Distinguishing Light-Headedness from Vertigo
Light-headedness and vertigo are fundamentally different sensations: vertigo is a false sensation of self-motion or spinning of the visual surroundings indicating vestibular system dysfunction, while light-headedness is a non-specific sensation of disturbed spatial orientation without rotational movement, typically suggesting cardiovascular, metabolic, or psychiatric causes rather than vestibular pathology. 1
Core Definitions
Vertigo represents true vestibular dysfunction and is defined as:
- A false sensation that you or the room is spinning or rotating 1
- An illusory perception of self-motion or object-motion 2
- Often accompanied by nausea, vomiting, and intolerance to head motion 3
- Never associated with loss of consciousness 1
Light-headedness is characterized by:
- A vague sensation of giddiness, faintness, or feeling "woozy" without rotational movement 4, 5
- May indicate impending syncope (presyncope) 6
- Suggests cardiovascular causes like orthostatic hypotension or medication side effects 3
- Can reflect metabolic disturbances or psychiatric conditions 1
Clinical Significance of the Distinction
The distinction matters because vertigo indicates vestibular system pathology (either peripheral ear/vestibular apparatus or central brainstem/cerebellar), while non-vertiginous dizziness suggests cardiovascular, metabolic, psychiatric, or other non-vestibular causes. 1
Peripheral vestibular causes of vertigo include:
- Benign paroxysmal positional vertigo (BPPV) - 42% of all vertigo cases 3
- Vestibular neuritis - 41% of peripheral vertigo 3
- Ménière's disease with fluctuating hearing loss 7
Central causes of vertigo include:
- Posterior circulation stroke - 25% of acute vestibular syndrome cases 3
- Vestibular migraine - 14% of all vertigo cases 7
- Vertebrobasilar insufficiency 7
Light-headedness typically suggests:
- Orthostatic hypotension 6
- Medication side effects (antihypertensives, sedatives, cardiovascular drugs) 7, 3
- Cardiac arrhythmias or decreased cardiac output 6
- Anxiety, panic disorder, or hyperventilation 7
- Metabolic disturbances including hypoglycemia 3
Practical Clinical Approach
Rather than relying on patients' subjective descriptions of "dizziness," focus on timing, duration, and triggers, as patients have difficulty accurately describing symptom quality. 3, 1, 6
Key questions to clarify vertigo:
- "Do you feel like you or the room is spinning?" 1
- What is the duration of spinning episodes? (seconds suggest BPPV, minutes to hours suggest vestibular migraine or Ménière's, days to weeks suggest vestibular neuritis or stroke) 3
- Are there specific triggers like head position changes? 3
- Any associated hearing loss, tinnitus, or aural fullness? 7, 3
Key questions to identify light-headedness:
- Does standing up trigger the sensation? (suggests orthostatic hypotension) 3
- Any feeling of impending faint or blackout? (suggests presyncope) 4
- Review all medications, particularly antihypertensives and sedatives 7, 3
- Any palpitations or chest discomfort? (suggests cardiac etiology) 6
Common Pitfalls to Avoid
Do not rely solely on the patient's use of terms like "dizzy" or "spinning" - patients use these terms inconsistently and cannot reliably distinguish between vertigo and light-headedness based on their descriptions alone 3, 1, 6
Recognize that panic disorder and anxiety can mimic both vertigo and light-headedness - these conditions may produce vestibular dysfunction in addition to hyperventilation-related symptoms 7
Light-headedness never causes true rotational vertigo - if a patient describes spinning, this indicates vestibular pathology regardless of how they initially labeled their symptoms 1, 2
Loss of consciousness never occurs with vestibular disorders - if syncope occurred, the etiology is not vestibular even if the patient describes "dizziness" beforehand 1