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Earthquakes pose significant health challenges, including post-earthquake dizziness syndrome (PEDS), which is characterized by dizziness, vertigo, imbalance, nausea, and motion sensations. This review aimed to examine the intricate relationships between earthquake characteristics, building types, and dizziness, with a particular focus on the function of the autonomic nervous system in mediating these effects. The prevalence of PEDS varies based on earthquake magnitude, demographics, and environmental conditions, affecting 20-40 % of the population in regions such as Hokkaido, Kumamoto, Türkiye, Georgia, Fukushima, and Nepal. Its pathophysiology involves vestibular dysfunction, such as otolithic disturbances and benign paroxysmal positional vertigo; environmental instability from tilted or damaged structures; and psychological stress, which disrupts the vestibular, proprioceptive, and autonomic systems. Building dynamics influence the symptoms, with high-rise swaying, rigid low-rise jolts, and damaged structures exacerbating vestibular overload. Low-frequency quakes affect tall buildings, whereas high-frequency quakes affect rigid buildings, with aftershocks prolonging recovery. The autonomic nervous system plays a crucial role, with heightened sympathetic activity linked to dizziness and stress, thereby creating a feedback loop. Management strategies include seismic retrofitting, vestibular rehabilitation therapy, and psychological interventions such as cognitive-behavioral therapy, pharmacological treatments, and environmental adjustments to reduce sensory conflicts. Public education and preparedness are vital for minimizing panic and improving resilience, emphasizing the need for multidisciplinary approaches that combine engineering, medical, and psychological strategies to mitigate earthquake-related dizziness.