What are the recommended treatments and precautions for a patient experiencing sudden onset of dizziness (giddiness)?

Immediate Assessment and Management of Sudden Dizziness

You need an urgent clinical evaluation to distinguish between benign causes like BPPV and dangerous central causes like stroke—do not simply take medication without proper diagnosis, as this could mask a serious condition. 1

Critical First Steps: Rule Out Stroke

Your age and the sudden onset of dizziness require immediate assessment for stroke, which can present as isolated dizziness in up to 80% of cases without other neurological symptoms. 1

Key warning signs that require emergency evaluation: 1

• Sudden onset of continuous dizziness lasting more than minutes
• Associated headache, double vision, or difficulty walking
• Any numbness, weakness, or speech changes
• Severe imbalance or inability to walk

If you have any of these features, seek emergency care immediately—do not wait. 1

Determining the Cause Through Timing and Triggers

The specific pattern of your dizziness determines both the cause and treatment:

Duration of episodes: 1, 2

• Seconds to 1 minute: Likely BPPV (benign positional vertigo)—the most common cause
• Minutes to hours: Consider vestibular migraine or stroke/TIA
• Continuous for days: Suggests vestibular neuritis or central cause

Triggering factors: 1, 2

• Triggered by rolling over in bed, looking up, or bending down: Strongly suggests BPPV
• Triggered by standing up: Consider orthostatic hypotension (especially if on blood pressure medications)
• No clear trigger: Requires broader evaluation including stroke assessment

Essential Physical Examination

You need a healthcare provider to perform: 1, 2

Dix-Hallpike maneuver: This single test diagnoses BPPV with high accuracy and should be performed immediately if positional triggers are present. 1, 3

HINTS examination (Head Impulse, Nystagmus, Test of Skew): This has 100% sensitivity for detecting stroke when properly performed—far superior to early MRI (only 46% sensitivity). 1 This examination is critical and cannot be skipped in sudden-onset dizziness.

Orthostatic vital signs: Check blood pressure lying and standing to identify orthostatic hypotension, which commonly causes dizziness. 2, 4

Treatment Based on Diagnosis

If BPPV is Diagnosed (Positive Dix-Hallpike Test)

The Epley maneuver (canalith repositioning) is the definitive treatment with 80% success rate after 1-3 treatments. 5, 1 This is a physical procedure performed by a healthcare provider, not a medication.

Do not take meclizine or other vestibular suppressants as primary treatment for BPPV—they are ineffective and delay recovery. 5, 6 The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against routine medication treatment for BPPV. 5

Meclizine should only be considered for: 5, 6

• Severe nausea/vomiting during the repositioning procedure
• Patients who refuse the Epley maneuver
• Short-term use only (not ongoing treatment)

If Vestibular Neuritis or Other Peripheral Causes

Vestibular suppressants like meclizine (25-100 mg daily) may be used for short-term symptom relief (3-5 days maximum), but should be stopped as soon as possible to allow your brain to compensate. 5, 7 Prolonged use interferes with natural recovery mechanisms. 6

Vestibular rehabilitation therapy is the definitive treatment and promotes long-term recovery better than medications. 5, 8

If Orthostatic Hypotension

Review all medications that lower blood pressure, ensure adequate hydration, and consider medication adjustments with your physician. 2, 4

Critical Warnings About Medication Use

Meclizine and similar drugs cause significant risks: 5, 6, 7

• Drowsiness and cognitive impairment that interfere with driving and daily activities
• Increased fall risk, especially dangerous at your age
• Anticholinergic side effects: dry mouth, blurred vision, urinary retention, confusion
• Delayed recovery by preventing your brain's natural compensation

Never assume medications are safe to take without proper diagnosis—you could be masking a stroke or other serious condition. 1

What You Should Do Right Now

Immediate actions: 1

1. Seek medical evaluation today or tomorrow if symptoms are new or worsening
2. Go to emergency department immediately if you have severe continuous dizziness, inability to walk, headache, or any neurological symptoms
3. Avoid driving or operating machinery until evaluated and symptoms resolve
4. Implement fall precautions at home—remove tripping hazards, use handrails, avoid sudden position changes

Do not self-treat with over-the-counter medications before proper diagnosis. 5, 1

Follow-Up Requirements

You must be reassessed within 1 month to document whether symptoms have resolved or persisted, and to adjust treatment accordingly. 5, 1 Many causes of dizziness require ongoing management or rehabilitation rather than medication alone.