What is Dizziness?
 

DIzziness is a general term used to indicate any of these three distinct feelings:
 

• Vertigo: A sense of spinning or moving even when standing completely still.

• Lightheadedness: A feeling that you are about to faint, especially when standing

• Disequilibrium: A feeling of unsteadiness with balance

Primary Causes of Dizziness
 

Primary causes typically originate directly within the vestibular system (the inner ear structures responsible for balance) and its main nerves.
 

• Benign Paroxysmal Positional Vertigo (BPPV)

• Vestibular Neuritis

• Meniere's Disease

• Labyrinthitis

Secondary Causes of Dizziness
 

• Cardiovascular Conditions: orthostatic hypotension, cardiac arrhythmias, or reduced cardiac output that decreases blood flow to the brain.

• Medications: blood pressure medications, psychiatric medications, opioids

• Neurological Conditions: migraine-associated vertigo (vestibular migraine), postural orthostatic tachycardia syndrome (POTS) (a form of dysautonomia), stroke, multiple sclerosis, normal pressure hydrocephalus, Friedreich's ataxia, spinocerebellar ataxia

• Metabolic Conditions: Dehydration, anemia, hypoglycemia (low blood sugar), thyroid disorders, B12 deficiency, B1/thiamine deficiency

• Psychiatric Conditions: anxiety, panic disorder, functional disorder

Diagnostics

1.  History and Physical Examination
​

• Neurological assessment

• Dix-Hallpike Maneuver

• Orthostatic vitals (taking blood pressure and pulse while lying down and standing up)

• HINTS exam (head impulse test, nystagmus, test of skew) for continuous dizziness ​​

2. Advanced Testing
 

• MRI or CT

• EKG and/or Holter EKG Monitoring

• Echocardiogram

3.  Laboratory and Blood Work

​

• Complete Blood Count (CBC)

• Metabolic Panel & TSH
   

Management 
 

• Interventional Procedures: Canalith repositioning maneuvers (e.g., Epley maneuver) for BPPV.

• Medications depending on symptoms

• Vestibular Rehabilitation Therapy and ENT specialist referral

• Lifestyle: Fall prevention measures (change positions slowly; use a cane or walker; remove loose rugs; hydrated; install grab bars in bathroom) and dietary modifications (maintain adequate hydration and limit sodium, caffeine, and alcohol).
  
  
                                                        References & Guidelines
   

• American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).

• American College of Emergency Physicians (ACEP). Clinical guidance for the evaluation of acute dizziness and vertigo.

• Society for Academic Emergency Medicine (SAEM). GRACE-3: Acute Dizziness and Vertigo in the Emergency Department.

• American Academy of Family Physicians (AAFP). Dizziness: Evaluation and Management.