Balance differentials

Cause	Description	Management
Benign Paroxysmal Positional Vertigo (BPPV)	Brief episodes of dizziness triggered by specific head movements, such as rolling over in bed or looking up. Inner ear debris affecting balance organs is often the cause.	Management typically involves Canalith repositioning manoeuvres (e.g., Epley manoeuvre) to move the inner ear debris out of the semicircular canal. Vestibular rehabilitation exercises may also be provided by the GP or referral to an audiologist.
Meniere's Disease	Recurrent episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness or pressure in the ear. Believed to be due to abnormal fluid build-up in the inner ear.	Medications to control acute symptoms (e.g. prochlorperazine, cinnarizine), vestibular rehabilitation exercises. For recurrent attacks trial betahistine, for a length of time in accordance to patient’s response.
Vestibular Neuritis	Sudden onset of severe vertigo, often with nausea and vomiting, without hearing loss. Caused by inflammation of the vestibular nerve, typically due to a viral infection.	Management focuses on symptom relief with medications for nausea and vestibular suppressants (e.g., antihistamines - prochlorperazine, cinnarizine) during the acute phase. Vestibular rehabilitation exercises may be beneficial in the recovery phase to promote compensation.
Labyrinthitis	Similar to vestibular neuritis but with additional symptoms of hearing loss and possibly tinnitus. Caused by inflammation of the inner ear structures, often due to infection.	Management is similar to vestibular neuritis and may include medications for symptom relief, such as vestibular suppressants and corticosteroids during the acute phase, as well as vestibular rehabilitation exercises for long-term recovery and compensation.
Migraine-Associated Vertigo (MAV)	Vertigo or dizziness associated with migraines. Often accompanied by headache, sensitivity to light and sound, and nausea. Believed to be related to abnormal processing of sensory information in the brain.	Management involves migraine-specific treatments such as medications (e.g., triptans, antiemetics), lifestyle modifications (e.g., stress management, regular sleep patterns), and avoidance of triggers known to precipitate migraines. Vestibular rehabilitation therapy may also be helpful.
Orthostatic Hypotension	Dizziness or light-headedness upon standing up, often due to a drop in blood pressure. Can be caused by dehydration, medications, or underlying medical conditions affecting the autonomic nervous system.	Management includes lifestyle modifications (e.g., increasing fluid and salt intake, avoiding alcohol), wearing compression stockings, adjusting medications that may contribute to low blood pressure, and implementing counter-pressure manoeuvres (e.g., tensing leg muscles when standing) to improve blood flow.
Motion Sickness	Dizziness, nausea, and vomiting triggered by motion, such as travel in cars, boats, or airplanes. Caused by conflicting sensory signals to the brain regarding motion and position	Management strategies include medications (e.g., antihistamines, anticholinergics), acclimatization techniques (gradual exposure to motion), behavioural therapies (e.g., focusing on a fixed point), and using supportive measures like wearing wristbands or patches.
Anxiety or Panic Attacks	Dizziness or light-headedness often accompanied by palpitations, sweating, and feelings of impending doom. Typically related to acute stress or panic disorder.	Management involves cognitive-behavioural therapy (CBT), relaxation techniques (e.g., deep breathing, progressive muscle relaxation), medication (e.g., selective serotonin reuptake inhibitors, benzodiazepines), and addressing underlying stressors or triggers through therapy or lifestyle changes.
Hyperventilation Syndrome	Dizziness, light-headedness, and tingling sensations in the extremities due to rapid or shallow breathing, leading to changes in blood chemistry. Often associated with anxiety or panic attacks.	Management focuses on addressing breathing patterns through techniques such as paced breathing, rebreathing into a paper bag (for acute episodes), relaxation exercises, and CBT to modify dysfunctional breathing patterns and reduce anxiety.
Medication Side Effects	Dizziness as a side effect of certain medications, including blood pressure medications, sedatives, antidepressants, and antipsychotics, among others.	Management involves reviewing and adjusting medications under the guidance of a healthcare professional. Depending on the medication and severity of symptoms, alternatives may be considered, dosage adjustments made, or additional medications prescribed to alleviate dizziness.
Neurological Disorders	Dizziness can be a symptom of various neurological conditions, including multiple sclerosis, Parkinson's disease, and stroke.	Management depends on the specific neurological disorder and may involve medications to manage symptoms, physical therapy for balance and coordination, lifestyle modifications, and in some cases, surgical interventions or other specialized treatments targeted at the underlying condition.
Cardiovascular Disorders	Conditions affecting blood flow to the brain, such as carotid artery stenosis, arrhythmias, or transient ischemic attacks (mini-strokes), can cause dizziness.	Management varies based on the underlying cardiovascular disorder and may include medications to control blood pressure or heart rate, lifestyle modifications (e.g., diet, exercise), surgical interventions (e.g., carotid endarterectomy), and addressing any contributing factors such as smoking or high cholesterol.
Inner Ear Disorders (Other than BPPV)	Conditions affecting the inner ear, such as vestibular migraine, Meniere's disease, and vestibular neuritis/labyrinthitis, can lead to recurrent episodes of vertigo or chronic dizziness.	Management depends on the specific inner ear disorder but may include a combination of medications (e.g., diuretics, vestibular suppressants), lifestyle modifications, vestibular rehabilitation exercises, and in some cases, surgical interventions or other specialized treatments targeted at the underlying cause.
Cervical Vertigo	Dizziness or imbalance triggered by certain head movements or neck positions, often due to dysfunction or injury in the cervical spine (neck).	Management may include physical therapy for cervical spine stabilization and strengthening exercises, postural training, ergonomic adjustments, and pain management strategies (e.g., medications, heat therapy) to address underlying cervical spine issues contributing to vertigo.
Hypoglycaemia	Low blood sugar levels can cause dizziness, weakness, and confusion. It is often associated with diabetes but can occur in individuals without diabetes as well.	Management involves addressing the underlying cause of hypoglycaemia, such as adjusting diabetes medications or insulin doses, consuming fast-acting carbohydrates to raise blood sugar levels (e.g., glucose tablets, fruit juice), and implementing dietary changes and monitoring to prevent future episodes.
Dehydration	Inadequate fluid intake leading to dehydration can cause dizziness, weakness, and confusion.	Management focuses on rehydration through oral fluids or, in severe cases, intravenous.