Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Antivertigo medications and drug-induced vertigo. Dizziness: approach to evaluation and management. Acute dizziness, vertigo, and unsteadiness. TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls. Saber Tehrani AS, Kattah JC, Kerber KA, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Newman-Toker DE, Cannon LM, Stofferahn ME, et al. Clinical practice guideline: Ménière's disease. Misdiagnosing dizzy patients: Common pitfalls in clinical practice. Pharmacologic intervention is limited because it often affects the ability of the central nervous system to compensate for dizziness. Other etiologies of dizziness require specific treatment to address the cause. Vestibular rehabilitation is helpful in treating many peripheral and central etiologies. Canalith repositioning procedures (e.g., Epley maneuver) are the most helpful in treating benign paroxysmal positional vertigo. The treatment for dizziness is dependent on the etiology of the symptoms. Laboratory testing and imaging are usually not required but can be helpful. The physical examination may include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver (for patients with triggered dizziness), and the HINTS (head-impulse, nystagmus, test of skew) examination when indicated. Peripheral etiologies can cause significant morbidity but are generally less concerning, whereas central etiologies are more urgent. The differential diagnosis is broad and includes peripheral and central causes. Clinicians should focus on the timing of the events and triggers of dizziness to develop a differential diagnosis because it is difficult for patients to provide quality reports of their symptoms. In rare cases, the Epley maneuver will not relieve your symptoms and you will need to have surgery on the ear canal.Dizziness is a common but often diagnostically difficult condition. Most patients experience symptom relief after the Epley maneuver is performed. He or she may also recommend wearing a soft collar. In order to keep your head still, your doctor may recommend sleeping with two or more pillows to tilt your head to a 45-degree angle. Movements that could cause the crystals to dislodge include bending over too quickly, lying down too quickly, tilting your head or moving your head back and forth.
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