How do you differentiate and manage dizziness?

From the Guidelines

Differentiating and managing dizziness requires first identifying the specific type of dizziness the patient is experiencing, with the approach beginning with distinguishing between vertigo, lightheadedness, disequilibrium, or presyncope. The most recent and highest quality study 1 provides guidance on differentiating between various causes of vertigo and dizziness, emphasizing the importance of a thorough clinical evaluation to determine the underlying cause. Key points to consider in the management of dizziness include:

• Identifying the specific type of dizziness, such as vertigo, lightheadedness, disequilibrium, or presyncope
• Distinguishing between peripheral and central causes of vertigo
• Using the Epley maneuver as the first-line treatment for benign paroxysmal positional vertigo (BPPV) 1
• Considering vestibular rehabilitation therapy for chronic dizziness, which has been shown to be highly effective in promoting habituation and balance training 1
• Managing orthostatic hypotension by addressing underlying causes, ensuring adequate hydration, and using compression stockings or medications like fludrocortisone or midodrine as needed 1
• Reviewing and adjusting medications as necessary to minimize medication-induced dizziness 1
• Educating patients on the importance of follow-up and the potential for disease recurrence, as well as providing guidance on safety measures to prevent falls 1. By prioritizing the most recent and highest quality evidence, clinicians can provide effective management and improve outcomes for patients with dizziness.

From the FDA Drug Label

May cause drowsiness: Use caution when driving a car or operating dangerous machinery ( 5. 1). Common adverse reactions are anaphylactic reaction, drowsiness, dry mouth, headache, fatigue, and vomiting.

The question asks about ways to describe dizziness, but the provided drug label for meclizine hydrochloride does not directly address dizziness. Instead, it mentions drowsiness as a potential side effect.

• Dizziness is not explicitly mentioned in the label.
• The label does discuss vertigo, which is a related but distinct condition, as meclizine hydrochloride is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2. However, dizziness and vertigo can be related and may sometimes be used interchangeably in a clinical context, but they have different meanings:
• Vertigo is a type of dizziness characterized by the sensation of spinning or feeling like the environment around you is spinning.
• Dizziness is a broader term that can encompass various symptoms, including lightheadedness, faintness, and unsteadiness.

Given the information provided in the drug label, no conclusion can be drawn about dizziness.

From the Research

Types of Dizziness

• Vertigo: a sense of false movement, often described as a rotational sensation 3, 4, 5, 6
• Presyncope: a feeling of impending faint, often caused by orthostatic hypotension or other cardiovascular issues 3, 4
• Disequilibrium: a loss of balance, often associated with neurological or musculoskeletal disorders 3, 4, 5, 6
• Lightheadedness: a vague or ill-defined sensation, often described as an inability to concentrate or focus the mind 3, 4, 5, 6

Causes of Dizziness

• Benign paroxysmal positional vertigo (BPPV): a common cause of vertigo, often triggered by head movement 3, 4, 6, 7
• Meniere's disease: a disorder of the inner ear, characterized by vertigo, hearing loss, and tinnitus 3, 4, 6, 7
• Vestibular neuritis: an inflammation of the vestibular nerve, often causing vertigo and balance problems 3, 4, 6, 7
• Orthostatic hypotension: a drop in blood pressure upon standing, often causing presyncope or lightheadedness 3, 4
• Psychiatric disorders: such as depression, anxiety, and hyperventilation syndrome, often causing lightheadedness or vague dizziness 3, 5

Diagnosis and Management

• Patient history and physical examination are crucial in diagnosing the cause of dizziness 3, 4, 5, 6
• The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies 4
• Laboratory testing and imaging are not always necessary, but may be useful in certain cases 3, 4, 5, 6
• Treatment of dizziness depends on the underlying cause, and may include canalith repositioning procedures, vestibular rehabilitation, or medication 3, 4, 7