Dizziness can be seen in many conditions, but among the various types of cervical spondylosis, vertebral artery cervical spondylosis (CSA) is more common and is often misdiagnosed as other conditions. Today, we will briefly introduce the diseases that are often misdiagnosed as vertebral artery cervical spondylosis with dizziness as the main manifestation. 1) Meniere’s syndrome: It is generally believed that the cause of Meniere’s syndrome is related to vascular nerve dysfunction. The capillary permeability increases, the membrane vagus accumulates water so that the vestibular membrane of the cochlea protrudes to the vestibular order, and the ectolymphatic interrogation gap is blocked; at the same time, the elliptical sac and balloon protrude into the jugular and semicircular canal, and the endolymphatic pressure increases violently, and symptoms such as vertigo, nausea and vomiting occur when the limit is exceeded, and there may be transient nystagmus. However, each attack lasts for several hours or 1 to 2 d, and rarely for more than 1 week. The symptoms of CSA are mainly caused by the strain, distortion and compression of vertebral artery, which leads to the lack of blood supply to the brain, and the symptoms of cervical vertigo, nausea, vomiting, nystagmus and tinnitus. Unlike cervical vertigo, Meniere’s syndrome is often preceded by tinnitus and deafness, sometimes for several months, and always occurs on the affected side. The tinnitus is especially prominent when vertigo occurs, and it is mostly constant and high-pitched, with a background of “whirring” sounds mixed with screaming or machine sounds. 2) Transient ischemic attack: Transient ischemic attack in the vertebrobasilar system is characterized by sudden onset of vertigo and balance disorders, which may be accompanied by tinnitus, sudden onset of collapse, transient general amnesia, and symptoms similar to those of cervical syncope. However, transient ischemic attack symptoms are often accompanied by focal neurological deficits, and the attack usually recovers completely within 30 min, often leaving minor neurological deficits manifested beyond 2 h, such as dyskinesia, choking, dysphagia or cerebellar ataxia, which recover within 24 h. No other signs and symptoms of cervical spondylosis. 3) Cerebral atherosclerosis: cranial atherosclerosis most often invades the internal carotid artery and vertebrobasilar artery, and the atheromatous plaque causes vascular stenosis, cerebral blood supply deficiency, dizziness, vertigo, headache symptoms and memory loss when cerebral ischemia occurs. In the distant stage, the disease develops into cerebral atrophy, and cerebrovascular accidents occur due to arterial thrombosis or rupture. However, tinnitus is rare in this disease, and the symptoms of dizziness and vertigo are not related to body position, and there is no nystagmus. Digital subtraction angiography (DSA) can show luminal narrowing or aneurysmal lesions caused by cerebral artery atherosclerosis, and EEG, CT or MRI can help determine the functional condition of cerebral arteries and the lesion condition of brain tissue heart. 4) Migraine comorbidity: Special types of migraine such as basilar artery migraine are mostly seen in children and adolescent women, and may have symptoms of vertebrobasilar artery ischemia such as black blindness, heavy head, vertigo, tinnitus, bilateral limb numbness and weakness, fall attacks, and nystagmus. However, pulsating occipital headache, often accompanied by nausea and vomiting, often occurs 20-30 min after the appearance of visual abnormalities such as flashes, dark spots, blurred vision, and visual field defects as aura. The use of nonsteroidal anti-inflammatory analgesics, ergot preparations or the 5-hydroxytryptamine agonist sumatriptan is effective during the attacks of such diseases. In contrast, cervical spondylosis headache has no episodic characteristics, is persistently distended and often associated with the neck position. Local physical therapy massage of the neck and cerebrovascular dilating drugs are effective. 5) Hypoglycemic syncope: The energy supply required by brain cells comes almost entirely from glucose. Due to fasting, malnutrition, drugs such as hypoglycemic drugs, extra-pancreatic tumors, etc., inappropriate hyperinsulinemia is caused and blood glucose drops. Clinical symptoms similar to cervical syncope such as mental inattention, slow thinking, drowsiness, unsteady gait, and even syncope and coma may occur. While hypoglycemic attack, due to reflex glucagon secretion, symptoms of sympathetic excitation, such as sweating, palpitation, hunger, weakness, rapid heartbeat and other symptoms, when blood glucose <2.8 mmoL/L, the above symptoms improve rapidly after giving glucose orally or intravenously, can be distinguished.