Dizziness and vertigo assessment (Assessment of dizziness and vertigo)
An assessment to work out what is causing dizziness or vertigo, to tell common inner-ear causes from rarer serious ones, and to guide treatment.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- The assessment works out what type of dizziness you have and what is causing it, from common inner-ear causes to rarer serious ones.
- Most dizziness is due to common, treatable causes, but certain warning signs point to serious problems that need urgent care.
- How long episodes last, what triggers them, and which other symptoms occur are key to the diagnosis, alongside examination.
- Many causes are diagnosed clinically; scans are used selectively, mainly when a serious cause is suspected.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Clarifies what type of dizziness you have and what is causing it
Dizziness with stroke-like warning signs – sudden severe headache, slurred speech, weakness, double vision or inability to walk – which needs emergency...
You describe your symptoms and are examined. Position or eye-movement tests may briefly bring on dizziness. Often a likely cause is identified the same...
A clear explanation of the likely cause and a plan matched to it.
You describe your symptoms and are examined. Position or eye-movement tests may briefly bring on dizziness. Often...
For BPPV, a repositioning manoeuvre may be done there and then, which can settle symptoms quickly, though it...
A hearing test, blood tests, heart tracing or brain scan may be arranged where needed, and are reported separately.
Depending on the cause, this may be vestibular rehabilitation exercises, adjusting medicines, treating an...
What is a dizziness and vertigo assessment?
Dizziness is a broad word that can mean different things – a spinning sensation (vertigo), feeling faint or light-headed, or feeling off-balance. A dizziness and vertigo assessment is used to work out which type you have and what is causing it. Many causes are common and not dangerous, such as benign paroxysmal positional vertigo (BPPV), inner-ear inflammation (labyrinthitis or vestibular neuronitis), Meniere's disease, vestibular migraine, low blood pressure, anxiety or medicine side effects. Occasionally, though, dizziness can be a sign of something serious, such as a problem with the brain's blood supply.
Much of the assessment is talking and examination. The key questions are what 'dizziness' actually feels like to you, how long episodes last, what triggers them, and whether there are other symptoms such as hearing changes, headache, or neurological symptoms. The clinician examines your eyes, ears, balance and, where relevant, your nervous system, and may use position tests such as the Dix-Hallpike test for BPPV, or specific eye-movement tests to help tell inner-ear causes from rarer central ones.
The assessment gathers information and guides treatment; it is not itself a treatment. A major aim is to separate common, treatable inner-ear causes from the rarer serious causes that need urgent attention, and to recognise the warning signs that point to them.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Common inner-ear vertigo compared with warning-sign vertigo
| Feature | Common inner-ear causes | Possible serious cause |
|---|---|---|
| Trigger | Often head position or movement | Can be sudden and constant |
| Other symptoms | Hearing change, nausea | Slurred speech, weakness, double vision |
| Walking | Unsteady but able | New severe imbalance, unable to walk |
| Headache | Usually mild or none | Sudden severe headache or neck pain |
| Eye tests | Pattern fits inner ear | Pattern suggests central cause |
Most dizziness is from common inner-ear causes, but the features on the right can point to a serious problem such as a stroke and need urgent assessment. If in doubt, seek urgent help rather than wait.
Preparing for your test
- Try to describe what 'dizziness' actually feels like – spinning, faint, or off-balance – as this guides everything.
- Note how long episodes last (seconds, minutes, hours or days) and what brings them on or eases them.
- Mention other symptoms, such as hearing loss, ringing in the ears, headache, or any weakness or speech problems.
- Bring a list of your medicines, as some cause dizziness or low blood pressure.
- Note any recent ear infections, head injury, or migraines.
- If episodes are triggered by position, be ready for position tests that may briefly bring on the dizziness.
- Write down your questions, including what the likely cause is and what would need urgent attention.
What happens
The clinician spends time understanding exactly what you mean by dizziness, because the word covers very different sensations. They ask how long episodes last, what triggers them – such as rolling over in bed, standing up, or certain movements – and whether you have other symptoms such as hearing changes, ringing in the ears, headache, or any weakness, numbness or speech problems.
They then examine you. This usually includes watching your eye movements, checking your ears, testing your balance and walking, and often measuring your blood pressure lying and standing. If your symptoms suggest BPPV, they may do a position test such as the Dix-Hallpike, where your head is moved into set positions while they watch your eyes for the brief, characteristic flicker. In sudden, continuous vertigo, specific eye-movement tests help tell common inner-ear causes from rarer central ones.
Depending on the findings, further tests such as a hearing test, blood tests, a heart tracing or a brain scan may be arranged, used selectively rather than routinely. Often the likely cause can be identified the same day, with a plan to treat it – for example a repositioning manoeuvre for BPPV, or vestibular rehabilitation exercises. If warning signs of a serious cause are present, urgent assessment is arranged instead.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Dizziness with stroke-like warning signs – sudden severe headache, slurred speech, weakness, double vision or inability to walk – which needs emergency care, not a routine clinic.
- As a way to obtain a brain scan when the history and examination clearly point to a common inner-ear cause.
- As a substitute for reviewing medicines or blood pressure that may be causing the dizziness.
- When fainting or palpitations suggest a heart cause that needs a different assessment.
Delay or rearrange if…
- You are acutely unwell, for example with a severe infection, which should be treated first.
- You have just started or changed a medicine that can cause dizziness, so the picture may settle.
- Symptoms are very intermittent and you have no episode or trigger to demonstrate on the day.
- Key information is missing, such as a description of the sensation, triggers, or a medicines list.
Alternatives to discuss
- Initial assessment by a GP, who can diagnose and treat many common causes and refer if needed.
- Reviewing or adjusting medicines and managing low blood pressure before specialist referral.
- Vestibular rehabilitation exercises for ongoing balance symptoms.
- Referral to a balance clinic, ENT or neurology for unclear or persistent cases.
- Treating an underlying cause such as migraine or anxiety rather than the dizziness alone.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Clarifies what type of dizziness you have and what is causing it
- Separates common, treatable inner-ear causes from rarer serious ones
- Can lead to immediate treatment, such as a repositioning manoeuvre for BPPV
- Identifies contributing factors such as medicines, low blood pressure or anxiety
- Reassures many people that their dizziness is not dangerous
- Flags warning signs that need urgent attention
Risks & complications
- Position tests can briefly bring on the dizziness or nausea you are being assessed for
- The cause not being fully clear after one appointment, especially with vague symptoms
- Symptoms varying from day to day, making them harder to pin down
- Needing further tests or a follow-up before the cause is confirmed
- An inner-ear and a non-ear cause (such as anxiety or low blood pressure) overlapping
- An unexpected finding that leads to further investigation
- Needing referral to a balance clinic or specialist for less clear cases
- A serious central cause being mistaken for an inner-ear problem if warning signs are subtle
- False reassurance if an evolving condition is not yet apparent
The assessment itself is talking and examination, so it carries no real physical risk, though position tests may briefly trigger the dizziness. The most important issue is not missing the small number of serious causes, such as a stroke affecting balance, which can occasionally mimic an inner-ear problem. Be clear about any warning signs – sudden severe headache, slurred speech, weakness, double vision or being unable to walk – and ask what would need urgent attention.
Published figures to discuss
The assessment itself causes no physical harm, so the meaningful uncertainty is diagnostic, and the most important question is whether a rare but serious central cause is being missed. Bedside eye-movement testing helps separate common inner-ear causes from central ones in sudden, continuous vertigo, but it is not perfect and depends on who performs it and when. The figures below come from research and apply mainly to the acute setting; they explain why warning signs and review matter rather than giving a fixed accuracy for every patient.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| HINTS bedside eye-movement testing for a central cause (in acute continuous vertigo) | Sensitivity reported around 90% and specificity around 84% in study settings | Helpful but not perfect, and reliability depends on the examiner and the timing. | HINTS for posterior circulation stroke in acute vestibular syndrome (systematic review) – PMCpmc.ncbi.nlm.nih.govPublished figure |
| Dizziness as a presentation of posterior circulation stroke | Around 5-10% of these strokes present with acute dizziness | Uncommon, but the reason warning signs are taken seriously even when an inner-ear cause seems likely. | HINTS for posterior circulation stroke in acute vestibular syndrome (systematic review) – PMCpmc.ncbi.nlm.nih.govPublished figure |
| BPPV recurrence | Common after successful repositioning | Recurrent positional vertigo may need repeat manoeuvres; persistent neurological symptoms need reassessment. | HINTS for posterior circulation stroke in acute vestibular syndrome (systematic review) – PMCpmc.ncbi.nlm.nih.govSource-linked context |
| False reassurance from a normal early scan | Recognised in posterior circulation stroke | Severe acute continuous vertigo with neurological signs, new headache or vascular risk needs urgent assessment even if early imaging is negative. | HINTS for posterior circulation stroke in acute vestibular syndrome (systematic review) – PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is nothing to recover from physically, though position tests may leave you briefly dizzy or queasy. What matters afterwards is knowing the likely cause, starting any treatment, and understanding which symptoms would need urgent attention.
- Brief dizziness or nausea after position tests, which usually settles
- No lasting after-effects from the assessment itself
- Gradual improvement with treatment such as repositioning or exercises, rather than instant cure
- Symptoms that fluctuate while a cause is confirmed or treated
- Being asked to return if symptoms persist or the cause is unclear
Aftercare
- Make sure you understand the likely cause and the plan to treat it.
- If you are given vestibular rehabilitation exercises, do them as advised, as they often work gradually.
- If a repositioning manoeuvre is done for BPPV, follow any after-care advice and know it may need repeating.
- Review medicines that may contribute to dizziness with your usual clinician.
- Take care with activities such as driving, ladders or swimming until your dizziness is controlled.
- Know the warning signs that mean you should seek urgent help rather than wait.
- Use reliable information rather than relying on adverts for balance gadgets or supplements.
- A clear description of what your dizziness feels like and how long it lasts
- A note of triggers and anything that helps
- A list of other symptoms, especially hearing or neurological ones
- An up-to-date list of medicines
- A note of recent ear infections, head injury or migraines
- Your questions about the cause and what would need urgent attention
- Knowing how and when you will get any test results
⚠ Get urgent help if…
- Sudden severe headache or neck pain with the dizziness – seek urgent help
- Slurred speech, facial droop, or weakness or numbness on one side – call 999 for possible stroke
- Double vision, loss of vision, or difficulty swallowing
- New severe unsteadiness so that you cannot walk or stand
- Fainting, blacking out, or chest pain or palpitations with the dizziness
- Sudden hearing loss in one or both ears with vertigo
- Any symptom your clinician told you to treat as urgent
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A useful result is a clear idea of what type of dizziness you have and its likely cause, with a plan to treat it. For many people this is a common, treatable inner-ear cause such as BPPV, which may even settle with a repositioning manoeuvre during the appointment. A key part of the result is reassurance that warning signs of a serious cause are absent, or, if they are present, that urgent assessment is arranged.
It is important to be realistic. Dizziness can be hard to pin down, more than one cause can coexist, and the picture is not always clear after one visit. Examination and bedside eye-movement tests are good at telling common inner-ear causes from rarer central ones, but they are not perfect, which is why warning signs and review matter. A normal assessment is reassuring but does not guarantee that symptoms will not need revisiting if they change.
A dizziness assessment reflects the situation at the time. Some causes, such as a single bout of inner-ear inflammation, settle and do not return; others, such as BPPV, Meniere's disease or vestibular migraine, can recur and may need treatment again. The assessment and plan may therefore need revisiting if symptoms come back or change. Where dizziness is linked to medicines, blood pressure or anxiety, managing these over time affects how the symptoms behave.
Related tests, treatments or support
A dizziness and vertigo assessment is often combined with hearing tests, blood pressure checks, a heart tracing, or blood tests, depending on the suspected cause. A brain scan is used selectively, mainly when a serious cause is suspected. Treatment may include repositioning manoeuvres for BPPV, vestibular rehabilitation exercises, medicine review, or managing migraine, blood pressure or anxiety, each discussed as part of the plan.
Follow-up & long-term care
After the assessment you should know the likely cause and the plan. For BPPV, you may be reviewed to check a repositioning manoeuvre has worked, as it sometimes needs repeating. For other causes, follow-up checks whether treatment or exercises are helping. If the cause is unclear or symptoms persist, referral to a balance clinic or specialist may be arranged. You should know which symptoms mean you should seek urgent help.
- Continuing vestibular rehabilitation exercises if they are helping
- Repeat repositioning manoeuvres if BPPV returns
- Managing contributing factors such as medicines, blood pressure or anxiety
- Treating recurrent conditions such as Meniere's disease or vestibular migraine over time
- Reassessment if dizziness returns, changes, or new symptoms appear
Repeat, follow-on and what comes next
- BPPV repositioning manoeuvres often need repeating, and BPPV can return.
- A cause not clear at first may become apparent on review or with further tests.
- More than one cause can coexist, so the plan may be adjusted over time.
- Recurrent conditions such as Meniere's disease or vestibular migraine need ongoing management.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of the likely cause and a plan matched to it.
- Treatment where possible, such as a repositioning manoeuvre or rehabilitation exercises, with realistic expectations.
- Attention to contributing factors such as medicines, blood pressure or anxiety.
- A named contact and clear warning signs that should prompt urgent help.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The length and complexity of the consultation
- Whether it is with a GP, audiologist, ENT specialist or neurologist
- Whether hearing tests or specialist balance tests are used
- Blood tests, a heart tracing or a brain scan if needed, charged separately
- Whether treatment such as a repositioning manoeuvre is included
- Any follow-up appointments, vestibular rehabilitation, or onward referral
- Reports or letters requested for other purposes
- The consultation fee and what it covers
- Whether examination and any repositioning manoeuvre are included
- Whether hearing or balance tests are included or charged separately
- The cost of blood tests, a heart tracing or a brain scan if needed, with reporting
- The cost and timing of any follow-up or vestibular rehabilitation
- What happens, and what it costs, if the cause is unclear and further tests are needed
- The cancellation policy
On the NHS? Dizziness and vertigo assessment is available on the NHS when clinically indicated, often starting with a GP, with referral to a balance clinic or specialist if needed; private assessment may be used for speed, choice or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Labelling dizziness as a harmless inner-ear problem without checking for warning signs.
- Ordering, or withholding, a brain scan without explaining why.
- Not reviewing medicines or blood pressure that could be causing the dizziness.
- Not explaining that treatments such as repositioning or exercises often work gradually or need repeating.
- Not setting out which symptoms would need urgent attention.
Marketing red flags
- Promising a quick cure for all dizziness regardless of the cause.
- Selling brain scans or extensive tests as routine for every dizzy patient.
- Promoting balance gadgets or supplements as proven treatments.
- Downplaying warning signs that should prompt urgent assessment.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What type of dizziness do I have, and what is the likely cause?
- Is this an inner-ear problem, and could anything more serious be involved?
- Do I need any tests or a scan, and what would they change?
- Can it be treated today, for example with a repositioning manoeuvre, or with exercises?
- What warning signs should make me seek urgent help?
- Could my medicines, blood pressure or anxiety be contributing?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is dizziness usually a sign of something serious?
What is BPPV, and can it be treated quickly?
Will I need a brain scan?
Why do the position tests make me feel worse?
What dizziness needs urgent help?
Is a dizziness assessment available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS – Dizziness NICE CKS – Vertigo HINTS for posterior circulation stroke in acute vestibular syndrome (systematic review) – PMC Central vertigo – StatPearls (NIH)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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