History (recurrent vertigo)

Items from the history which are important include:

• speed on onset of vertigo
• activity at onset of vertigo
• length of attacks
• other symptoms are associated with attacks of recurrent vertigo - importantly, is there associated tinnitus or hearing loss
• any associated visual disturbance
• is the patient nauseated

These items of information will help direct the clinician to a cause of the vertigo. For example:

• benign positional vertigo - the onset of vertigo is related to a change in posture; symptoms are short-lived e.g a minute; no associated symptoms apart from possibly nausea
• migraine will be associated with symptoms associated with the disturbance of vertebro-basilar circulation - there will generally be a severe headache following the episode of vertigo
• meniere's disease - associated with hearing loss and tinnitus
• multiple sclerosis - bouts of vertigo may be longer than expected - there may be persistent nystagmus when the patient is not experiencing vertigo