Dizziness with or without associated neurologic symptoms is the most common symptom of posterior circulation transient ischemic attack (TIA) and can be more frequent before posterior circulation strokes. This entity carries a high risk of recurrent events and should be considered as a potential cause of spontaneous episodic vestibular syndrome. Diagnostic evaluation should include intracranial and extracranial imaging of the vertebral arteries and basilar artery. Aggressive medical management with antiplatelet therapy, statin use, and risk factor modification is the mainstay of treatment. This article highlights the importance of diagnosing, evaluating, and treating posterior circulation TIAs manifesting as dizziness or vertigo.