What is the most common cause of long-term dizziness?

Most Common Cause of Long-Term Dizziness

Anxiety or panic disorder is the most common cause of long-term (chronic) dizziness, followed by medication side effects and posttraumatic vertigo. 1

Understanding Chronic Dizziness

When evaluating causes of dizziness, it's important to categorize based on timing and triggers:

1. Acute Vestibular Syndrome: Continuous dizziness lasting days to weeks with nausea, vomiting, and head motion intolerance
2. Triggered Episodic Vestibular Syndrome: Brief episodes triggered by specific actions (like position changes)
3. Spontaneous Episodic Vestibular Syndrome: Untriggered episodes lasting minutes to hours
4. Chronic Vestibular Syndrome: Dizziness lasting weeks to months or longer

For long-term dizziness specifically (chronic vestibular syndrome), the most common causes in order of frequency are:

• Anxiety or panic disorder
• Medication side effects
• Posttraumatic vertigo
• Posterior fossa mass lesions
• Cervicogenic vertigo

Differentiating from Other Common Causes of Dizziness

While Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo overall 1, 2, 3, it typically presents as brief episodes (seconds to minutes) triggered by position changes, not as chronic dizziness.

Key differences between BPPV and chronic causes:

• BPPV episodes are brief (typically <1 minute)
• BPPV is triggered by specific head movements
• BPPV is not associated with hearing loss, tinnitus, or aural fullness 1
• BPPV can be diagnosed with specific positional tests (Dix-Hallpike, supine roll)

Diagnostic Approach for Long-Term Dizziness

When evaluating chronic dizziness:

1. Medication review: Identify potentially vestibulotoxic medications or those with dizziness as a side effect
2. Psychiatric assessment: Screen for anxiety disorders, panic disorder, and depression
3. Neurologic evaluation: Look for signs of posterior fossa lesions or other central causes
4. Cervical spine assessment: Evaluate for cervicogenic causes
5. History of trauma: Determine if there was previous head/neck trauma

Warning Signs Requiring Further Investigation

Be vigilant for these red flags that may indicate a more serious central cause:

• Downbeating nystagmus without torsional component
• Direction-changing nystagmus without changes in head position
• Baseline nystagmus without provocative maneuvers
• Associated neurological symptoms
• Failure to respond to appropriate treatment 1

Important Clinical Pitfalls

1. Misdiagnosis risk: Central causes of dizziness (like cerebellar tumors) can mimic peripheral vestibular disorders in 12-20% of cases 4
2. Terminology confusion: Patients often use "dizziness" to describe various sensations (vertigo, lightheadedness, disequilibrium)
3. Recurrence patterns: Even properly treated vestibular conditions like BPPV can recur (26%) or persist (4%) 5
4. Underdiagnosis: Despite being common, vestibular disorders are frequently underdiagnosed or misdiagnosed 6

For chronic dizziness specifically, always consider anxiety and medication side effects first, as these represent the most common causes of truly long-term dizziness symptoms.