Skip to Main Content




I got my giddiness in 1690 (at the age of 23) by eating 100 golden pippins at a time at Richmond. Four years later at a place 20 miles further on in Surrey I got my deafness; and these two ‘friends’ have visited me one or other year since, and being old acquaintances have often sought fit to come together.

Jonathan Swift (1667–1745), describing his Ménière syndrome


When patients complain of ‘dizziness’, they can be using this term to describe many different phenomena, and hence a careful history is required to unravel the problem. Other patients may use different terms to explain the same sensation, for example, ‘giddiness’, ‘swimming in the head’, ‘my brain spinning’, ‘whirling’ and ‘swinging’.


‘Dizzy’ comes from an old English word, dysig, meaning foolish or stupid. Strictly speaking, it means unsteadiness or lightheadedness—without movement or motion or spatial disorientation.


‘Vertigo’, on the other hand, comes from the Latin vertere (to turn) and -igo for a condition. It should describe a hallucination of rotation of self or the surroundings in a horizontal or vertical direction.1


The term ‘dizziness’, however, is generally used collectively to describe all types of equilibrium disorders and, for convenience, can be classified as shown in FIGURE 46.1.


Key facts and checkpoints

  • Approximately one-third of the population will have suffered from significant dizziness by age 65 and about a half by age 80.2

  • The commonest causes in family practice are postural hypotension and hyperventilation.

  • The ability to examine and interpret the sign of nystagmus accurately is important in the diagnostic process.

  • A drug history is very important, including prescribed drugs and others such as alcohol, cocaine, marijuana and illicit drugs.

  • Ménière syndrome is overdiagnosed. It has the classic triad: vertigo–tinnitus–deafness (sensorineural).

  • Vertebrobasilar insufficiency is also overdiagnosed as a cause of vertigo. It is a rare cause but may result in dizziness and sometimes vertigo but rarely in isolation.


Defined terminology




Vertigo is defined as an episodic sudden sensation of circular motion of the body or of its surroundings or an illusion of motion, usually a rotatory sensation. Other terms used by the patient to describe this symptom include ‘everything spins’, ‘my head spins’, ‘the room spins’, ‘whirling’, ‘reeling’, ‘swaying’, ‘pitching’ and ‘rocking’. It is frequently accompanied by autonomic symptoms such as nausea, retching, vomiting, pallor and sweating.


Vertigo is characteristically precipitated by standing or turning the head or by movement. Patients have to walk carefully and may become nervous about descending stairs or crossing the road and usually seek support. Therefore the vertiginous patient is usually very frightened and tends to remain immobile during an attack.


Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.