Reviewed on : 4 Aug 2014

Reviewed by : Peter Dekker, Consultant ENT Surgeon

Expires : 4 Aug 2016

Assessment

Is it really vertigo (ENT cause) rather than light-headedness (anxiety, syncope, postural hypotension)

• consider duration: minutes for Benign Paroxysmal Positional Vertigo (BPPV), hours for Meniere’s and Migraine Associated Vertigo, days for Labyrinthitis or vascular cause

Management

• treat acute labyrinthitis with 2-3 days of prochlorperazine, but avoid long courses which delay central compensation. Do not use betahistine for acute labyrinthitis. Encourage early mobilisation.
• for Menieres disease, consider betahistine. Also avoid excess salt and caffeine.
• for Migraine, consider life-style measures such as elimination of caffeine. Migraine prophylaxis can also be considered. Note that head and neck pain may not occur at the same time as vertigo/dizziness.
• BPPV will not be helped by prochlorperazine.  GP may consider Hallpike test for diagnosis, and Epley manoeuvre for treatment, or refer to ENT for these and for vestibular rehabilitation.
• See DVLA guidelines on ‘liability to sudden attacks of unprovoked or unprecipitated disabling giddiness’

Referral

Refer ENT Vertigo Clinic if suspected BPPV, Meniere’s or uncertain diagnosis.