Dizziness and Vertigo

People use dizziness to describe several experiences, including spinning, faintness and unsteadiness. These descriptions can overlap and may change during one illness. New neurological symptoms, severe imbalance or collapse can require emergency assessment.

Dizziness is an umbrella term Dizziness can mean vertigo, light headedness, feeling close to fainting, imbalance or a less specific altered sensation. The medical term for feeling close to fainting is presyncope. Vertigo is a false sensation that you or your surroundings are moving. It often feels like spinning, but some people describe tilting, swaying or being pulled. The way dizziness feels is useful, but it does not reliably identify one body system. People may struggle to classify the sensation, and several causes can produce overlapping descriptions. Timing and triggers often provide stronger clues Clinicians ask when the dizziness began, how long each episode lasts and whether it is continuous or episodic. They also ask whether anything clearly triggers an episode. Triggered episodic dizziness consists of brief attacks brought on by a specific action. Rolling in bed may suggest benign paroxysmal positional vertigo, while standing may suggest postural hypotension. Head movement can worsen many causes of vertigo. BPPV is more specifically triggered by particular position changes and usually settles within a short time when the head is still. Spontaneous episodic dizziness comes in attacks without one reliable immediate trigger. Possible causes include vestibular migraine, Ménière's disease, an intermittent heart rhythm problem and, less commonly, a transient ischaemic attack. Continuous dizziness that begins suddenly and lasts for hours or days needs a different assessment. Vestibular neuritis, labyrinthitis and posterior circulation stroke can produce this pattern. Associated symptoms change the assessment Clinicians ask about double vision, vision loss, weakness, numbness, speech or swallowing difficulty, severe headache and new trouble walking. These features can indicate a neurological emergency. Sudden dizziness without imbalance or another focal neurological sign is less likely to reflect a serious neurological condition. Other medical causes can still require assessment. Hearing loss, tinnitus or pressure in one ear can support an inner ear cause. Sudden hearing loss still requires immediate specialist or emergency assessment because prompt treatment may protect hearing. Palpitations, chest discomfort, breathlessness, bleeding, dehydration or fainting shift attention towards circulation, heart rhythm or another general medical cause. Medicines, alcohol, infection, migraine, anxiety and low blood sugar can also contribute. Dizziness and imbalance are often multifactorial, especially in older adults. Vision, sensation in the feet, muscle strength, medicines and the balance system may all contribute together. Common positional vertigo Benign paroxysmal positional vertigo is usually shortened to BPPV. It occurs when tiny calcium particles, called otoconia, move into a semicircular canal within the inner ear. BPPV causes brief vertigo after particular head movements, such as rolling in bed or looking upwards. Hearing loss and continuous severe dizziness are not typical features. A trained healthcare professional may perform the Hallpike manoeuvre. A characteristic combination of vertigo and nystagmus can establish posterior canal BPPV in the appropriate clinical pattern. Nystagmus means involuntary rhythmic eye movement. Its direction and behaviour provide clues, but nystagmus should not be interpreted without the complete examination. A trained professional can offer a canalith repositioning manoeuvre, such as the Epley manoeuvre, after BPPV is diagnosed. They first check whether the movement is safe for the person's neck and back. It helps many people, although symptoms may not disappear immediately and treatment may need repeating. Other vestibular patterns Vestibular neuritis usually causes sudden, continuous vertigo, nausea and unsteadiness without new hearing loss. Labyrinthitis can cause a similar pattern with hearing loss or tinnitus. Ménière's disease is a rare inner ear condition causing repeated vertigo with fluctuating hearing loss, tinnitus or pressure in the ear. These symptoms do not confirm the condition by themselves. Vestibular migraine can cause episodes of dizziness or vertigo lasting from minutes to days. NICE advises considering it when episodes last five minutes to seventy two hours and recurrent headache is part of what has happened. Faintness and postural symptoms Presyncope may feel like greying vision, weakness, warmth or an expectation of passing out. It does not identify the underlying cause. Postural hypotension is a fall in blood pressure after standing. Dehydration, medicines, prolonged bed rest, pregnancy and several medical conditions can contribute. A clinician may measure blood pressure and pulse after lying down and again after standing. A significant change supports postural hypotension, but it does not explain every symptom automatically. An ECG records the heart's electrical activity during the test. It can identify some rhythm problems, while a normal ECG does not exclude an intermittent arrhythmia. Examination must match the dizziness pattern A clinician checks eye movements, hearing, speech, limb strength, sensation, coordination and walking. They also assess pulse, blood pressure, hydration and relevant medicine use. For sudden continuous vertigo with nausea or vomiting and gait unsteadiness, clinicians call the pattern an acute vestibular syndrome. Stroke can resemble an inner ear disorder in this setting. The HINTS examination combines three specialised eye movement tests. NICE recommends it only when a healthcare professional with training and experience is available. HINTS is not a home test and is not designed for every dizzy person. It is inappropriate for brief positional attacks or people without the required acute vestibular pattern. When trained HINTS assessment is unavailable, NICE recommends immediate stroke pathway referral for unexplained acute vestibular syndrome. A routine non contrast CT scan cannot reliably exclude every posterior circulation stroke. Tests answer different questions Typical BPPV often needs no brain scan when the symptom pattern and Hallpike findings fit. Imaging is selected when the pattern, examination or risk raises concern about another cause. Blood tests may check glucose, anaemia, infection or another suspected problem. Hearing tests, ECG monitoring or brain and blood vessel imaging are used when they answer a specific clinical question. A normal test does not erase a concerning symptom pattern. Clinicians interpret each result with symptom timing, triggers, examination findings and how the condition changes. What may happen after assessment Brief positional vertigo may be assessed and treated with a repositioning manoeuvre. Recurrent or persistent dizziness may need GP, audiology, vestibular, cardiology or neurological assessment. Avoid driving, climbing ladders or using machinery while dizzy. Sit or lie down if needed, move carefully and seek help according to the associated features. When to get help Call 999 now if dizziness or vertigo occurs with facial droop, arm weakness or speech difficulty. Call even if the symptoms improve or stop. Also call 999 for sudden dizziness with new double vision, vision loss, severe difficulty walking, one sided weakness or numbness, confusion, swallowing difficulty or a severe headache. Do not drive yourself to A&E. Call 999 if someone faints and does not recover fully, has chest pain or palpitations, has a seizure, or fainted during exercise or while lying down. Call 999 or go to A&E for vertigo with sudden hearing loss. Sudden hearing loss without other emergency features still needs immediate assessment within twenty four hours. Seek same day urgent assessment for new continuous vertigo with vomiting and unsteadiness, especially when walking is difficult. Contact NHS 111 if you are unsure where to go. Arrange a GP review if dizziness keeps returning, does not settle or affects daily activities. Review is also important with tinnitus, hearing change, pulse changes, fainting or medicine concerns. This lesson explains how dizziness is assessed. It cannot identify the cause of an individual episode or replace urgent medical care.

Dizziness does not divide neatly into two body systems. Timing, triggers, associated symptoms and a pattern specific examination usually guide assessment more safely than symptom quality alone.