The first stop in your journey towards diagnosis and treatment is usually your family physician, also known as a general practitioner (GP). In cases of acute dizziness, you may end up seeing an emergency physician at the hospital. The main role of these primary care physicians is to rule out a serious acute health issue such as a stroke. They will probably also investigate other health issues that may contribute to dizziness, may refer you for tests, and may prescribe symptomatic medication.

Discussion of your symptoms

Primary care physicians will begin by asking you to describe your symptoms. You may get more out of your appointment if you are able to do some advance preparation. Terms used by primary care physicians to describe symptoms:

Light-headedness (sensation of being woozy and about to faint) is classified into four categories:

• vasovagal (simple faint)
• cardiac (heart related)
• metabolic (low blood sugar, anemia, infection, dehydration or drugs)
• brain (heart and stroke) – this is the least likely cause of light-headedness

Vertigo (the false sensation that you or your surroundings are spinning) is considered one of two types, depending on the cause:

• Central vertigo (originates in the brain)
  A patient with this symptom may be having a stroke and needs to get to an emergency department as soon as possible.
• Peripheral vertigo (has its source in the balance organs of the inner ear)
  It may be a symptom of a vestibular (inner ear balance system) disorder such as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis or labyrinthitis.

Red flag signs

The doctor will also be on the lookout for danger signs of a potentially serious problem. Red flags include:

• fever of 39.4°C (103°F) or greater
• chest pain/heart racing or symptoms of a stroke – stroke symptoms are treated as a medical emergency and include: headache; passing out; double vision; facial numbness, slurred speech or swallowing problems; weakness in one arm or leg; and difficulty walking
• fainting or collapsing
• behavioural changes
• new, different or severe headache

Other red flag signs the doctor will consider are:

• persistent vertigo (lasting more than a few minutes)
• history of stroke
• risk factors for stroke, such as diabetes and high blood pressure
• older patient.

Physical exam

The doctor will do a physical exam. It may include checking:

• vital signs (heart rate and blood pressure)
• gait (walking)
• eyes, looking for involuntary eye movement (nystagmus)
• ears and hearing
• strength and reflexes

Diagnostic tests, such as a head impulse test or Dix Hallpike manoeuvre, may also be done to see how your vestibular system (inner ear balance system) is functioning.

Depending on the symptoms, the doctor may call for more investigation. This might include sending you for further tests such as:

• blood (haemoglobin and blood sugar)
• CT (computerized tomography) of the head
• ECG (electrocardiogram) to check the functioning of your heart