The room spins when you stand up. A foggy, disconnected sensation follows you through the day. Months after recovering from COVID-19, you still cannot trust your own balance.

You are not imagining this.

Research published in Frontiers in Neurology found that 60% of Long COVID patients experience persistent dizziness or vertigo, often lasting nearly a year after their initial infection.¹ For many, these symptoms become the defining feature of their post-COVID life, affecting everything from work performance to simply walking across a room.

The good news: Long COVID dizziness is treatable. Understanding why your brain and body are responding this way is the first step toward recovery. This guide explains what is happening in your vestibular and nervous systems, why symptoms persist, and what treatment approaches actually work based on current medical research.

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What Causes Dizziness After COVID-19?

Long COVID dizziness is not a single condition. It results from multiple overlapping mechanisms that COVID-19 triggers in your body. Understanding which systems are affected helps determine the right treatment approach.

Direct Damage to Your Vestibular System

Your vestibular system, located in your inner ear, controls balance and spatial orientation. Research from MIT and Massachusetts Eye and Ear, published in Communications Medicine, confirmed that SARS-CoV-2 can directly infect the inner ear.² The virus enters through ACE2 receptors present in vestibular hair cells and Schwann cells, the same receptors it uses to infect your lungs.

This direct infection can cause vestibular neuritis (inflammation of the vestibular nerve), labyrinthitis (inner ear inflammation), and benign paroxysmal positional vertigo (BPPV).

A 2024 study in Otology & Neurotology analyzed the National COVID Cohort Collaborative database and found that COVID-19 patients are 2.39 times more likely to develop vestibular disorders compared to the general population.³

Autonomic Nervous System Dysfunction

Your autonomic nervous system (ANS) controls involuntary functions like heart rate, blood pressure, and digestion. COVID-19 frequently disrupts this system, leading to a condition called dysautonomia. The most common form in Long COVID patients is POTS, or Postural Orthostatic Tachycardia Syndrome.

When you stand up, your ANS should automatically adjust blood flow to maintain stable blood pressure to your brain. In POTS, this regulation fails. Your heart rate spikes, blood pressure drops, and insufficient blood reaches your brain, causing lightheadedness, dizziness, and sometimes fainting.

Studies suggest that up to 79% of Long COVID patients meet diagnostic criteria for POTS or orthostatic intolerance.⁴

Related reading: Does COVID Affect Your Nervous System?

Neuroinflammation and Disrupted Brain Function

Emerging research reveals that Long COVID creates persistent inflammation in the brain. A groundbreaking 2024 study from Amsterdam UMC using specialized PET imaging found widespread neuroinflammatory activity in Long COVID patients that persisted more than two years after infection.⁵ The inflammation levels were comparable to those seen in multiple sclerosis and Alzheimer's disease.

This neuroinflammation disrupts neurovascular coupling, the process by which your brain regulates blood flow to active regions. When neurovascular coupling fails, brain areas responsible for processing balance and spatial information cannot function properly. The result is persistent dizziness, brain fog, and difficulty concentrating.

Learn more: How fNCI Brain Imaging Works

Vascular and Microclot Damage

COVID-19 creates a hypercoagulable state in the body, increasing the risk of blood clots. Microclots can form in the tiny blood vessels supplying your inner ear and brain. The inner ear is particularly vulnerable because it depends on a single small artery for blood supply. Any disruption to this blood flow can cause dizziness, hearing changes, and balance problems.

The Three Types of Long COVID Dizziness

Not all dizziness feels the same. Identifying which type you experience helps healthcare providers determine the underlying cause and appropriate treatment.

Vertigo: The Spinning Sensation

True vertigo creates an illusion of movement, typically a spinning or rotating sensation. You may feel like the room is moving around you, or that you are spinning even while sitting still. Vertigo in Long COVID usually indicates vestibular system involvement, either peripheral (inner ear) or central (brain).

Common triggers include changing head position, rolling over in bed, or looking up. If your vertigo episodes are brief (lasting seconds to minutes) and triggered by specific head movements, you may have BPPV, which is highly treatable with repositioning maneuvers like the Epley technique.⁶

Lightheadedness: The Faint, Woozy Feeling

Lightheadedness creates a sensation of nearly fainting, often described as feeling "woozy" or like you might pass out. This type of dizziness typically worsens when standing and improves when lying down.

Lightheadedness in Long COVID strongly suggests autonomic dysfunction or POTS. Your brain is not receiving adequate blood flow, particularly when you are upright. Symptoms often worsen after meals, in warm environments, or during prolonged standing.

Disequilibrium: The Off-Balance Sensation

Disequilibrium is a sense of unsteadiness or imbalance without the spinning sensation of vertigo or the faintness of lightheadedness. You may feel "drunk" or like you are walking on an uneven surface. This type of dizziness often reflects central nervous system involvement or problems with the brain's integration of vestibular, visual, and sensory information.

Some Long COVID patients develop Persistent Postural-Perceptual Dizziness (PPPD), a chronic condition where the brain becomes hypersensitive to motion and visual stimuli. A 2024 Johns Hopkins study documented PPPD emerging as a complication of Long COVID in both adult and pediatric patients.⁷

Related reading: Understanding Post-Concussion Dizziness

How Long Does Long COVID Dizziness Last?

One of the most frustrating aspects of Long COVID dizziness is the unpredictable timeline. Recovery varies significantly from person to person.

A study of over 1,000 Long COVID patients found symptoms persisted an average of 43 weeks (approximately 10 months) after initial infection.¹ Research from Montefiore Einstein tracked COVID patients for up to two years and found that 43% still reported vestibular symptoms at their follow-up assessments.⁸

Several factors influence recovery time:

• Patients who required hospitalization during acute COVID infection tend to experience longer symptom duration
• Women and those with pre-existing anxiety or vestibular conditions may face longer recovery timelines
• The specific cause of dizziness matters: BPPV often resolves quickly with treatment, while autonomic dysfunction may require months of rehabilitation

The encouraging news is that vestibular compensation does occur. Your brain can adapt to vestibular damage over time, especially with targeted rehabilitation. However, this compensation appears to progress more slowly in Long COVID patients compared to those with typical vestibular disorders, making specialized treatment particularly valuable.

Diagnosing the Source of Your Dizziness

Effective treatment requires accurate diagnosis. Because Long COVID dizziness has multiple potential causes, a thorough evaluation is essential.

Standard Vestibular Testing

Conventional diagnosis may include:

• Videonystagmography (VNG) to assess eye movements
• Video head impulse test (vHIT) to evaluate vestibular reflexes
• Caloric testing to measure inner ear function

These tests help identify peripheral vestibular dysfunction.

For suspected POTS, a tilt table test or active standing test measures how your heart rate and blood pressure respond to position changes. A diagnosis of POTS requires a sustained heart rate increase of 30 beats per minute (or above 120 bpm) within 10 minutes of standing, without a significant drop in blood pressure.⁹

Advanced Brain Imaging

Standard imaging like MRI and CT scans often appear normal in Long COVID patients, even when symptoms are severe. This is because conventional imaging cannot detect the functional changes occurring in the brain.

Advanced functional brain imaging can reveal what standard tests miss. Technologies that measure blood flow patterns during cognitive tasks can identify which brain regions are not functioning properly. This information allows treatment to be precisely targeted to the affected areas rather than using a one-size-fits-all approach.

Learn more: About fNCI Functional Brain Imaging

Treatment Approaches That Work

Long COVID dizziness responds to treatment, but the approach must address the underlying cause. Most patients benefit from a combination of therapies.

Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy (VRT) is the first-line treatment for most vestibular disorders.¹⁰ A physical therapist specializing in vestibular conditions guides you through exercises designed to help your brain compensate for vestibular dysfunction.

Key components include:

• Gaze stabilization exercises to improve visual focus during head movement
• Balance retraining to improve stability
• Habituation exercises to reduce sensitivity to movements that trigger symptoms

For BPPV, canalith repositioning maneuvers like the Epley technique achieve success rates exceeding 80-90% in resolving symptoms.

Related reading: Vestibular Therapy for Concussion Symptoms

POTS and Dysautonomia Management

If autonomic dysfunction is contributing to your dizziness, treatment focuses on improving blood volume, heart rate regulation, and nervous system function.

Non-pharmacological approaches include:

• Increasing salt and fluid intake to expand blood volume
• Wearing compression garments on the lower body and abdomen
• Starting recumbent exercise (swimming, recumbent cycling) before progressing to upright activities
• Eating smaller, more frequent meals and avoiding large carbohydrate-heavy foods
• Avoiding triggers like prolonged standing, heat exposure, and alcohol

Medications such as beta-blockers or ivabradine may be prescribed to control heart rate. The NIH RECOVER-AUTONOMIC trial is currently testing additional treatments including IVIG for Long COVID POTS patients.¹¹

Learn more: POTS Treatment at Cognitive FX

Addressing Neuroinflammation and Brain Function

For patients whose dizziness stems from disrupted brain function, treatment must go beyond the vestibular system alone. Therapies that address neurovascular coupling dysfunction can help restore normal blood flow regulation in the brain.

This often requires a multidisciplinary approach combining aerobic exercise (which promotes healthy brain blood flow), cognitive therapy, vision therapy, and vestibular rehabilitation working together. Exercise is particularly important because it has been shown to promote BDNF release and support brain recovery, but it must be carefully paced to avoid triggering post-exertional malaise.

When Standard Treatments Are Not Enough

Many Long COVID patients try vestibular physical therapy and symptom management for months without significant improvement. When conventional approaches plateau, intensive treatment programs offer a different path.

The Intensive Treatment Approach

Rather than spreading therapy over months of weekly sessions, intensive programs deliver concentrated treatment over one to two weeks. This approach accelerates neuroplasticity, the brain's ability to form new neural connections and adapt.

An intensive program typically includes multiple hours of therapy daily, with sessions in aerobic exercise, vestibular rehabilitation, vision therapy, cognitive therapy, and other modalities tailored to each patient's specific needs. The combination of therapies working together creates results that isolated weekly sessions often cannot achieve.

Targeted Treatment Through Brain Imaging

Treatment works best when it targets the specific brain regions that are not functioning properly. Without objective data about where dysfunction exists, therapy becomes guesswork.

Functional brain imaging before treatment identifies which areas need attention. Therapy can then focus precisely on those regions. Post-treatment imaging confirms improvement and guides any additional interventions needed.

At Cognitive FX, we use our proprietary fNCI (functional NeuroCognitive Imaging) technology to map brain function before and after treatment. This approach has helped our team treat over 1,000 patients annually with Long COVID and post-concussion symptoms, achieving measurable improvement in more than 90% of cases.

Learn more: EPIC Treatment Program

Our EPIC Treatment program combines advanced brain imaging with intensive multidisciplinary therapy to help Long COVID patients recover faster.

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Red Flags: When to Seek Immediate Medical Attention

While most Long COVID dizziness is not dangerous, certain symptoms require urgent evaluation:

• Sudden severe vertigo with hearing loss (may indicate stroke or sudden inner ear damage)
• Dizziness accompanied by slurred speech, facial drooping, or weakness on one side of the body
• Severe headache with dizziness (worst headache of your life)
• Recurrent fainting episodes
• Dizziness with chest pain or shortness of breath
• New dizziness after a recent head injury

If you experience any of these symptoms, seek emergency medical care immediately.

Living With Long COVID Dizziness While Pursuing Treatment

Recovery takes time. These strategies can help you manage symptoms and maintain quality of life during the process.

Pace your activities. Post-exertional symptom worsening is common in Long COVID. Track your activity levels and symptoms to identify your limits. Rest before you crash, not after.

Modify your environment. Reduce visual clutter in your home. Use nightlights to prevent falls. Remove trip hazards like loose rugs. Consider a shower chair if standing in the shower triggers symptoms.

Communicate with your employer. Many patients benefit from workplace accommodations such as the ability to sit during tasks, taking breaks, or working from home on high-symptom days.

Address mental health. Chronic dizziness is exhausting and isolating. Anxiety can worsen vestibular symptoms, creating a vicious cycle. Working with a therapist who understands chronic illness can help.

Stay connected. Long COVID support groups, both online and in-person, provide valuable community and practical tips from others navigating similar challenges.

Frequently Asked Questions About Long COVID Dizziness

Why does Long COVID cause dizziness?

Long COVID causes dizziness through multiple mechanisms: direct viral damage to the inner ear vestibular system, autonomic nervous system dysfunction (POTS), neuroinflammation disrupting brain function, and microvascular damage affecting blood flow. Most patients have more than one contributing factor.

How long does dizziness last after COVID?

Duration varies widely. Some patients recover within weeks, while others experience symptoms for months or years. Research shows average symptom duration of approximately 10 months, with about 43% of patients still symptomatic at one to two years. Treatment significantly improves outcomes and speeds recovery.

Can COVID damage your inner ear permanently?

COVID-19 can damage inner ear structures, but permanent damage is uncommon. Research suggests most acute vestibular damage from COVID is transient. The brain can also compensate for vestibular damage through neuroplasticity, especially with proper rehabilitation. Early treatment improves long-term outcomes.

Is dizziness a common symptom of Long COVID?

Yes. Studies show between 37-60% of Long COVID patients experience dizziness or vertigo.¹ It is one of the most frequently reported neurological symptoms, alongside brain fog and fatigue.

What is the connection between Long COVID and POTS?

POTS (Postural Orthostatic Tachycardia Syndrome) frequently develops after COVID-19 infection. Studies suggest up to 79% of Long COVID patients meet diagnostic criteria for POTS or orthostatic intolerance. The virus appears to damage autonomic nerves or trigger autoimmune responses that impair autonomic function.

When should I see a doctor for COVID dizziness?

Seek evaluation if dizziness persists more than four weeks after COVID infection, if symptoms are severe enough to affect daily activities, if you experience frequent near-fainting or actual fainting, or if symptoms are progressively worsening rather than improving.

Taking the Next Step Toward Recovery

Long COVID dizziness is real, it is common, and it is treatable. The path to recovery starts with understanding what is causing your symptoms and finding providers who specialize in treating the neurological effects of COVID-19.

If you have been struggling with dizziness, brain fog, fatigue, or other Long COVID symptoms for months without improvement, specialized care can help. Our team at Cognitive FX combines advanced brain imaging technology with intensive, multidisciplinary treatment to help patients recover faster than traditional approaches allow.

We have successfully treated patients from across the United States and around the world. Our outcomes data shows that over 90% of patients experience measurable improvement in brain function and symptoms after completing our EPIC Treatment program.

Ready to Get Your Life Back?

You do not have to live with chronic dizziness. Our team has helped thousands of patients recover from Long COVID and other brain-related conditions.

What to expect:

• Free initial consultation to discuss your symptoms and determine if you are a candidate for treatment
• Advanced fNCI brain imaging to identify exactly which brain regions are affected
• Customized one-week intensive treatment targeting your specific dysfunction
• Measurable results with post-treatment brain imaging to confirm improvement

"After months of dizziness and brain fog that kept me from working, I completed EPIC Treatment and felt like myself again. The brain imaging showed exactly what was wrong and the treatment targeted those areas. I wish I had found Cognitive FX sooner."

— Long COVID Patient

References

• Frosolini A, Parrino D, Fabbris C, et al. Magnetic Resonance Imaging Confirmed Olfactory Bulb Reduction in Long COVID-19: Literature Review and Case Series. Brain Sciences. 2022;12(4):430. Published 2022 Mar 25. doi:10.3390/brainsci12040430 ↩ ↩² ↩³

• Jeong M, Ocwieja KE, Han D, et al. Direct SARS-CoV-2 infection of the human inner ear may underlie COVID-19-associated audiovestibular dysfunction. Communications Medicine. 2021;1(1):44. Published 2021 Oct 29. doi:10.1038/s43856-021-00044-w ↩

• Shoucri S, et al. Increased Incidence of Vestibular Disorders in Patients With SARS-CoV-2. Otology & Neurotology. 2024;45(6):e477-e484. doi:10.1097/MAO.0000000000004195 ↩

• Blitshteyn S, Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. Immunologic Research. 2021;69(2):205-211. doi:10.1007/s12026-021-09185-5 ↩

• Visser D, Golla SSV, Verfaillie SCJ, et al. Long COVID is associated with extensive in-vivo neuroinflammation on [18F]DPA-714 PET. Brain. 2024. doi:10.1093/brain/awae178 ↩

• The Vertigo Doctor. How To Treat Long Covid Dizziness In 4 Steps. https://thevertigodoctor.com/blog/long-covid-dizziness/ ↩

• Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191-208. ↩

• Montefiore Einstein. Study Finds "Long COVID" Includes Auditory and Vestibular (Balance) Problems. Published November 6, 2023. https://montefioreeinstein.org/news/2023/11/06/study-finds-long-covid-includes-auditory-and-vestibular-balance-problems ↩

• Sheldon RS, Grubb BP 2nd, Olshansky B, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12(6):e41-e63. ↩

• Academy of Neurologic Physical Therapy. Long COVID and Dizziness: Physician Fact Sheet. Vestibular Special Interest Group. 2022. https://www.neuropt.org/docs/default-source/vestibular-sig/vsig-physician-fact-sheets/long-covid-and-dizziness-2022.pdf ↩

• NIH RECOVER Initiative. RECOVER-AUTONOMIC Clinical Trial. ClinicalTrials.gov Identifier: NCT05172349. ↩