Dizziness and vertigo triage

Office-first approach to dizziness/vertigo that prioritizes stroke and cardiac red-flag exclusion.

Last reviewed February 7, 2026

Red flags

Acute focal neurologic deficit, severe ataxia, or persistent central-vertigo concern.
Syncope, chest pain, or arrhythmia concern accompanying dizziness.
Progressive severe symptoms with inability to ambulate safely.

Establish timing and triggers: continuous acute symptoms, spontaneous episodes, or brief position-triggered vertigo; symptom quality alone is insufficient.
Review orthostatic vitals, medication contributors, and hydration status.
Check focal neurologic findings, gait stability, and cardiovascular warning features.

Stabilize immediate contributors such as dehydration or medication-related hypotension.
Use outpatient workup after a reassuring syndrome-specific assessment. HINTS is limited to trained clinicians evaluating an acute vestibular syndrome with nystagmus; head CT does not reliably exclude posterior stroke.
Confirm typical positional BPPV with appropriate positional testing before Epley treatment; acute persistent vertigo without a secure peripheral diagnosis needs urgent assessment.
Document escalation criteria if symptoms persist, worsen, or change pattern.

Arrange close follow-up for unresolved dizziness within a defined interval.
Escalate for recurrent syncope, neurologic progression, or new cardiopulmonary concerns.
Ensure explicit return precautions for stroke-like symptoms and sudden deterioration.

Something out of date or unclear? Suggest an update. Leave out any patient details.