Dizzy Diagnostics

Your patient isn’t HIDING things from you, they may just not see the connection.

Things patients rarely volunteer because they don’t know they’re relevant:
👉🏼Motion sickness: boats, cars, amusement rides, video games
👉🏼Hx of stomach issues as a child
👉🏼Habits that may have quietly changed (avoiding big grocery stores, wearing sunglasses more often, not driving long distances, not going to public events because of the crowds)
👉🏼hormonal changes. Menstrual cycle, birth control changes, pregnancy/postpartum, perimenopause
👉🏼Life happenings. Stressful events, sicknesses, change in routines
👉🏼Changes in sleep quality
👉🏼Changes in diet or hydration
👉🏼Medication changes
👉🏼 Other symptoms: neck pain, nausea, pre-syncope, sensation changes, other ear symptoms, visual changes, etc

This takes time and we usually aren’t getting through all of these topics in one visit.

What would you add??

We are using part 2 to highlight some of the not-so-obvious questions that need to be asked during a vestibular eval.

💤 Sleep quality: avg hours slept, frequency of waking, history of sleep apnea, daytime fatigue
🍔 Diet: frequency of eating, nutritional density of foods, eating enough?
💧Hydration: total amount of water, water distribution during day
☕️ Caffeine: how much, how often
🚶🏿Activity levels: sitting for long periods? Activity avoidance?
🏋🏽‍♀️Exercise: type, frequency, symptom response to exercise

Some of the questions that can be harder to ask:
😓 Psychological history: anxiety, depression, PTSD
😓 Stress levels: personal, work, financial, etc
😓 Life events: job loss, death in family, etc.

These things may seem unrelated, but when dealing with dizziness (especially chronic!), it all matters.

Build these topics into your evaluation template so you never miss a detail that could make a difference!

START YOUR SUBJECTIVE STRONG!

Here are some of our top questions about dizziness we ask every patient:

Quality: “What does it feel like? Describe your dizziness without saying dizzy.”
Frequency: “Is is always there, or does it come and go?”
Timing: “How long does it last? Seconds, minutes, hours, days?”
Triggers: “Do you notice any triggers? Movements, visual input, diet, weather, stress, etc?”
Relieving factors: “What makes it better? Holding still, gentle movement, medication, etc?”
Other otologic symptoms: hearing changes, aural fullness, tinnitus, otalgia

Specific questions we ask to differentiate between BPPV and vestibular migraine:
- History of migraine
- Family history of migraine
- History of motion sickness
- Sensitivity to light, sound, smell
- Headaches or other sensations
Presence of these means it’s likely not JUST BPPV!

Use these questions to build a solid subjective history.. this will make differential diagnosis MUCH easier!

Do you follow a template for subjective history during a vestibular eval, or do you wing it???