1 bone.
For patients with pulsating dizziness and an old tailbone injury, I usually refer to an IPA-trained orthopedic manual PT for a head to toe orthopedic alignment and postural assessment.
I hope that information is helpful.
I have a few other blogs in this topic:
Here
Here
Best wishes!
My name is Donna.
I’m from Ireland and I’ve been experiencing a lot of pulsating/throbbing feeling at the back of my head.
I’ve been to the hospital because I was very unwell 3 weeks ago and my balance wasn’t good at all, I was told I had BPPV (benign paroxysmal positional vertigo) and I have been taking motion sickness medication for this and doing manuveres to try help.
I felt great for about a week no dizziness, no head throbby feeling, like I was back to my usual self
and then all of a sudden 3 days ago I felt a bit off, I do not feel very well and my appetite felt a bit off and then I started experiencing this throbbing pulsation dizzy feeling I also had ear pain but that subsided. Can BPPV cause pulsating dizziness?
It’s so hard to describe the feeling but it feels like a pulsing, throbbing and spinny sensation but my room isn’t actually spinning, if I move my head too quickly I get the feeling, or if I’m going for a walk or if I look down.
I also have to sleep on my back because I feel lightheaded if I try turning over to sleep on my side and I am finding it hard to try to sleep because I am a side sleeper
I feel really frustrated and just want to feel normal again.
Hi Donna,
I’m sorry to hear all that!
I have heard this complaint from other patients and experienced it myself, so I’ve written a few blog articles on this topic.
You may want to check out:
Pulsating Dizziness
Upper Cervical Dizziness
Who Can Help
Possible root causes
You said you have been diagnosed with BPPV, so I encourage you to seek BPPV treatment as soon as possible. BPPV can be resolved if you find the right healthcare provider.
Don’t give up! You may have more than one root cause of your discomfort.
Also in response to your specific question about BPPV and pulsating dizziness:
BPPV typically does NOT cause pulsating dizziness. I usually hear that specific complaint from patients with upper cervical dizziness.
However, it is possible (but uncommon) that patients with BPPV could perceive “visual pulsations” lasting seconds to minutes when the vertigo is triggered by certain positioning or movements due to the symptom of oscillopsia.
Sometimes BPPV treatments or vestibular exercises can worsen neck problems. I discuss the considerations for co-occuring neck issues and BPPV treatment in this article.
I have found that many patients have both BPPV and upper cervical dizziness, so I recommend for those patients to address both problems for a full recovery from dizziness and vertigo. I treat the BPPV and refer to another specialist for the upper cervical care.
Dr. Bell,
Thank you for this thorough and very helpful article. I’ve been struggling with pulsating dizziness for 9 months now following a whiplash injury, and there is extremely limited information about it out there, so I was relieved to see a professional put it into words.
Can you share a bit more about how the cervical instability and muscle weakness can perpetuate the pulsating dizziness after the subluxation has been addressed? I’ve seen a number of upper cervical chiropractors, and they assure me my C1/C2 are in alignment, but the symptoms persist. My neurotologist believes that a full course of cervical PT will help tremendously.
Thank you!
Hi George,
If the cervical spine is unstable or the spinal muscles are weak, then the bones may not hold the adjustment once in place.
Cervical PT may be a good solution. I am glad your neurotologist is on board! Many vestibular doctors deny the importance of the cervical spine in resolving dizziness.
You can also work with your professional team of providers to determine if you have a deeper root cause of upper cervical issues that needs to be addressed, so your adjustment can hold.
This blog is on that topic.
This blog is on who can help with upper cervical dizziness.
This blog provides more of an overview of the topic.
Also this blog on neck pain and this blog on neck stiffness may be helpful as you search for answers and relief.
I have pulsating dizziness (my hearing also seems blocked for a bit) when I stand up from a sitting position. It’s sometimes so bad is causes a panic attack. I am also experiencing episodes of vertigo.
I get this too! I thought I was the only one!
Can the neck ever realign itself with time, just from sleeping at night or from movement from the day?
Yes, some people notice that certain movement or recreational activities naturally cause their spine to realign. This varies from person to person but may include activities like swimming, biking, weight training, stretching, or gymnastics/ tumbling.
However, in many cases, the spine needs hands-on manual therapy adjustments to restore full mobility to any spinal joints that are stuck out of place.
It is optimal to find someone who can palpate all the joints of the neck or back to target an adjustment to a specific hypo-mobile joint, instead of snapping or popping big sections of the spine all at once.
Cracking large sections of many spinal segments at once can cause the weaker (hyper mobile) areas tend to give, while the hypo-mobile joints (stiffer areas) may not budge.
To learn what type of orthopedic manual therapy provider may be able to help, you can check out this article.
I have had a heart condition for four years resulting in lots of extra beats, irregular rhythm and SOB. Over the past couple of days I have been getting this dizziness that feels like pulses whenever I move and I can feel my eyes flutter when doing so.
The Dr’s that I have seen have not come across these symptoms before.
I am not experiencing symptoms of vertigo (the room doesn’t spin I just feel light headed and sometimes I get a tingling sensation in my hands when it happens).
I will bring this information to my next GP to see if it can be helped.
My husband has been experiencing pulsing in his head followed by dizziness. He went into the hospital and did a whole bunch of tests after finding out he has high blood pressure. All tests were negative, he even has been released from a neurologist who said there is nothing on his end wrong with him. He now is on high blood pressure medicine, but the pulsing is there in the frontal lobe of his head and at the top.
He can’t work as he is dizzy. I feel I am banging my head against a wall as we can not get him any relief and heart is good, no diseases, his blood tests show clean and he has had 2 Ct scans, an MRI and still, totally clean. Doctors will not address the issue. Glad I found this blog!
I’ve got pulsing dizziness about 3 weeks ago. It came out of nowhere, also my both arms are tickling and kind of numb till the end of my fingers, also sometimes I feel kind of cold. I am nauseas as well. This feeling is there for the whole day. Also sometimes I feel my heartbeat change, but I had that for long time. Also I can hear beeping sound in my ear sometimes in the past day. Do you have any ideas or suggestions please. I know it’s too much what I wrote
Thanks
Hi Henrietta,
I always suggest notifying your primary care provider of any new symptoms, so they can give you individual medical advice.
As far as the pulsating dizziness and beeping sounds in your ear, this blog might help you learn about which providers can treat it.
This blog may help you learn more.
I hope you feel better soon!