Is Dizziness a Medical Diagnosis?
No, dizziness is not a medical diagnosis—it is a symptom that requires further characterization into specific vestibular syndromes or underlying pathologies to guide appropriate evaluation and treatment. 1
Why Dizziness Is Not a Diagnosis
Dizziness functions as a presenting complaint, not a final diagnosis, because it encompasses multiple distinct clinical entities with vastly different causes, prognoses, and treatments. 2 The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that taking a history focused on timing and triggers is more important than the specific descriptor patients use, as patients have difficulty accurately describing their symptoms. 1, 2
In emergency department settings, nearly half of patients presenting with dizziness receive a medical diagnosis that is nonvestibular and nonneurologic, while only one-third receive a vestibular-related diagnosis. 1 This demonstrates that "dizziness" serves as an entry point requiring systematic evaluation rather than representing a discrete diagnostic entity.
The Proper Diagnostic Framework
Categorize by Timing and Triggers
Rather than accepting "dizziness" as a diagnosis, clinicians must classify presentations into one of four distinct vestibular syndromes based on timing and triggers: 1, 3
Triggered episodic vestibular syndrome: Episodes lasting seconds to minutes triggered by specific head or body position changes (e.g., BPPV, superior canal dehiscence) 1, 3
Spontaneous episodic vestibular syndrome: Episodes lasting minutes to hours without specific triggers (e.g., vestibular migraine, Ménière's disease, posterior circulation TIA) 1, 3
Acute vestibular syndrome: Acute persistent continuous dizziness lasting days to weeks with nausea, vomiting, and intolerance to head motion (e.g., vestibular neuritis, labyrinthitis, posterior circulation stroke) 1, 3
Chronic vestibular syndrome: Dizziness lasting weeks to months or longer (e.g., anxiety/panic disorder, medication side effects, posttraumatic vertigo) 1, 3
Distinguish True Vertigo from Non-Vertiginous Dizziness
The distinction between vertigo (false sensation of self-motion or spinning) and non-vertiginous dizziness (disturbed spatial orientation without false sense of motion) matters because vertigo indicates vestibular system pathology, while non-vertiginous dizziness suggests cardiovascular, metabolic, psychiatric, or other non-vestibular causes. 2
Common Pitfall to Avoid
Do not rely on the patient's description of "spinning" versus "lightheadedness"—instead focus on timing and triggers to categorize the vestibular syndrome. 4, 3 The American College of Radiology explicitly warns against this outdated approach, as patients cannot reliably characterize their symptom quality. 4
Clinical Implications
Each vestibular syndrome category has its own differential diagnosis requiring specific evaluation approaches. 1 For example, BPPV (triggered episodic vestibular syndrome) requires Dix-Hallpike testing and responds to canalith repositioning procedures, 3 while acute vestibular syndrome requires HINTS examination to differentiate vestibular neuritis from posterior circulation stroke. 4, 3
Approximately 10-20% of patients with dizziness elude a final diagnosis even after thorough evaluation, 5, 6 but this reflects the complexity of the symptom rather than justifying "dizziness" as an acceptable diagnostic endpoint.