Overview
Dizziness and vertigo are common symptoms with many possible causes — neurological, vestibular or other. They may present as a spinning sensation (vertigo), unsteadiness of gait or generalised light-headedness.
The approach is systematic, aiming for a clear diagnosis and safe management.
Types of dizziness
Determining the type of dizziness is the first step, as it guides the work-up:
- Vertigo — a sensation that the surroundings are spinning
- Unsteadiness — a feeling of losing your balance
- Pre-syncopal dizziness — a feeling of faintness or light-headedness
- Positional — vertigo triggered by changes in head position (BPPV)
Causes
Causes include vestibular problems (benign paroxysmal positional vertigo, vestibular neuritis), vestibular migraine, certain neurological conditions, but also cardiac or ENT causes.
Diagnosis
A detailed history and neurological examination are decisive. Assessment includes clinical investigation of the cause, differentiation from cardiac or ENT causes and, where needed, referral for additional testing.
Treatment approach
Depending on the diagnosis, the plan may include treatment, repositioning manoeuvres (e.g. for positional vertigo), medication adjustment or referral to a partner specialist.
A clear explanation of the cause helps the patient manage the symptom safely.
When to see a neurologist
- Emergency: sudden, severe dizziness with double vision, speech difficulty, weakness or numbness — call emergency services
- Recurrent dizziness or vertigo that affects daily life
- Dizziness with a severe headache or a recent injury
- Gait unsteadiness or recurrent falls