Dizziness is seen frequently in patients in the family medicine and emergency department settings. The differential diagnosis of dizziness can be expansive but with a targeted history and physical examination, a correct diagnosis often can be established and appropriate treatment offered. Common etiologies of dizziness include hypotension, benign paroxysmal positional vertigo (BPPV), and Meniere disease. Strokes and malignancies also can cause this symptom. Imaging is indicated if intracranial pathology is suspected. BPPV typically is self-limited but maneuvers such as the Epley maneuver can be used for more rapid resolution. Meniere disease can be difficult to manage. First-line treatments are lifestyle and diet modification. Avoidance of triggers is important for patients with vestibular migraine. Some vestibular-suppressive drugs and anticonvulsants may be useful in the prevention and management of vestibular migraine. (This is an off-label use of some anticonvulsants.).
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