Assessing dizziness starts with the history.
Dizziness can be challenging to assess, with symptoms arising from vestibular, neurological, cardiovascular and other causes.
A careful history — particularly the timing, triggers and associated symptoms — can help narrow the differential diagnosis and guide appropriate investigation.
How does the dizziness present?
Consider when the symptoms occur, what triggers them, how long they last and whether there are associated auditory, migraine or neurological features.
Brief episodes with positional change
Consider BPPV, particularly when vertigo is triggered by rolling in bed, looking up, bending over or other changes in head position.
Episodic vertigo
Consider episodic vestibular disorders such as vestibular migraine or Ménière’s disease, guided by episode duration and associated auditory or migraine features.
Sudden persistent vertigo
Acute persistent vertigo requires careful differentiation between peripheral vestibular dysfunction and central causes.
Ongoing dizziness or imbalance
Consider vestibular hypofunction, PPPD, neurological causes, multisensory imbalance and other non-vestibular contributors.
Dizziness presentation at a glance
Our clinical flowchart provides a more detailed guide to common presentations, differential diagnoses, management and onward referral.
VIEW / DOWNLOAD FLOWCHARTWhen can vestibular testing help?
Vestibular function testing provides objective information about the inner ear and vestibular pathways and can help determine whether vestibular dysfunction may be contributing to a patient’s symptoms.
Recurrent or unexplained vertigo
Persistent dizziness or imbalance
Suspected unilateral or bilateral vestibular hypofunction
Suspected Ménière’s disease
Suspected superior canal dehiscence or third-window disorder
Persistent symptoms following vestibular neuritis
Complex presentations where peripheral vestibular involvement is unclear
Clinical Resources
More information about our vestibular assessment and specialised testing pathways.
Vestibular Testing
Learn about the different components of a vestibular assessment and what each test can tell us.
Ménière’s Testing
Learn more about our specialised assessment pathway for patients with suspected Ménière’s disease.
SCD Testing
Vestibular and audiological testing for patients with symptoms suggestive of superior canal dehiscence.