Dizziness (vertigo / light-headedness)

When patients say "dizzy" they usually mean one of two distinct symptoms — and getting the distinction right is the difference between treating an inner-ear problem and treating a heart-rhythm problem.

Vertigo vs presyncope

• Vertigo is the room spinning. Comes from problems with the inner ear (BPPV — benign positional vertigo — is by far the most common; vestibular neuritis; Ménière's), or rarely the brainstem. Often worse with head movement. May come with nausea or vomiting.
• Presyncope is the about-to-faint feeling. Comes from drops in blood pressure (postural hypotension, dehydration), heart rhythm problems, anaemia, low blood sugar in diabetics. Often worse on standing up.

The treatment for the two is completely different — anti-vertigo drugs help vertigo, fluid and BP medication review help presyncope. Mixing them up wastes time.

Common causes

• BPPV (the room spins when you roll over in bed; brief episodes lasting seconds to minutes)
• Postural hypotension (you feel faint on standing up quickly; often in elderly, in patients on multiple BP medications, in dehydrated patients)
• Anaemia
• Heart rhythm problems (rare but important; usually with palpitations or fainting)
• Cervical spondylosis with vertebrobasilar insufficiency
• Migraine-associated vertigo
• Side effect of medication

What we do at OPD

History first — is it spinning or about-to-faint, does it happen on head movement, on standing, with palpitations, lasting seconds or hours. Examination: BP lying then standing, pulse check, simple bedside vestibular tests (Dix-Hallpike for BPPV). Tests depending on the pattern: ECG, CBC, sugar, thyroid, sometimes MRI if neurological signs.

BPPV — the most common cause — is fixed by a 10-minute bedside manoeuvre (Epley's manoeuvre) in most patients. No medication needed.