Dizziness Treatment in General Practice_ A Primary Care Approach

Dizziness Treatment in General Practice: A Primary Care Approach

General Practitioners (GPs) play a crucial role in the initial assessment and management of dizziness. As the first point of contact for many patients, GPs need to employ a systematic approach to diagnose and treat this common yet complex symptom. Here's a guideline for dizziness treatment in a GP setting:

Initial Assessment:

Detailed history taking: Onset, duration, triggers, associated symptoms

Differentiating between vertigo, lightheadedness, and imbalance

Reviewing medications that may cause dizziness as a side effect

Assessing for red flags indicating serious underlying conditions

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Physical Examination:

Vital signs, including orthostatic blood pressure measurements

Neurological examination, including cranial nerves

Otoscopic examination

Simple balance tests (e.g., Romberg test, tandem gait)

Dix-Hallpike maneuver for suspected BPPV

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Common Causes and Their Management:

a) Benign Paroxysmal Positional Vertigo (BPPV):

Teach and perform Epley maneuver

Provide instructions for home exercises (e.g., Brandt-Daroff exercises)

b) Vestibular Neuritis/Labyrinthitis:

Short-term vestibular suppressants (e.g., meclizine)

Consider short course of oral corticosteroids

Advise on gradual return to normal activities

c) M茅ni猫re's Disease:

Lifestyle modifications (low-salt diet, avoid caffeine and alcohol)

Prescribe diuretics if appropriate

Consider referral to ENT for further management

d) Migraine-Associated Vertigo:

Identify and avoid triggers

Prescribe migraine prophylaxis if frequent episodes

Consider vestibular migraine in recurrent vertigo with migraine history

e) Anxiety-Related Dizziness:

Cognitive-behavioral techniques

Consider short-term anxiolytic medication

Referral for psychological support if needed

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Medication Management:

Prescribe antihistamines (e.g., meclizine, dimenhydrinate) for symptomatic relief

Antiemetics for associated nausea (e.g., ondansetron)

Careful use of benzodiazepines for acute, severe vertigo (short-term only)

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Patient Education:

Explain the likely cause of dizziness

Provide reassurance when appropriate

Advise on fall prevention and safety measures

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Vestibular Rehabilitation:

Provide basic vestibular exercises for suitable patients

Consider referral to physiotherapy for specialized vestibular rehabilitation

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Lifestyle Advice:

Encourage adequate hydration

Advise on sleep hygiene

Recommend gradual increase in physical activity as tolerated

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Follow-up and Monitoring:

Schedule follow-up appointments to assess progress

Adjust treatment plan based on response

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Referrals:

ENT for persistent or complex cases

Neurology if neurological symptoms are present

Cardiology for suspected cardiovascular causes

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Investigations:

Basic blood tests to rule out anemia, electrolyte imbalances, or thyroid dysfunction

Consider further investigations (e.g.