[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-209124-en":3,"doc-seo-209124-105":30,"detail-sidebar-cat-0-en-105":92},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},209124,1374391975076,"Riley","https://ap-avatar.wpscdn.com/avatar/14000253ca4ec9f6853?x-image-process=image/resize,m_fixed,w_180,h_180&k=1783305029341752051",7,"Healthcare","A Holistic Approach to a Dizzy Patient - A Practical Update","Dizziness is a frequent symptom in clinical practice and is categorized into vertigo, disequilibrium, presyncope, and psychogenic dizziness. Correctly separating these entities matters because causes, prognosis, and management differ. Vertigo may originate from central or peripheral nervous system disorders; central causes can be life-threatening. Peripheral etiologies include conditions such as vestibular migraine, BPPV, vestibular neuritis, Ménière’s disease, and cervical vertigo. The HINTS examination supports central-peripheral differentiation, while detailed history and stepwise clinical assessment guide diagnosis. A holistic strategy combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy improves quality of life.","Open Access Review  \nArticle DOI: 10.7759/cureus.27681  \nReview began 07/30/2022  \nReview ended 08/01/2022  \nPublished 08/04/2022  \n© Copyright 2022  \nKoukoulithras et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nA Holistic Approach to a Dizzy Patient: A Practical Update  \nIoannis Koukoulithras 1 , Gianna Drousia 2 , Spyridon Kolokotsios 2 , Minas Plexousakis 2 , Alexandra Stamouli 2 , Charis Roussos 2 , Eleana Xanthi 2  \n1. Department of Neurosurgery, Faculty of Medicine, University of Ioannina, Ioannina, GRC 2. Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC  \nCorresponding author: Ioannis Koukoulithras, [giannis1999kouk@hotmail.com](giannis1999kouk@hotmail.com)  \nAbstract  \nDizziness is one of the most common symptoms encountered by physicians daily. It is divided into four categories: vertigo, disequilibrium, presyncope, and psychogenic dizziness. It is essential to distinguish these four symptoms because the causes, prognosis, and treatment differ. Vertigo constitutes a disease of the central or peripheral nervous system. Central origin vertigo may be a life-threatening situation and must be detected as soon as possible because it includes diseases such as stroke, hemorrhage, tumors, and multiple sclerosis. Peripheral origin vertigo includes benign diseases, which may be fully treatable such as vestibular migraine, benign paroxysmal positional vertigo, vestibular neuritis, Ménière’s disease, and cervical vertigo. The HINTS (head impulse, nystagmus, test of skew) examination is essential to distinguish central from peripheral causes. A detailed history including the duration of vertigo (episodic or continuous), its trigger, and a clinical examination step by step following the appropriate protocol could help to make a definite and accurate diagnosis and treatment. Due to a lack of expertise in dizziness and inappropriate treatment, many patients are admitted to dizziness clinics with long-standing dizziness. A holistic treatment combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy should be initiated to improve the quality of life of these patients. So, this review aims to recommend a clinical protocol for approaching a dizzy patient with vertigo and to present in detail the epidemiology, pathophysiology, symptoms, diagnosis, and contemporary treatments of all causes of vertigo.  \nCategories: Neurology, Otolaryngology, Physical Medicine & Rehabilitation  \nKeywords: peripheral vertigo, chronic subjective dizziness, vestibular rehabilitation, cervical vertigo, meniere’s disease, central vertigo, vestibular neuritis, vestibular migraine, persistent dizziness, benign paroxysmal positional vertigo  \nIntroduction And Background  \nDizziness has been described as one of the foremost common medical conditions, affecting 15-35% of the overall population at some point in their lives [1] . In the United States, an estimated 7.5 million individuals with dizziness are examined in ambulatory care settings each year, and it is one of the most prevalent primary complaints in emergency departments [2] . Dizziness is often classified into four categories [1,2] :  \nvertigo, disequilibrium without vertigo, presyncope (near-faint), and psychophysiological dizziness, which is commonly related to anxiety and panic.  \nVertigo is a sensation of spinning or moving, either the person or the visual surrounding. Vertigo constitutes a disease of the central or peripheral nervous system [2] . In most cases, dizziness and vertigo occur in adult patients and a smaller percentage in young patients. These numbers explain why almost 20% of patients older than 60 years have experienced severe dizziness that affects their daily activities [2] .  \nThe differential diagnosis of verti","cbCaietKDoYSCMbw","https://ap.wps.com/l/cbCaietKDoYSCMbw","pdf",1296619,1,18,"English","en",105,"# Introduction And Background\n## Classification of dizziness\n## Central vs peripheral vertigo\n# HINTS and clinical assessment\n# Holistic management and clinical protocol","[{\"question\":\"How are dizziness symptoms categorized and why does it matter?\",\"answer\":\"Dizziness is divided into vertigo, disequilibrium, presyncope, and psychogenic dizziness. Distinguishing these categories is essential because causes, prognosis, and treatment differ.\"},{\"question\":\"What makes central vertigo potentially life-threatening and how can it be detected?\",\"answer\":\"Central origin vertigo may involve stroke, hemorrhage, tumors, or multiple sclerosis, requiring prompt detection. The HINTS examination helps distinguish central from peripheral causes.\"},{\"question\":\"What does a holistic treatment for chronic dizziness include?\",\"answer\":\"A holistic approach combines medications with vestibular rehabilitation, physiotherapy, and psychotherapy to improve patients’ quality of life.\"}]","A Holistic Approach to a Dizzy Patient - A Practical Update | PDF",1788609744,45,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":87,"head_meta":89,"extra_data":91,"updated_unix":28},"a-holistic-approach-to-a-dizzy-patient-a-practical-update","",{"@graph":36,"@context":86},[37,54,69],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/a-holistic-approach-to-a-dizzy-patient-a-practical-update/209124/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":23,"description":14,"dateModified":62,"datePublished":63,"encodingFormat":61,"isAccessibleForFree":64,"interactionStatistic":65},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-09-06","2026-09-05",true,{"@type":66,"interactionType":67,"userInteractionCount":20},"InteractionCounter",{"@type":68},"ViewAction",{"@type":70,"mainEntity":71},"FAQPage",[72,78,82],{"name":73,"@type":74,"acceptedAnswer":75},"How are dizziness symptoms categorized and why does it matter?","Question",{"text":76,"@type":77},"Dizziness is divided into vertigo, disequilibrium, presyncope, and psychogenic dizziness. Distinguishing these categories is essential because causes, prognosis, and treatment differ.","Answer",{"name":79,"@type":74,"acceptedAnswer":80},"What makes central vertigo potentially life-threatening and how can it be detected?",{"text":81,"@type":77},"Central origin vertigo may involve stroke, hemorrhage, tumors, or multiple sclerosis, requiring prompt detection. The HINTS examination helps distinguish central from peripheral causes.",{"name":83,"@type":74,"acceptedAnswer":84},"What does a holistic treatment for chronic dizziness include?",{"text":85,"@type":77},"A holistic approach combines medications with vestibular rehabilitation, physiotherapy, and psychotherapy to improve patients’ quality of life.","https://schema.org",{"og:url":52,"og:type":88,"og:title":13,"og:site_name":59,"og:description":14},"article",{"robots":90,"canonical":52},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":93},[94,98,102,106,111,116,119,124,129,132,136],{"id":20,"doc_module":4,"doc_module_name":46,"category_name":95,"show_sort_weight":96,"slug":97},"Story & Novel",90,"story-novel",{"id":47,"doc_module":4,"doc_module_name":46,"category_name":99,"show_sort_weight":100,"slug":101},"Literature",80,"literature",{"id":53,"doc_module":4,"doc_module_name":46,"category_name":103,"show_sort_weight":104,"slug":105},"Exam",70,"exam",{"id":107,"doc_module":4,"doc_module_name":46,"category_name":108,"show_sort_weight":109,"slug":110},5,"Comic",60,"comic",{"id":112,"doc_module":4,"doc_module_name":46,"category_name":113,"show_sort_weight":114,"slug":115},6,"Technology",50,"technology",{"id":11,"doc_module":4,"doc_module_name":46,"category_name":12,"show_sort_weight":117,"slug":118},40,"healthcare",{"id":120,"doc_module":4,"doc_module_name":46,"category_name":121,"show_sort_weight":122,"slug":123},8,"Research & Report",30,"research-report",{"id":125,"doc_module":4,"doc_module_name":46,"category_name":126,"show_sort_weight":127,"slug":128},9,"Religion & Spirituality",20,"religion-spirituality",{"id":127,"doc_module":4,"doc_module_name":46,"category_name":130,"show_sort_weight":127,"slug":131},"World Cup","world-cup",{"id":133,"doc_module":4,"doc_module_name":46,"category_name":134,"show_sort_weight":133,"slug":135},10,"Lifestyle","lifestyle",{"id":137,"doc_module":4,"doc_module_name":46,"category_name":138,"show_sort_weight":107,"slug":139},19,"General","general"]