Vertigo

Jeremy Raab, MD and James J. Arnold, DO, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A symptom, not a disease process. Causes can be peripheral or central, benign or life-threatening. Cause determines treatment.

  • May be described as a sensation of movement (“room spinn...

DIAGNOSIS

HISTORY

  • Avoid over-reliance on patient description of how symptoms feel; focus on triggers and timing (1).

  • TiTrATE is a clinically useful evaluation tool: Timing, Triggers, And a Targeted Eval...

TREATMENT

GENERAL MEASURES

Treatments depend on cause. 
  • BPPV: Epley maneuver (1,2,5)[A] and modified Epley maneuver (2)[B] (Epley maneuver–YouTube)

  • Vestibular neuritis and labyrinthitis

    • Vestibular-suppr...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Balance exercises should be adhered to for symptom reduction and return to normal activities of daily living (ADLs). 

Patient Monitoring

After 1 to 2 weeks, assess ...

REFERENCES

1 Muncie H, Sirmans S, James E. Dizziness: approach to evaluation and management. Am Fam Physician.  2017;95(3):154–162.  [View Abstract]
2 Swartz R, Longwell P. Treatment of vertigo...

ADDITIONAL READING

  • Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence–based review): report of the Quality Standards Subcommitte...

SEE ALSO

  • Ménière Disease; Motion Sickness; Vertigo, Benign Paroxysmal Positional (BPPV)

  • Algorithm: Dizziness

CODES

ICD10

  • R42 Dizziness and giddiness

  • H81.10 Benign paroxysmal vertigo, unspecified ear

  • H81.49 Vertigo of central origin, unspecified ear

  • H81.399 Other peripheral vertigo, unspecified ear

  • H81.311 Aural v...

CLINICAL PEARLS

  • TiTrATE your assessment.

  • Acute, spontaneous, continuous vertigo with a normal horizontal head impulse, direction-changing nystagmus, and skew deviation (HINTS positive) is highly sensit...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

×