Precipitating, Exacerbating, or Relieving Factors (Triggers)
Symptoms that are brought on or increased by a change in head position, or with eyes closed, suggest peripheral disease. Symptoms noticed only while standing, but never when sitting or lying, suggest vascular or orthopedic disease. Symptoms that are constant and are unaffected by position change are suggestive of central or psychiatric pathology.
To aid in differential diagnosis in a patient complaining of vertigo or dizziness, I developed a brief guideline based on typical duration (timing) and precipitating, exacerbating factors (triggers) for the most common causes of these complaints.
Typical timing and triggers for common disorders causing vertigo and dizziness
|
Pathology
|
Timing |
Triggers |
| BPPVTransient vertigo | Less than one minute | Change in head position relative to gravity (e.g. tilting, lying down) |
| Orthostatic Hypotension | Less than one minute | Rising from sitting or supine |
| Meniere’s disease(vertigo, unilateral tinnitus) |
Hours | Salt, caffeine, tobacco, stress, alcohol |
| Vestibular Migraine(vertigo, motion intolerance) |
Hours | Chocolate, cheese, red wine, hormonal changes, stress, bright/flickering light, atmospheric pressure change, disruption of sleep pattern, caffeine withdrawal |
| Vestibular neuritis/ Labyrinthitis(prolonged vertigo) |
Hours to days with gradual decrease |
Prior viral symptoms, idiopathic |
| Cerebellar Stroke(Ataxia, vertigo) | Sudden onset persistent symptoms |
Stroke risk factors |
| Anxiety/Hyperventilation(lightheaded, parasthesias) |
Varies | Situational |
