From the Guidelines
When evaluating a patient with dizziness, it is crucial to ask specific history questions to characterize the symptoms and identify potential causes, focusing on the exact sensation experienced, onset, duration, frequency, triggers, and associated symptoms, as recommended by the most recent guidelines 1.
Key History Questions
To evaluate a patient with dizziness effectively, the following key history questions should be asked:
- The exact sensation experienced (vertigo/spinning, lightheadedness, imbalance, or near-fainting)
- Onset timing, duration of episodes, and frequency
- Triggers such as position changes, head movements, or specific situations
- Associated symptoms like hearing loss, tinnitus, ear fullness, headache, nausea, vomiting, visual disturbances, or neurological symptoms
- Complete medication history, as many drugs can cause dizziness
- Past medical history for conditions affecting the inner ear, cardiovascular system, or neurological function
- Recent infections, trauma, or surgeries
- Family history of similar symptoms or relevant conditions
- Recent lifestyle changes, stress levels, sleep patterns, and alcohol consumption
Importance of Characterizing Symptoms
Characterizing the symptoms is essential to distinguish between peripheral vestibular disorders (like BPPV or Meniere's disease), central nervous system issues, cardiovascular problems, or medication side effects, guiding appropriate diagnostic testing and management strategies, as noted in the guidelines for benign paroxysmal positional vertigo (BPPV) 1.
Diagnostic Approach
The diagnostic approach should be based on the patient's history and physical examination, with additional testing reserved for cases where the diagnosis is unclear or atypical symptoms are present, as recommended by the guidelines 1.
Recent Guidelines
Recent guidelines emphasize the importance of a thorough history and physical examination in diagnosing and managing dizziness, with a focus on identifying the underlying cause and developing an appropriate treatment plan 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
History Questions for Evaluating Dizziness (Vertigo)
When evaluating a patient with dizziness (vertigo), several history questions can help determine the underlying cause. These questions include:
- Timing of the events: When did the dizziness start, and how long does it last? 2, 3
- Triggers of dizziness: Are there any specific actions or movements that trigger the dizziness? 2, 3
- Quality of symptoms: Although patients may have difficulty describing the quality of their symptoms, it is still important to ask about the characteristics of the dizziness, such as whether it is constant or episodic. 2, 3
- Associated symptoms: Are there any other symptoms associated with the dizziness, such as hearing loss, tinnitus, or nausea? 2, 4
Specific Questions for Common Causes of Vertigo
Some specific questions can help identify common causes of vertigo, including:
- Benign paroxysmal positional vertigo (BPPV): Is the dizziness triggered by head motion or changes in position? 2, 3
- Meniere disease: Is the dizziness associated with unilateral hearing loss or tinnitus? 2
- Vestibular neuritis: Is the dizziness episodic and not associated with any specific trigger? 2
- Vestibular migraine: Is the dizziness associated with headache, sensitivity to light or sound, or other migraine symptoms? 5
Importance of History Questions
The history questions are essential in evaluating patients with dizziness (vertigo) because they can help: