Dizziness

Abstract 

Dizziness is common, and approximately 1% of the population consult a GP each year for this symptom. Vertigo is more specific, and suggests a vestibular disorder. Visual and proprioceptive inputs are also important in maintaining balance. Features in the history help localize the problem. Physical examination includes assessment of hearing, eye movements, including the Halmagyi test and Hallpike positional testing and postural blood pressure. Investigations, including caloric testing or electronystagmography, may support the diagnosis. Patients benefit from an accurate diagnosis and explanation of their condition. Vestibular sedatives can be used to manage symptoms acutely but prolonged use should be avoided as these drugs delay compensation. Benign paroxysmal positional vertigo (BPPV) can be treated with particle repositioning manoeuvres. Mènière’s disease can usually be managed with a low-salt diet and diuretics, while patients with migrainous vertigo can be successfully treated with migraine prophylactic drugs. Many of these disorders remit spontaneously, but in some cases symptoms are progressive. It is appropriate to refer the patient to an audiovestibular physician or other specialist with an interest if the diagnosis is unclear, compensation fails to occur within 3 months following an acute episode, or the dizziness is associated with hearing loss, tinnitus or neurological symptoms.

Keywords: benign positional paroxysmal vertigo, dizziness, electronystagmography, Hallpike test, Ménière’s disease, migraine, neurology, peripheral vestibular dysfunction, vertigo, vestibular rehabilitation