Dizziness and Light-headedness Management

Definitions and Differentiation

The American College of Cardiology defines light-headedness as a feeling of faintness or being about to pass out, while true dizziness (vertigo) involves a false sensation of spinning or movement 1
The Barany Society defines vertigo as a false sensation of self-motion and a false sensation that the visual surroundings are spinning or flowing 2
Light-headedness (Presyncope) specifically refers to symptoms before potential syncope, including extreme lightheadedness, visual sensations like "tunnel vision" or "graying out", and variable degrees of altered consciousness without complete loss of consciousness 1, 3

Light-headedness/Presyncope is often associated with orthostatic changes, palpitations, tremulousness, generalized weakness, blurred vision, and is related to cardiovascular causes or orthostatic hypotension 1, 3
Vertigo is characterized by a distinct spinning or rotational sensation, often accompanied by nausea, vomiting, and difficulty with balance, and may be triggered by specific head positions or movements 2, 4, 5

Orthostatic hypotension, cardiac arrhythmias, medication side effects, dehydration, and anxiety or panic disorders are common causes of light-headedness/presyncope 1, 3, 6
Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, labyrinthitis, Ménière's disease, and vestibular migraine are common causes of vertigo 2, 4, 5

Orthostatic blood pressure measurements and cardiac evaluation are important for diagnosing light-headedness/presyncope 1, 3
Examination for nystagmus, Dix-Hallpike maneuver, and hearing assessment are important for diagnosing vertigo 2, 4, 5

Volume depletion should be treated with hydration and electrolyte replacement 3
Anxiety-related light-headedness should be treated with cognitive behavioral therapy, breathing exercises, and anxiolytics if necessary 6
BPPV should be treated with canalith repositioning procedures (Epley maneuver) 5
Vestibular migraine should be treated with migraine prophylaxis medications 2, 5

Prolonged use of vestibular suppressant medications should be avoided as they can delay central compensation and recovery 8
"Red flags" suggesting central causes of vertigo include new headache, neurological symptoms, vertical nystagmus, and inability to stand/walk 5, 7
Elderly patients are more likely to have multiple contributing factors to dizziness and higher risk of falls 5, 8