Vertigo - Diagnosing vertigo

Your GP will ask you about your symptoms and carry out some simple tests to help differentiate between vertigo and general dizziness.

In some cases, you may be referred for some further tests.

Important questions

To make an accurate diagnosis of vertigo, your GP will want to know:

• details of the first episode of your symptoms
• what symptoms you had – for example, whether you felt lightheaded or if you or your surroundings were spinning
• how often your symptoms occur
• how long your symptoms usually last for
• if your symptoms are associated with hearing loss, tinnitus, nausea, vomiting or fullness in the ear
• if your symptoms are affecting your daily activities – for example, whether you're unable to walk during an episode of vertigo
• whether anything triggers your symptoms or makes them worse, such as moving your head in a particular direction
• what makes your symptoms better 

You may be asked a number of further questions to help determine the cause of your vertigo, such as:

• if you are you taking any medication
• if you have a family history of migraines (severe headaches) or Ménière's disease (a rare disorder that affects the inner ear)
• if you have recently had an ear infection or head injury

Physical examination

Your GP may also carry out a physical examination to check for signs of conditions that may be causing your vertigo. This could include looking inside your ears and checking your eyes for signs of uncontrollable movement (nystagmus).

Your GP may check your balance or try to recreate your symptoms using a test such as Dix-Hallpike's manoeuvre.

Dix-Hallpike's manoeuvre

Dix-Hallpike's manoeuvre is a test that can bring on the symptoms of vertigo. It's often used to confirm cases of benign paroxysmal positional vertigo (BPPV).

The test involves moving quickly from a sitting to a lying position, with your head below the horizontal line of the surface that you're lying on. As you lie back, you'll be asked to rotate your head towards the person testing you, keeping your eyes open.

In cases of BPPV, the symptoms of vertigo may appear for several seconds before disappearing. This may be corrected immediately by a corrective manoeuvre called Epley's manoeuvre (see treating vertigo for more information about this).

Further tests

Depending on your symptoms, your GP may refer you to a hospital or specialist for further tests.

Hearing tests

If you have tinnitus (ringing in your ears) or hearing loss, your GP may refer you to an ear, nose and throat (ENT) specialist who can carry out some hearing tests. 

Some possible hearing tests that you might have are:

• an audiometry test – a machine called an audiometer produces sounds of different volume and pitch. You listen to the sounds through headphones and signal when you hear a sound, either by raising your hand or pressing a button.
• tuning fork test – a tuning fork produces sound waves at a fixed pitch when it's gently tapped. The tester will tap the tuning fork before holding it at each side of your head.

Read more about how hearing tests are carried out.

Electronystagmography 

Electronystagmography (ENG) is sometimes used to check for signs of nystagmus in more detail. Nystagmus can indicate a problem with the organs that help you balance.

During this test, special goggles are placed over your eyes and you will be asked to look at various still and moving targets.

In some cases, these goggles are fitted with a video camera to record the movements of your eyes. This is known as videonystagmography (VNG).

Caloric testing

A caloric test involves running warm or cool water into your ear for about 30 seconds. The change in temperature stimulates the balance organ in the ear, allowing the specialist to check how well it's working.

This test is not painful, although it is normal to feel dizzy for a couple of minutes afterwards.

Posturography

A machine to test your balance may be used to give valuable information about how you are using your vision, proprioception (sensations from your feet and joints) and the input from your ear to maintain balance. This may help to plan rehabilitation as well as monitor your treatment.

Scans

In some cases, a scan of your head may be used to look for the cause of your vertigo, such as an acoustic neuroma (a non-cancerous brain tumour).

Usually, either a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan is used. An MRI scan uses a strong magnetic field and radio waves to produce a detailed image of the inside of your head, whereas a CT scan uses a series of detailed X-rays to create an image.