An approach to the dizzy patient

Dizziness is common, yet it is a complaint that causes anxiety for both the patient and doctor. A diagnosis can usually be made clinically on the basis of the history and examination and, contrary to popular belief, almost all patients can be cured or helped substantially.

Key Points

With a careful history and examination, a diagnosis can be made for most patients with vertigo. Key points of the examination include the head impulse test and the Dix-Hallpike test.
Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness. Most cases eventually remit spontaneously, but treatment with particle repositioning manoeuvres is very effective.
Migraine-related vertigo is an underdiagnosed cause of recurrent vertigo without auditory symptoms, especially in young patients who are otherwise healthy.
Remember that although panic attacks can certainly cause dizziness, all patients with organic vertigo experience some degree of anxiety. Reassurance and a clear explanation go a long way in treating the anxiety component.
The patient with a single severe attack of vertigo should not be diagnosed with ‘a middle ear infection’. Middle ear pathology without a lesion of the inner ear never causes dizziness; the patient might have had a cerebellar infarct or haemorrhage.

Monday 6 July 2026

An approach to the dizzy patient

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