What is the history of present illness (HPI) for a patient experiencing vertigo (dizziness)?

From the Guidelines

A comprehensive History of Present Illness (HPI) for a patient experiencing vertigo should include the onset, duration, character, aggravating and alleviating factors, associated symptoms, and impact on daily activities, as outlined in the clinical practice guideline for Ménière's disease 1. When evaluating a patient with vertigo, it is crucial to document the specifics of their symptoms to differentiate between various potential causes.

• The onset and duration of vertigo episodes should be noted, including whether the episodes are sudden or gradual and how long they last, typically between 20 minutes to 24 hours as seen in Ménière's disease 1.
• Characterizing the sensation precisely is vital; vertigo is described as a spinning sensation, which can be due to vestibular or nonvestibular causes 1.
• The frequency of episodes and any patterns or triggers, such as positional changes or specific movements, should be documented.
• Associated symptoms like fluctuating hearing loss, tinnitus (ringing, buzzing, or other noises in the ear), ear fullness, nausea, vomiting, headache, or visual disturbances should be noted, as these can be indicative of Ménière's disease or other inner ear disorders 1.
• It's also important to ask about recent illnesses, medication changes, trauma, or stress, as these can contribute to or exacerbate vertigo.
• Assessing how the vertigo affects daily functioning, work, and quality of life is essential for understanding the impact of the condition on the patient and for guiding appropriate management and treatment decisions. The vestibular system, which includes the inner ear and vestibular pathways in the brain, plays a critical role in balance, coordination, and posture maintenance, and its dysfunction can lead to vertigo 1. By taking a detailed and comprehensive HPI, healthcare providers can better distinguish between peripheral causes like Ménière's disease, central causes, cardiovascular causes, or other etiologies, and thus guide an appropriate diagnostic workup and management plan.

From the FDA Drug Label

MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).

The FDA drug label does not answer the question.

From the Research

History of Present Illness (HPI) for Vertigo

The HPI for a patient experiencing vertigo (dizziness) involves a detailed account of the patient's symptoms, including the onset, duration, and exacerbating and alleviating factors 2. The patient's history is crucial in determining whether the cause is vertigo or another condition, such as orthostatic hypotension 3.

Key Components of HPI

• Onset: When did the symptoms start? 4
• Duration: How long do the symptoms last? 5
• Exacerbating and alleviating factors: What triggers or relieves the symptoms? 2
• Timing and triggers: Are the symptoms continuous or episodic? Are they triggered by head motion or other factors? 5, 4
• Associated symptoms: Are there any accompanying symptoms, such as unilateral hearing loss, aural fullness, or tinnitus? 2

Classification of Vertigo

The patient's symptoms can be classified as:

• Episodic vertigo triggered by head motion, which may be due to benign paroxysmal positional vertigo 5
• Vertigo with unilateral hearing loss, which suggests Meniere disease 5
• Episodic vertigo not associated with any trigger, which may be a symptom of vestibular neuritis 5
• Continuous or episodic symptoms, which can be further characterized using a timing-and-triggers approach 4