Diagnostic Question Explorer

Ask“Can you describe exactly what you feel when an episode starts?”

Ambiguous — open-ended description is needed to separate vertigo, presyncope, and disequilibrium before going further.

Ask“Do you feel the surroundings spinning, or yourself turning?”

Suggests true rotational vertigo — typically vestibular in origin.

Ask“Do you feel like you're floating or disconnected from your body?”

May reflect functional or anxiety-related dizziness rather than a vestibular lesion.

Ask“Do you feel as though you're about to faint or black out?”

Indicates presyncope — look for orthostatic or cardiac causes, not the labyrinth.

Ask“Is it more a sense of imbalance, as though you might fall when walking?”

Suggests disequilibrium — evaluate proprioceptive, cerebellar, and multisensory inputs.

Ask“Is the sensation like spinning, or like being on a merry-go-round?”

Confirms rotational vertigo — most often a peripheral vestibular problem.

Ask“How long does each episode last — and is it brief and triggered by movement?”

Brief, position-triggered spells point to BPPV.

Ask“Do episodes come and go, each lasting less than a day?”

Recurrent attacks of 20 minutes to several hours with hearing fluctuation and tinnitus suggest Ménière's disease.

Ask“Was the onset sudden, with symptoms persisting for several days?”

Acute, continuous vertigo without hearing loss suggests vestibular neuritis; recurrent hours-long attacks with headache suggest vestibular migraine.

Ask“Do you feel dizzy most days — and are there any symptom-free periods at all?”

Persistent daily dizziness suggests PPPD; consider central pathology (cerebellar/brainstem) when accompanied by other signs.

Ask“Is your dizziness triggered by lying down, rolling over, or sitting up?”

Otoconia in a semicircular canal cause brief, position-triggered episodes — BPPV.

Ask“Does it worsen in crowds, supermarkets, or while scrolling on a screen?”

Visually-induced dizziness suggests PPPD (visual dependence) or vestibular migraine.

Ask“Does rapid head turning make you feel dizzy or unsteady?”

Movement-provoked symptoms point to vestibular hypofunction, vestibular migraine, or BPPV depending on duration.

Ask“Did the symptoms begin suddenly, without any particular trigger?”

Spontaneous, continuous vertigo is often post-viral neuritis — but mandates exclusion of posterior-circulation stroke.

Ask“Is it brought on by loud sounds, coughing, straining, or nose-blowing?”

Sound- or pressure-evoked vertigo suggests a third-window lesion such as superior canal dehiscence or perilymph fistula.

Ask“Do you feel worse during emotional stress or panic?”

Stress-provoked dizziness suggests PPPD, psychogenic dizziness, or an anxiety-related syndrome.

Ask“Have you had vertigo with fluctuating hearing and ringing in one ear?”

Recurrent vertigo with low-frequency SNHL, tinnitus, and aural fullness — Ménière's disease (endolymphatic hydrops).

Ask“Did your hearing drop suddenly before or during the dizziness?”

Acute cochleo-vestibular involvement — labyrinthitis; an AICA stroke can mimic this and must be excluded.

Ask“Has hearing in one ear declined gradually, with constant tinnitus?”

Progressive asymmetric SNHL with mild imbalance suggests vestibular schwannoma — image with gadolinium MRI.

Ask“Do you feel pressure or fullness in the ear during or before episodes?”

Aural fullness is seen in Ménière's disease and perilymph fistula.

Ask“Have you noticed any change in hearing or any ringing in the ears?”

Normal hearing favours vestibular neuritis (nerve-only) or a central cause — both typically spare the cochlea.

Ask“Have you ever had migraine, or headaches with visual or sensory aura?”

Supports vestibular migraine — a common cause of episodic vertigo with or without headache.

Ask“Do you have high blood pressure, diabetes, or a previous stroke or TIA?”

Raises concern for vertebrobasilar insufficiency or ischaemic vertigo, especially in older adults.

Ask“Have you had chronic ear problems or ear surgery (mastoidectomy, tympanoplasty)?”

May indicate labyrinthine injury, labyrinthitis, or post-surgical vestibular dysfunction.

Ask“Have you recently had strong antibiotics (e.g., gentamicin) or loop diuretics?”

Risk of bilateral vestibular loss — imbalance and oscillopsia without true spinning vertigo.

Ask“Are you taking medication for anxiety, depression, or seizures?”

Can suppress central vestibular compensation or cause drug-induced dizziness.

Ask“Have there been recent changes to your medications, or are you on many at once?”

Increases the risk of multifactorial dizziness, especially in the elderly.

Ask“Do you feel anxious or fearful when you are dizzy?”

A psychogenic overlay — anxiety amplifies the perception of dizziness.

Ask“Are you afraid of falling even when you feel physically stable?”

Indicates functional dizziness or heightened fall anxiety, common in the elderly.

Ask“Do you get sudden palpitations, breathlessness, or a feeling of dread?”

May reflect panic attacks, often comorbid with chronic dizziness or PPPD.

Ask“Have your symptoms continued despite normal tests and treatment?”

Strongly points to PPPD.

Ask“Do you frequently monitor your body for signs of imbalance?”

Suggests somatosensory amplification, characteristic of functional dizziness.

Ask“Does the child get carsick or motion-sick easily?”

Commonly associated with vestibular migraine; may be an early marker of susceptibility.

Ask“Are there recurrent brief episodes of unsteadiness or clumsiness?”

May suggest benign paroxysmal vertigo of childhood or an evolving migraine variant.

Ask“Has the child ever described the room spinning?”

Verbalisation is limited in children, but this points toward true vertigo episodes.

Ask“Is there a family history of migraine?”

Strongly supports vestibular migraine in the child.

Ask“Have you had any falls or near-falls?”

Suggests balance impairment from multisensory decline or vestibulopathy.

Ask“Are you taking blood-pressure tablets or sedatives?”

May contribute to orthostatic hypotension, sedation, or central suppression.

Ask“Do you have problems with vision or with sensation in the feet?”

Visual and proprioceptive deficits compound vestibular loss in the elderly.

Ask“How many regular medications are you taking?”

Increases the risk of drug-induced dizziness and confounds the diagnosis.

Ask“Does your work involve heights, machinery, or driving?”

Identifies safety-critical roles (pilots, drivers, crane operators) where vertigo carries serious risk.

Ask“Have your symptoms affected your ability to work?”

Assesses functional impairment and the need for workplace accommodation.

Ask“Have your symptoms affected your social life or relationships?”

Suggests psychosocial impact and a possible functional or anxiety-related disorder.

Ask“Do you avoid public transport, crowds, or fast-moving visual scenes?”

Indicates visually-induced dizziness — possibly PPPD or vestibular migraine.