What do you mean when you say Dizzy – Part VI

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 vertigoLess than one minuteChange in head position
relative to gravity (e.g. tilting, lying down)
Orthostatic Hypotension Less than one minuteRising from sitting or
supine
Meniere’s
disease
(vertigo,
unilateral tinnitus)
HoursSalt, caffeine, tobacco,
stress, alcohol
Vestibular Migraine(vertigo, motion
intolerance)
HoursChocolate, 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)
VariesSituational

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.