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 in the Neck

Pulsating dizziness may occur in patients with a history of neck injury. 

It 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. 

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.

To learn more about root causes that may cause the upper cervical alignment issues to become chronic, click here.

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.

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.

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. Then make a commitment to finish their treatment plan.


This blog is provided for informational 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.