From the Guidelines
The history of present illness for a patient with vertigo should include onset, duration, frequency, and triggers, as well as associated symptoms such as nausea, vomiting, hearing loss, tinnitus, and fullness in the ear, to distinguish between peripheral and central causes of vertigo. When evaluating a patient with vertigo, it's essential to document the character of vertigo, whether it's a spinning sensation (rotatory) or a feeling of imbalance, and to note exacerbating and alleviating factors, along with the impact on daily activities and any previous episodes or treatments 1. The timing of symptoms in relation to medications, recent illnesses, or trauma is also important, as it can help identify potential causes of vertigo, such as Meniere's disease, benign paroxysmal positional vertigo (BPPV), or vestibular neuritis 1.
Some key components to include in the history of present illness for a patient with vertigo are:
- Onset: sudden or gradual
- Duration: seconds, minutes, hours, or days
- Frequency: single episode or recurrent
- Triggers: positional changes, head movements, or spontaneous
- Associated symptoms: nausea, vomiting, hearing loss, tinnitus, fullness in the ear, headache, visual disturbances, or neurological symptoms like weakness, numbness, or speech difficulties
- Character of vertigo: spinning sensation (rotatory) or feeling of imbalance
- Exacerbating and alleviating factors
- Impact on daily activities and any previous episodes or treatments
- Timing of symptoms in relation to medications, recent illnesses, or trauma
It's also important to consider the patient's medical and surgical history, including any prior ear surgery, otorrhea/chronic ear infections, otalgia, or prior hearing loss, as well as any neurologic history, ongoing headaches, or facial numbness that may be consistent with central nervous system pathology 1. By taking a thorough history, clinicians can provide crucial clues to the underlying etiology of vertigo and determine whether urgent neuroimaging is needed to rule out serious central nervous system pathology. Additionally, patient education and counseling are essential in managing vertigo, particularly in patients with BPPV, to reduce the risk of falls and improve overall outcomes 1.
From the Research
Components of History of Present Illness for a Patient with Vertigo
When taking the history of present illness for a patient with vertigo, several key components should be included to help determine the underlying cause and guide further evaluation and treatment. These components include:
- Timing and duration of symptoms: When did the vertigo start, and how long does it last? 2
- Provoking factors: Are there any specific actions or positions that trigger or worsen the vertigo? 3, 2
- Associated signs and symptoms: Are there any other symptoms accompanying the vertigo, such as nausea, vomiting, headache, or hearing loss? 4, 5
- Character of the vertigo: Is the vertigo rotatory, or does the patient feel like they are being pulled to one side? 3
- Triggers: Are there any specific triggers that bring on the vertigo, such as changes in position or movement? 3, 6
- Severity of symptoms: How severe are the symptoms, and do they interfere with daily activities? 5
- Past medical history: Has the patient had any previous episodes of vertigo or other conditions that may be related to the current symptoms? 5
- Family history: Is there a family history of migraine, vertigo, or other conditions that may be relevant to the patient's symptoms? 5
Additional Considerations
In addition to these components, it is also important to consider the patient's overall clinical presentation and any potential red flags that may indicate a more serious underlying condition. These may include:
- Associated neurologic signs and symptoms: Are there any other neurologic symptoms, such as weakness, numbness, or difficulty with coordination and balance? 2
- Vascular risk factors: Does the patient have any risk factors for vascular disease, such as hypertension, diabetes, or smoking? 6
- History of trauma: Has the patient experienced any recent trauma or injury that may be related to the vertigo? 2