Dizziness and vertigo are common presentations in primary care, seen either acutely or chronically, with diverse causes including peripheral otological conditions, central neurological causes, systemic conditions, and psychological or functional causes. Symptoms vary widely, and can make diagnosis more challenging. Some causes are urgent (‘red flags’), requiring specialist referral or immediate treatment. This article guides clinical assessment, investigation, management and referrals in primary care.
BösnerSSchwarmSGrevenrathP, et al. (2018)
Prevalence, aetiologies and prognosis of the symptom dizziness in primary care – a systematic review. BMC Family Practice19(1), 33. DOI: 10.1186/s12875-017-0695-0.
4.
CasselbrantMLFurmanJMRubensteinE, et al. (1995)
Effect of otitis media on the vestibular system in children. Annals of Otology, Rhinology & Laryngology,
104(8): 620–624. DOI: 10.1177/000348949510400806.
5.
ChimirriSAielloRMazzitelloC, et al. (2013)
Vertigo/dizziness as a drug adverse reaction. Journal of Pharmacology and Pharmacotherapy4(Suppl 1): S104–S109. DOI: 10.4103/0976-500X.120969.
6.
CohenHFriedmanEMLaiD, et al. (1997)
Balance in children with otitis media with effusion. International Journal of Pediatric Otorhinolaryngology42(2): 107–115. DOI: 10.1016/s0165-5876(97)00113-4.
7.
Domínguez-DuránEMármol-SzombathyIPalmero-OlmoE, et al. (2021)
Epidemiology of balance disorders in primary care. Acta Otorrinolaringológica Española72(1): 11–20.
8.
GawronWPośpiechLOrendorz-FrączkowskaK (2004)
An evaluation of postural stability and the effects of middle-ear drainage on vestibulospinal reflexes of children with chronic otitis media with effusion. International Journal of Pediatric Otorhinolaryngology68(9): 1175–1179. DOI: 10.1016/j.ijporl.2004.03.017.
9.
GuptaVThakkerAGuptaKK (2020)
Vestibular schwannoma: What we know and where we are heading. Head and Neck Pathology14(4): 1058–1066. DOI: 10.1007/s12105-020-01155-x.
10.
HalmagyiGAkdalGWelgampolaM, et al. (2023)
Neurological update: Neuro-otology 2023. Journal of Neurology270(12): 6170–6192. DOI: 10.1007/s00415-023-11922-9.
11.
KattahJCTalkadAVWangDZ, et al. (2009)
HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke40(11): 3504–3510.
12.
KimHALeeH (2012)
Recent advances in central acute vestibular syndrome of a vascular cause. Journal of Neurological Sciences321(1-2): 17–22.
13.
LempertTOlesenJFurmanJ, et al. (2022)
Vestibular migraine: Diagnostic criteria (update). Journal of Vestibular Research22(1): 1–6. DOI: 10.3233/VES-201644.
ParnesLSAgrawalSKAtlasJ (2003)
Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Canadian Medical Association Journal169(7): 681–693.
21.
PopkirovSStaabJPStoneJ (2018)
Persistent postural perceptual dizziness (PPPD): A common, characteristic and treatable cause of chronic dizziness. Practical Neurology18: 5–13. DOI: 10.1136/practneurol-2017-001809.
22.
RossALeemeyerARBruintjesTD, et al. (2024)
Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: Study protocol. BMJ Open14:e085715. DOI: 10.1136/bmjopen-2024-085715.
StaabJPEckhardt-HennAHoriiA, et al. (2017)
Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research27(4): 191–208. DOI: 10.3233/VES-170622.
25.
StruppMBrandtT (2012)
Central vertigo. Otorhinolaryngology Clinics: An International Journal,
4(2): 71–76.
26.
StruppMBisdorffAFurmanJ, et al. (2022)
Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. Journal of Vestibular Research32(5): 389–406. DOI: 10.3233/VES-220201.
27.
TarnutzerAALeeSHRobinsonKA, et al. (2017)
ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging. Neurology88(15): 1468–1477. DOI: 10.1212/wnl.0000000000003814.
28.
ThompsonTLAmedeeR (2009)
Vertigo: A review of common peripheral and central vestibular disorders. The Ochsner Journal9(1): 20–26.
