The history is the test.

Vertigo is a symptom, not a diagnosis — a false sense of movement, usually spinning, that comes from the balance organs of the inner ear or the parts of the brain that process balance. Dozens of conditions can cause it, from harmless to life-threatening.

The good news is that vertigo, unlike many complaints, usually gives up its diagnosis to careful questions alone. This chapter walks through those questions one theme at a time — what the dizziness feels like, how long it lasts, what brings it on, what comes with it, and the warning signs you must never miss.

Dizziness accounts for a large share of primary-care and emergency presentations, and a systematic history is the single most valuable diagnostic step.1,2 The patient's experience is almost entirely subjective, so the clinician's job is to convert that experience into language with diagnostic meaning — distinguishing true vertigo from presyncope and disequilibrium, and peripheral causes from central ones.

The chapter is organised by the discriminating axes of the history: terminology, timing, triggers, associated auditory and neurological symptoms, the wider medical and psychosocial context, red flags, and the validated algorithms (HINTS, SO STONED) that package these into a reproducible method.3,4

History-taking in vertigo is an exercise in disciplined pattern recognition. Nonsequential or excessively general questioning drives diagnostic confusion and unnecessary imaging; a structured approach lets you form a focused differential and prioritise testing rationally.4 The temporal frame — acute, episodic, or chronic vestibular syndrome — and the company the vertigo keeps do most of the diagnostic work.

The throughline of the chapter is that good history is also safehistory: red flags such as focal deficits, atypical nystagmus, or a normal head impulse in the acute vestibular syndrome must be actively sought, because in the posterior circulation early MRI misses a meaningful fraction of strokes.3