Dizziness can be one of the more challenging aspects of outpatient neurology and I often work with other specialities including cardiologists and ENT surgeons. For some people this may be a feeling of light headedness or pre-syncope due to blood pressure changes.
Vertigo is a sensation of movement, spinning or rotation. This may be due to problems in the vestibular apparatus in the inner ear such as an infection “vestibular neuritis” or loose crystals causing BPPV that can respond dramatically to a simple Epley procedure. In others, there may be sensitivity in the brainstem where this information is processed. Patients may have severe episodic vertigo as part of the migraine spectrum that responds well to therapies.
Finally, information from the vestibular system is processed in the temporal lobes and is closely linked to emotion. Persistent vertigo may have effects on mood and anxiety and these patients may require additional support.
I try to avoid medications that only provide short-term relief and concentrate on identifying the causes and dealing with the problem, with referral for vestibular rehabilitation and medication if necessary.