Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2001 Aug;51(469):666–671.

A systematic review of vertigo in primary care.

K Hanley 1, T O'Dowd 1, N Considine 1
PMCID: PMC1314080  PMID: 11510399

Abstract

The symptom of vertigo is usually managed in primary care without further referral. This review examines the evidence on which general practitioners can base clinical diagnosis and management of this relatively common complaint. Research in this area has in the main been from secondary and tertiary centres and has been of variable quality. Indications are that the conditions that present in general practice are most likely to be benign positional vertigo, acute vestibular neuronitis, and Ménière's disease; however, vascular incidents and neurological causes, such as multiple sclerosis, must be kept in mind. An important practice point is that vestibular sedatives are not recommended on a prolonged basis for any type of vertigo. There is a need for basic epidemiological and clinical management research of vertigo in general practice.

Full Text

The Full Text of this article is available as a PDF (75.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bailey K. E., Sloane P. D., Mitchell M., Preisser J. Which primary care patients with dizziness will develop persistent impairment? Arch Fam Med. 1993 Aug;2(8):847–852. doi: 10.1001/archfami.2.8.847. [DOI] [PubMed] [Google Scholar]
  2. Baloh R. W., Honrubia V., Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. 1987 Mar;37(3):371–378. doi: 10.1212/wnl.37.3.371. [DOI] [PubMed] [Google Scholar]
  3. Baloh R. W. Vertigo. Lancet. 1998 Dec 5;352(9143):1841–1846. doi: 10.1016/S0140-6736(98)05430-0. [DOI] [PubMed] [Google Scholar]
  4. Belal A., Jr, Glorig A. Dysequilibrium of ageing (presbyastasis). J Laryngol Otol. 1986 Sep;100(9):1037–1041. doi: 10.1017/s0022215100100520. [DOI] [PubMed] [Google Scholar]
  5. Bergenius J., Borg E. Audio-vestibular findings in patients with vestibular neuritis. Acta Otolaryngol. 1983 Nov-Dec;96(5-6):389–395. doi: 10.3109/00016488309132724. [DOI] [PubMed] [Google Scholar]
  6. Bird J. C., Beynon G. J., Prevost A. T., Baguley D. M. An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract. 1998 Dec;48(437):1828–1832. [PMC free article] [PubMed] [Google Scholar]
  7. Blakley B. W. A randomized, controlled assessment of the canalith repositioning maneuver. Otolaryngol Head Neck Surg. 1994 Apr;110(4):391–396. doi: 10.1177/019459989411000407. [DOI] [PubMed] [Google Scholar]
  8. Brandt T., Daroff R. B. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980 Aug;106(8):484–485. doi: 10.1001/archotol.1980.00790320036009. [DOI] [PubMed] [Google Scholar]
  9. Brandt T., Daroff R. B. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980 Aug;106(8):484–485. doi: 10.1001/archotol.1980.00790320036009. [DOI] [PubMed] [Google Scholar]
  10. Brandt T. Phobic postural vertigo. Neurology. 1996 Jun;46(6):1515–1519. doi: 10.1212/wnl.46.6.1515. [DOI] [PubMed] [Google Scholar]
  11. Brill G. C. Acute labyrinthitis: a possible association with influenza. J R Coll Gen Pract. 1982 Jan;32(234):47–50. [PMC free article] [PubMed] [Google Scholar]
  12. Clark M. R., Sullivan M. D., Fischl M., Katon W. J., Russo J. E., Dobie R. A., Voorhees R. Symptoms as a clue to otologic and psychiatric diagnosis in patients with dizziness. J Psychosom Res. 1994 Jul;38(5):461–470. doi: 10.1016/0022-3999(94)90107-4. [DOI] [PubMed] [Google Scholar]
  13. Cohen H. S., Jerabek J. Efficacy of treatments for posterior canal benign paroxysmal positional vertigo. Laryngoscope. 1999 Apr;109(4):584–590. doi: 10.1097/00005537-199904000-00012. [DOI] [PubMed] [Google Scholar]
  14. Colledge N. R., Barr-Hamilton R. M., Lewis S. J., Sellar R. J., Wilson J. A. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996 Sep 28;313(7060):788–792. doi: 10.1136/bmj.313.7060.788. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Colledge N. R., Wilson J. A., Macintyre C. C., MacLennan W. J. The prevalence and characteristics of dizziness in an elderly community. Age Ageing. 1994 Mar;23(2):117–120. doi: 10.1093/ageing/23.2.117. [DOI] [PubMed] [Google Scholar]
  16. Cooper C. W. Vestibular neuronitis: a review of a common cause of vertigo in general practice. Br J Gen Pract. 1993 Apr;43(369):164–167. [PMC free article] [PubMed] [Google Scholar]
  17. DIX M. R., HALLPIKE C. S. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med. 1952 Jun;45(6):341–354. [PMC free article] [PubMed] [Google Scholar]
  18. Davis L. E. Dizziness in elderly men. J Am Geriatr Soc. 1994 Nov;42(11):1184–1188. doi: 10.1111/j.1532-5415.1994.tb06986.x. [DOI] [PubMed] [Google Scholar]
  19. Dobie R. A. Vertigo: a physiological approach. J Fam Pract. 1980 Oct;11(4):623–631. [PubMed] [Google Scholar]
  20. Drachman D. A., Hart C. W. An approach to the dizzy patient. Neurology. 1972 Apr;22(4):323–334. doi: 10.1212/wnl.22.4.323. [DOI] [PubMed] [Google Scholar]
  21. Eagger S., Luxon L. M., Davies R. A., Coelho A., Ron M. A. Psychiatric morbidity in patients with peripheral vestibular disorder: a clinical and neuro-otological study. J Neurol Neurosurg Psychiatry. 1992 May;55(5):383–387. doi: 10.1136/jnnp.55.5.383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Epley J. M. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992 Sep;107(3):399–404. doi: 10.1177/019459989210700310. [DOI] [PubMed] [Google Scholar]
  23. Evans J. G. Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and non-rotatory dizziness. Age Ageing. 1990 Jan;19(1):43–49. doi: 10.1093/ageing/19.1.43. [DOI] [PubMed] [Google Scholar]
  24. Evans J. G. Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and non-rotatory dizziness. Age Ageing. 1990 Jan;19(1):43–49. doi: 10.1093/ageing/19.1.43. [DOI] [PubMed] [Google Scholar]
  25. Froehling D. A., Silverstein M. D., Mohr D. N., Beatty C. W., Offord K. P., Ballard D. J. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc. 1991 Jun;66(6):596–601. doi: 10.1016/s0025-6196(12)60518-7. [DOI] [PubMed] [Google Scholar]
  26. Froehling D. A., Silverstein M. D., Mohr D. N., Beatty C. W. The rational clinical examination. Does this dizzy patient have a serious form of vertigo? JAMA. 1994 Feb 2;271(5):385–388. [PubMed] [Google Scholar]
  27. Grad A., Baloh R. W. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol. 1989 Mar;46(3):281–284. doi: 10.1001/archneur.1989.00520390047014. [DOI] [PubMed] [Google Scholar]
  28. Harrison M. S., Ozsahinoglu C. Positional vertigo: aetiology and clinical significance. Brain. 1972;95(2):369–372. doi: 10.1093/brain/95.2.369. [DOI] [PubMed] [Google Scholar]
  29. Kentala E. Characteristics of six otologic diseases involving vertigo. Am J Otol. 1996 Nov;17(6):883–892. [PubMed] [Google Scholar]
  30. Lawson J., Fitzgerald J., Birchall J., Aldren C. P., Kenny R. A. Diagnosis of geriatric patients with severe dizziness. J Am Geriatr Soc. 1999 Jan;47(1):12–17. doi: 10.1111/j.1532-5415.1999.tb01895.x. [DOI] [PubMed] [Google Scholar]
  31. Lempert T., Gresty M. A., Bronstein A. M. Benign positional vertigo: recognition and treatment. BMJ. 1995 Aug 19;311(7003):489–491. doi: 10.1136/bmj.311.7003.489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Lempert T., Wolsley C., Davies R., Gresty M. A., Bronstein A. M. Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: a placebo-controlled trial. Neurology. 1997 Sep;49(3):729–733. doi: 10.1212/wnl.49.3.729. [DOI] [PubMed] [Google Scholar]
  33. Luxon L. M. "A bit dizzy". Br J Hosp Med. 1984 Dec;32(6):315–321. [PubMed] [Google Scholar]
  34. Luxon L. M. Vertigo: new approaches to diagnosis and management. 1996 Nov 20-Dec 10Br J Hosp Med. 56(10):519-20, 537-41. [PubMed] [Google Scholar]
  35. Madlon-Kay D. J. Evaluation and outcome of the dizzy patient. J Fam Pract. 1985 Aug;21(2):109–113. [PubMed] [Google Scholar]
  36. Parnes L. S., Price-Jones R. G. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol. 1993 May;102(5):325–331. doi: 10.1177/000348949310200501. [DOI] [PubMed] [Google Scholar]
  37. Rascol O., Hain T. C., Brefel C., Benazet M., Clanet M., Montastruc J. L. Antivertigo medications and drug-induced vertigo. A pharmacological review. Drugs. 1995 Nov;50(5):777–791. doi: 10.2165/00003495-199550050-00002. [DOI] [PubMed] [Google Scholar]
  38. Saeed S. R. Fortnightly review. Diagnosis and treatment of Ménière's disease. BMJ. 1998 Jan 31;316(7128):368–372. doi: 10.1136/bmj.316.7128.368. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Sixt E., Landahl S. Postural disturbances in a 75-year-old population: I. Prevalence and functional consequences. Age Ageing. 1987 Nov;16(6):393–398. doi: 10.1093/ageing/16.6.393. [DOI] [PubMed] [Google Scholar]
  40. Skiendzielewski J. J., Martyak G. The weak and dizzy patient. Ann Emerg Med. 1980 Jul;9(7):353–356. doi: 10.1016/s0196-0644(80)80111-9. [DOI] [PubMed] [Google Scholar]
  41. Sloane P. D., Dallara J. Clinical research and geriatric dizziness: the blind men and the elephant. J Am Geriatr Soc. 1999 Jan;47(1):113–114. doi: 10.1111/j.1532-5415.1999.tb01912.x. [DOI] [PubMed] [Google Scholar]
  42. Sloane P. D., Dallara J., Roach C., Bailey K. E., Mitchell M., McNutt R. Management of dizziness in primary care. J Am Board Fam Pract. 1994 Jan-Feb;7(1):1–8. [PubMed] [Google Scholar]
  43. Sloane P. D. Dizziness in primary care. Results from the National Ambulatory Medical Care Survey. J Fam Pract. 1989 Jul;29(1):33–38. [PubMed] [Google Scholar]
  44. Sloane P., Blazer D., George L. K. Dizziness in a community elderly population. J Am Geriatr Soc. 1989 Feb;37(2):101–108. doi: 10.1111/j.1532-5415.1989.tb05867.x. [DOI] [PubMed] [Google Scholar]
  45. Troost B. T., Patton J. M. Exercise therapy for positional vertigo. Neurology. 1992 Aug;42(8):1441–1444. doi: 10.1212/wnl.42.8.1441. [DOI] [PubMed] [Google Scholar]
  46. Wolf J. S., Boyev K. P., Manokey B. J., Mattox D. E. Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo. Laryngoscope. 1999 Jun;109(6):900–903. doi: 10.1097/00005537-199906000-00011. [DOI] [PubMed] [Google Scholar]
  47. Yardley L., Beech S., Zander L., Evans T., Weinman J. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract. 1998 Apr;48(429):1136–1140. [PMC free article] [PubMed] [Google Scholar]
  48. Yardley L., Luxon L. M., Haacke N. P. A longitudinal study of symptoms, anxiety and subjective well-being in patients with vertigo. Clin Otolaryngol Allied Sci. 1994 Apr;19(2):109–116. doi: 10.1111/j.1365-2273.1994.tb01192.x. [DOI] [PubMed] [Google Scholar]
  49. Yardley L., Luxon L. Treating dizziness with vestibular rehabilitation. BMJ. 1994 May 14;308(6939):1252–1253. doi: 10.1136/bmj.308.6939.1252. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Yardley L., Masson E., Verschuur C., Haacke N., Luxon L. Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale. J Psychosom Res. 1992 Dec;36(8):731–741. doi: 10.1016/0022-3999(92)90131-k. [DOI] [PubMed] [Google Scholar]
  51. Yardley L., Owen N., Nazareth I., Luxon L. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract. 1998 Apr;48(429):1131–1135. [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES