How do medical professionals diagnose vertigo?

During an evaluation for vertigo, the health care professional usually asks questions to take a history of the events and symptoms associated with vertigo. This includes medications taken (even over-the-counter medications), recent illnesses, and prior medical problems. Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.

After getting the person’s medical history, a medical professional then performs a physical examination. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause.

Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem. A physician then performs the Dix-Hallpike test to try to reproduce vertigo. This test involves abruptly repositioning the patient’s head and monitoring the symptoms that might be provoked. Not every patient is a good candidate for this type of assessment, and the provider might instead perform a “roll test,” during which a patient lies flat and the head is rapidly moved from side to side. Like the Dix-Hallpike test, this may reproduce vertigo symptoms and may be helpful in determining the underlying cause of the vertigo.

If the diagnosis of peripheral vertigo is uncertain, it may be necessary to consult a vestibular physical therapist to help make the diagnosis and also treat the patient at the same time.

Some cases of vertigo may require an MRI or CT scan of the brain and inner ears to exclude a structural problem like stroke, multiple sclerosis, or acoustic neuroma, a non-malignant tumor. In rare cases, a small opening or fistula is identified between the perilymphatic space of the inner ear and the middle ear, leading to vertigo or other symptoms such as tinnitus or hearing loss.

If hearing loss is suspected, audiometry (a hearing test) may be ordered. Hearing loss is not associated with BPPV or other common causes of vertigo. Electronystagmography, or electrical evaluation of vertigo, may help distinguish between peripheral and central vertigo but is not routinely performed.