Vertigo & Balance Disorders
Use timing, triggers and neurological findings to distinguish vestibular syndromes safely.
Quick revision ↓ Medical Dictionary
01Define dizziness
Clarify whether the patient means spinning, imbalance, light-headedness or impending faint. Ask about duration, triggers, hearing symptoms, headache, medicines and vascular risk. Check observations and a relevant neurological examination. Timing and associated findings are often more useful than the word dizzy alone, and more than one mechanism can coexist.
02Positional episodes
Brief vertigo triggered by particular head positions can suggest benign paroxysmal positional vertigo. Appropriate positional testing and canalith repositioning require trained assessment and attention to contraindications. Symptoms that are continuous, associated with neurological deficits or inconsistent with the expected pattern need reassessment. Do not label all motion-sensitive dizziness as BPPV without evaluating the syndrome.
03Acute vestibular syndrome
Continuous acute vertigo with nausea, nystagmus and gait unsteadiness may arise from peripheral vestibular disease or posterior circulation stroke. Severe inability to stand, new neurological signs or other concerning findings requires an emergency pathway. HINTS is not a general dizziness test; it is used only in the appropriate syndrome by clinicians trained and experienced in it.
04Recurrent disorders
Episodes with fluctuating hearing, tinnitus and aural fullness suggest a different pattern from isolated BPPV and may raise concern for Ménière disease. Vestibular migraine is another cause of episodic vertigo. Diagnosis depends on the full clinical criteria and exclusion of alternatives, not on one symptom. Hearing assessment and specialist review may be needed.
05Recovery and safety
Short-term symptom treatment may be appropriate in selected acute disorders, but prolonged vestibular-suppressant use can impede rehabilitation and cause adverse effects. Encourage a diagnosis-specific recovery plan, falls precautions and vestibular rehabilitation when indicated. Discuss driving and work safety according to local rules. Persistent or changing symptoms require follow-up rather than indefinite symptomatic prescribing.
High-Yield Revision
- Use timing and triggers to classify dizziness.
- Posterior circulation stroke can mimic peripheral vertigo.
- HINTS requires the right syndrome and trained interpretation.
Common Pitfalls
- Using HINTS as a screening test for every dizzy patient.
- Calling all position-sensitive symptoms BPPV.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.