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Taking a history from a patient with dizziness

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • the following points are important when taking a history from a patient with dizziness
  • dizziness is a highly subjective symptom
    • different patients may describe dizziness in different ways
    • objective questions must attempt to differentiate vertigo from other froms of dizziness
    • clues as to the different types of dizzines should be looked for in the history (1)
      • vertigo
        • do you get the feeling of rotation?
        • does the surroundings spin around?
        • is there a tendency to fall to one side?
      • dysequilibrium
        • are you having a feeling of unsteadiness?
      • presyncope
        • do you feel faintish?
      • lightheadedness
        • do you feel lightheaded?
  • onset and duration of the symptoms: (2)
    • provide information concerning the likely pathological processes
      • causes of episode lasting only a few seconds include:
        • peripheral cause like
          • unilateral loss of vestibular function, acute vestibular neuronitis, Meniere's disease
      • causes of episodes lasting for several seconds to a few minutes include:
        • benign paroxysmal positional vertigo, perilymphatic fistula
      • causes of episodes lasting for several minutes to one hour include:
        • transient ischemic attack, perilymphatic fistula
      • causes of episodes lasting for several hours include
        • Meniere's disease, perilymphatic fistula, migraine, acoustic neuroma
      • causes of episodes lasting for days include
        • early acute vestibular neuronitis, CVA, migraine, multiple sclerosis
  • precipitating factors (2)
    • causes precipitating spontaneous episodes are
      • acute vestibular neuronitis; cerebrovascular disease, Meniere's disease,migraine, multiple sclerosis
    • changes in position of the head
      • acute labyrinthitis,benign positional paroxysmal vertigo,perilymphatic fistula cerebellopontine angle tumor,multiple sclerosis
    • standing up - suggesting of postural hypotension
  • associated symptoms, including:
    • deafness
    • tinnitus
    • otalgia
    • a feeling of fullness in the ear
    • discharge from the ear
    • neurological symptoms
  • any other medical problems:
    • vascular disease
    • multiple sclerosis
    • drug history, especially ototoxic drugs
    • cardiac disease, especially arrhythmias


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