When taking a history from a patient with vertigo, the following areas should be considered:

Current symptoms

Details of current symptoms must be identified:

  • Onset
  • Duration
  • Type (horizontal, vertical, subjective or objective)
  • Precipitant of vertigo, and any associated symptoms

Risk factors

Risk factors should be identified:

  • Previous episodes of vertigo
  • Ear problems
  • Head trauma
  • Use of ototoxic drugs

In addition, a review of risk factors for the central and peripheral causes should be undertaken.

Identifying potentially life-threatening central causes of vertigo is a crucial aspect of the assessment.

Central Causes

Central causes may be gradual or sudden in onset, but typically present as persistent, worsening vertigo.

Other features such as severe head or neck pain or symptoms of brainstem dysfunction i.e cranial nerve palsies or cerebellar symptoms are usually present.

Central vascular causes are more common in the elderly and those with vascular risk factors.

Peripheral Causes

Peripheral vertigo may be associated with symptoms of cochlear dysfunction such as tinnitus or hearing loss, depending on the cause. However, the absence of hearing disturbance does not exclude a peripheral cause such as vestibular neuritis.

Recurrent, very short attacks of vertigo precipitated by particular head movements, e.g. rolling in bed, are typical of BPPV, and hearing is not usually affected.

Peripheral vertigo Central vertigo
Onset Sudden Occasionally very sudden but usually gradual
Nausea and vomiting Severe Variable, usually minimal systemic upset
Effect of head position Worsened by position, often single critical position Little change, associated with more than one position
Associated auditory findings (aural fullness, tinnitus, hearing loss etc.) May be present Rare
Associated neurological symptoms (dysarthria/ diplopia, hemiparesis etc.) None Usually present

taken from ‘acute vertigo’ session.