Vertigo

Jeremy S. Raab, MD and James J. Arnold, DO, FACOFP, FAAFP Reviewed 06/2019

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 spin...

DIAGNOSIS

HISTORY

Avoid overreliance 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 Evalu...

TREATMENT

GENERAL MEASURES

Treatments depend on cause.

BPPV: Epley maneuver and modified Epley maneuver (1)[A] (Epley maneuver–YouTube) (5)[B]
Vestibular neuritis and labyrinthitis
- Vestibular-suppressant...

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

Muncie H, Sirmans S, James E. Dizziness: approach to evaluation and management. Am Fam Physician. 2017;95(3):154–162. [View Abstract on OvidMedline]

Newman-Toker DE, Edlow JA. TiTrAT...

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...

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...

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