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A guide to treatment options that work

  • Two of the most common reasons people seek medical attention
  • Accounted for approximately 3.9 million ER visits in the US in 2011

  • Exceeds $4 Billion per year in costs




Peripheral vertigo is the most common cause of vertigo in primary care. Ninety-three percent of primary care patients with vertigo have benign paroxysmal positional vertigo (BPPV), acute vestibular neuritis, or Ménière’s disease. Also common is labyrinthitis, perilymph fistula, immune-mediated inner ear disease and acoustic neuroma.


About one-fourth of cases of vertigo is caused by central deficits. Most cases of central vertigo are due to cerebrovascular disorders, migraine, cerebellar disorders, MS, posterior fossa tumors and neurodegenerative disorders. Treatment for many of these conditions may be warranted, provided the underlying cause has been identified and treated.


For those with unilateral or bilateral vestibular hypofunction who have vestibular deficit-associated impairments and functional limitations, the American Physical Therapy Association Neurology Section recommends vestibular rehabilitation.

A typical strategy that Health Quest employs is noisy galvanic vestibular stimulation and non-invasive vagus nerve stimulation, in conjunction with traditional vestibular rehabilitation therapy. This approach enhances the effectiveness of therapy and is likely mediated through the process of neuroplasticity in the peripheral and central nervous systems.


Diagnosis and prescribed treatment programs at Health Quest are performed by Dr. Sean Grady, DC with PT privileges, CFMP, DACNB. Dr. Grady holds the prestigious Diplomate from the American Chiropractic Neurology Board (DACNB), certifying him as a Functional Neurologist and allowing him to provide, in simple terms, brain rehab for those suffering from a variety of neurological conditions. These conditions include headache/migraine, vertigo/dizziness, stroke, neuropathy, concussion and Mild Traumatic Brain Injury. 

Dr. Grady is also certified as a whiplash and soft tissue injury specialist through the Whiplash Injury Biomechanics and Traumatology program at the Spine Research Institute of San Diego and is pursuing dual Fellowship certification in both Concussion/MTBI and Vestibular Rehabilitation from the American College of Functional Neurology. He is the only certified Functional Neurologist in a 40-mile radius of the Baltimore metropolitan area.

Typically, a Functional Neurologist serves in the same consulting manner as a Medical Neurologist. The difference is that the therapies or applications of a Functional Neurologist do not include drugs or surgery. The treatments are brain-based and follow the principles of neuroplasticity, the notion that the nervous system can change according to the stimulation it is exposed to.

As mentioned above, although the Functional Neurology model does not employ medication or surgery, Dr. Grady will work with other medical providers and specialists to ensure a cooperative and integrative approach to every patient’s health goals.


  • Byung In Han, H. S. (2011). Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises. Journal of Clinical Neurology, 184-196.
  • Dowd, K. H. (2002). Symptoms of vertigo in general practice: a prospective study of diagnosis. British Journal of General Practice, 809-812.
  • Hall CD ,  Herdman SJ ,  Whitney SL ,  Cass SP ,  Clendaniel RA ,  Fife TD , . . .  Woodhouse SN. (2016). Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. Journal of Neurologic Physical Therapy, 124-55.
  • Hesham M Samy, M. P. (2017, March 7). Dizziness, Vertigo and Imbalance: Medscape. Retrieved from Medscape.com: http://emedicine.medscape.com/article/2149881-overview
  • Philip E Zapanta, M. F. (2016, March 28). Vestibular Rehabilitation: Medscape. Retrieved from medscape.com: http://emedicine.medscape.com/article/883878-overview
  • Tehrani AS, S., Coughlan D, Hsieh YH, Mantokoudis G, Korley FK, Kerber KA, . . . Newman-Toker DE. (2013). Rising annual costs of dizziness presentations to U.S. emergency departments. Academy of Emergency Medicine, 689-696.