Giddiness history
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Here is a comprehensive guide to taking a history of giddiness (dizziness/vertigo):
History Taking for Giddiness
1. Define the Symptom First
Never accept "dizziness" or "giddiness" as a final descriptor. Ask the patient to characterise it into one of three categories:
| Category | Description |
|---|---|
| Vertigo | Sensation of movement of self or surroundings (spinning) |
| Pre-syncope / Lightheadedness | Feeling faint, "about to pass out" |
| Disequilibrium / Imbalance | Unsteadiness without abnormal head sensation |
Caution: patient descriptions can be unreliable and overlapping — timing and triggers are often more diagnostically useful than symptom type alone.
— Bradley and Daroff's Neurology in Clinical Practice
2. Key History Questions
Onset & Timing
- When did it first start?
- Continuous or episodic?
- Duration of each episode (seconds / minutes–hours / days)?
- Frequency? Last episode?
- Do symptoms fully resolve between episodes?
Triggers
- Positional changes (rolling in bed → BPPV)?
- Standing up (orthostatic hypotension)?
- Head movements?
- Sound or pressure changes (perilymph fistula)?
- Salty food intake (Menière's disease)?
- Stress, exercise, excitement (familial ataxia)?
- Migraine triggers (light, stress)?
Mitigating / Exacerbating Factors
- What makes it better or worse?
- Does visual fixation suppress it?
Severity
- Does it limit daily activities or cause falls?
3. Associated Symptoms
Ear (Labyrinthine) Symptoms
- Hearing loss (unilateral or bilateral, fluctuating?)
- Tinnitus (pulsatile or ringing?)
- Aural fullness
- Autophony
- Otorrhoea / otalgia
- Nausea, vomiting, sweating, diarrhea (autonomic features of true labyrinthine vertigo)
Neurological Symptoms (should NOT be present with pure labyrinthine vertigo — their presence points to a central cause)
- Extremity weakness or numbness
- Cranial nerve deficits (diplopia, facial weakness, dysphagia)
- Headache / visual aura / photophobia / phonophobia
- Memory loss or personality change
- Ataxia
Cardiovascular
- Palpitations (arrhythmia)
- Chest pain
- Syncope
4. Medication History
- Current medications (aminoglycosides, loop diuretics, antihypertensives, antiepileptics — all ototoxic or vestibulotoxic)
- Polypharmacy in the elderly is a major cause of chronic dizziness
5. Past Medical & Surgical History
- Prior ear infections, ear surgery, head trauma
- Hypertension, diabetes, cardiovascular disease
- Autoimmune disease (relevant for immune-mediated labyrinthitis)
- Migraines
6. Family History
- Hereditary hearing loss or vestibular disorders
- Familial ataxia syndromes
7. Social History
- Noise exposure (occupational or recreational)
- Tobacco and alcohol use
- Caffeine/stimulant intake (can exacerbate tinnitus and dizziness)
8. Differential Diagnosis by Duration — Key Pointer
Fig. 137.5 — Establishing a differential diagnosis with a chief complaint of vertigo (Cummings Otolaryngology)
| Duration | Think of |
|---|---|
| Seconds | BPPV, vertebrobasilar insufficiency, vestibular migraine |
| Minutes–hours | Menière's disease, superior canal dehiscence, vestibular migraine |
| Days | Labyrinthitis, vestibular neuritis |
| Constant + focal neurology | Stroke, MS, complicated migraine |
| Constant, no focal neurology | Polypharmacy, PPPD, cerebellar lesion, B12 deficiency, hypothyroidism, vision change |
9. Summary Table for History Taking in Vertigo
| Domain | Key Questions |
|---|---|
| Symptom description | Spinning? Faintness? Imbalance? |
| Onset & duration | Sudden/gradual? Seconds/hours/days? |
| Pattern | Continuous or episodic? Frequency? |
| Triggers | Positional? Standing? Sound? |
| Associated ear sx | Hearing loss, tinnitus, fullness, otorrhoea |
| Neurological sx | Weakness, diplopia, headache, ataxia |
| Autonomic sx | Nausea, vomiting, sweating |
| Medications | Ototoxics, antihypertensives, polypharmacy |
| PMH/FH/SH | Ear disease, migraine, cardiovascular, noise exposure |
— Cummings Otolaryngology Head and Neck Surgery; Bradley and Daroff's Neurology in Clinical Practice
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