“Dizzy” means several very different things. Sorting out which one you have is most of the diagnosis.
Dizziness is one of the least precise words in medicine. It is used to describe spinning vertigo, light-headedness on standing, a floating sensation, and simple unsteadiness on the feet — four separate problems with four separate causes. The first task is always translation.
The most common cause of true spinning vertigo, benign paroxysmal positional vertigo, is diagnosed at the bedside with a positional manoeuvre and treated at the same visit with a repositioning manoeuvre. A substantial number of patients arrive after months of symptoms, having had an MRI but never a Dix-Hallpike test.
Vestibular migraine is the other commonly missed diagnosis — episodic dizziness in someone with a migraine history, often without headache at all. It responds to migraine treatment, not to vestibular suppressants, which is why it matters that someone asks the question.
Sudden severe vertigo accompanied by double vision, slurred speech, facial or limb weakness, severe headache, or an inability to walk unaided can indicate a stroke in the back of the brain. Call 911 rather than waiting for an office appointment.
“A five-minute positional test at the bedside settles more dizziness cases than any scan does.”