From the Guidelines
Evaluation for Vertigo
Vertigo evaluation should start with a thorough medical history and physical examination to identify potential underlying causes, as suggested by 1. The patient should be asked about the duration, severity, and triggers of vertigo episodes, as well as any associated symptoms such as nausea, vomiting, or hearing loss.
Initial Diagnostic Tests
Initial diagnostic tests may include:
- Dix-Hallpike maneuver to assess for benign paroxysmal positional vertigo (BPPV) 1
- Head impulse test to evaluate vestibular function
- Electronystagmography (ENG) or videonystagmography (VNG) to assess eye movements and vestibular function
- Audiometry to evaluate hearing loss
Treatment
Treatment for vertigo depends on the underlying cause. For BPPV, the Epley maneuver or canalith repositioning procedure may be effective, as noted in 1. For other causes, medication such as meclizine (25-50 mg orally every 4-6 hours) or ondansetron (4-8 mg orally every 4-6 hours) may be prescribed to alleviate symptoms.
Vestibular Rehabilitation Therapy (VRT)
In some cases, vestibular rehabilitation therapy (VRT) may be recommended to help improve balance and reduce vertigo symptoms, as mentioned in 1. This typically involves a series of exercises and maneuvers tailored to the individual patient's needs, and may be performed over a period of several weeks or months.
Serious Underlying Conditions
It is essential to note that vertigo can be a symptom of a more serious underlying condition, such as a stroke or brain tumor, and patients with severe or persistent vertigo should be evaluated promptly and thoroughly to rule out these possibilities, as emphasized in 1.
From the Research
Evaluation of Vertigo
The evaluation of vertigo involves a stepwise approach to determine the underlying cause, which can be either peripheral or central in origin.
- The initial evaluation includes a detailed patient history to determine the timing and duration of symptoms, provoking factors, and associated signs and symptoms 2, 3, 4.
- The physical examination is crucial in evaluating vertigo, with a focus on the head and neck, neurologic systems, and special tests such as the Dix-Hallpike maneuver 2, 4, 5.
- The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies 4.
- Laboratory testing and imaging are not always required, but may be necessary in cases where central etiologies are suspected or when vertigo is persistent or atypical 2, 3, 4, 5.
Diagnostic Considerations
- Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Meniere's disease are common causes of peripheral vertigo 2, 4.
- Central vertigo should be suspected in the presence of neurological symptoms, in older patients, or when several risk factors for cerebrovascular disease are present 2, 5.
- The diagnosis of vertigo can often be accurately determined in a primary care setting using a stepwise algorithmic approach 3.
- Referral to a specialist should be considered when significant central disease is suspected or when vertigo of peripheral origin is persistent or atypical 3.