Differential Diagnosis for Dizziness Worse When Head is Looking Down
- Single most likely diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, including looking down. The symptoms are due to the movement of otolith crystals in the inner ear.
- Other Likely diagnoses
- Cervicogenic Dizziness: This condition is caused by neck pain or dysfunction, which can lead to dizziness when moving the head, including looking down. The exact mechanism is not fully understood but may involve proprioceptive input from the neck.
- Orthostatic Hypotension: Although not exclusively related to head position, orthostatic hypotension can cause dizziness when standing up or changing positions, which might be exacerbated by looking down due to decreased blood flow to the brain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vertebral Artery Dissection or Stroke: Although rare, a vertebral artery dissection can cause vertigo and is a medical emergency. The dissection can be triggered by neck movements, including looking down.
- Multiple Sclerosis: This condition can cause a wide range of neurological symptoms, including vertigo, which might be exacerbated by certain head positions. Early diagnosis is crucial for effective management.
- Rare diagnoses
- Meniere's Disease: This inner ear disorder can cause vertigo, but it is typically associated with hearing loss, tinnitus, and ear fullness. The vertigo episodes are usually not specifically triggered by looking down.
- Vestibular Migraine: Some patients with migraines can experience vertigo, which might be triggered by various factors, including visual or positional stimuli. However, looking down as a specific trigger is less common.