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Everyone must stay at home to help stop the spread of coronavirus. Advice for clinicians on COVID-19 (coronavirus) is here. If you are a member of the public looking for health advice, visit the NHS website or North Yorkshire Public Health. And if you are looking for the latest travel information, and advice about the government response to the outbreak, go to the website.

Last updated: 30 March, 2020 15:59pm

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Vertigo – Information for GPs


It is important to distinguish vertigo from non-rotary dizziness – consider asking ‘Did you feel lightheaded or did you see the world spin round as though you had just got off a playground roundabout?’

Patients with ‘dizziness’ but not vertigo need history and examination. Some may need referral for further investigation e.g. (FASS, Cardiology, Elderly Care)

Exclude Red Flag Symptoms

  • Any central neurological symptoms or signs, particularly cerebellar signs
  • New types of headaches (especially occipital)
  • Acute deafness
  • Vertical nystagmus
  • Cholesteatoma
  • Roma test – if positive consider central cause and refer to neurology
  • Exclude alternative diagnosis. Thyroid disease, diabetes, anaemia, postural hypotension, cardiac dysrhythmias, or drug side effects

Consider referral to secondary care if:

  • Unsteadiness
  • Recurrent falls
  • Lightheadedness
  • Presyncope
  • Loss of confidence
  • Older patient (e.g. > 75 years old)
  • Positional vertigo: Positional vertigo and torsional nystagmus fatigues in 30 seconds
  • Sustained vertigo: sustained vertigo and horizontal nystagmus Not positional
  • Nausea and vomiting common

Investigations prior to referral

Hallpike-Dix test if appropriate

Patient information leaflets

Information to include in referral letter

  • Extent of disease including onset and duration
  • Treatments already tried and their effects
  • Effect on quality of life
  • Any relevant medical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption
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