Dizziness

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History

• Age
• Character of symptoms (e.g. hallucination of movement, light headedness, unsteadiness)
• Time course e.g. sudden onset, short lasting, long lasting, recurring.
• Any other associated symptoms e.g. hearing loss, tinnitus, blackouts, visual disturbance, palpitations, falls.
• Precipitating factors/provocation e.g. head movements, standing up quickly.

Examination

Otoscopy
• Eye movements
• Examination of cranial nerves
• Cerebellar tests
• Rhomberg's Test
• Blood Pressure – if postural symptoms take lying and standing blood pressure

Vestibular neuronitis / “Labyrinthitis” (very severe vertigo with nystagmus +/- nausea and vomiting)

Acute symptoms usually last 24-36 hours and can be treated with short term anti-emetics. On-going sensation of imbalance may last 2 to 3 months. Gradual mobilization should be encouraged and medication avoided if possible as may slow rehabilitation.

Treatment : Symptomatic relief and mobilize as able.

If no subjective improvement after this time, consider referral to ENT for triage

Benign Paroxysmal Positional Vertigo (positional vertigo provoked by Hallpike Manoeuvre)
Manage by Repositioning techniques, Epley manoeuvre. Mild “positional” vertigo may occur in relation to degenerative change of the cervical spine

If necessary, refer to ENT for triage

Management: Migraine (recurrent vertigo associated with headache)

Consider migraine and try anti-migrainous treatment

Chronic imbalance (ongoing mild dizziness)

There is no specific drug therapy.
Consider anxiety/stress management.
Consider multifactorial dysequilibrium of the elderly.

If required, refer for confirmation of diagnosis and reinforcement of management plan

Meniere’s Disease (recurrent, episodic, severe vertigo associated with simultaneous hearing loss and tinnitus)

Lifestyle measures:

  • Salt and caffeine restriction
  • Weight loss
  • Stress/anxiety management

Drug therapy includes:

  • Prochlorperazine or cinnarizine for acute vertigo
  • Betahistine or low dose diuretic to induce and maintain remission.

If no response, consider referral to ENT for triage

Editorial Information

Last reviewed: 30 November 2015

Next review: 30 November 2017

Version: 2

Approved By: high-uhb.tam@nhs.net

Reviewer Name(s): Mr Angus Cain