Vertigo—The practitioner's view

Dizziness and vertigo (International Classification of Disease-R42) are listed under the top 10 symptoms in an outpatient setting seeking advice by a primary care physician. The lifetime prevalence of dizziness/vertigo is reported to be up to 30% with a female preponderance. The incidence of dizziness and vertigo increases with age. Common findings of comorbidities like hypertension, lipid disorders and others pointing to arteriosclerosis in the elderly are associated with dizziness symptoms; however, a causal relationship is not uniformly given. Therefore the role of concomitant disease for dizziness in the elderly is still under discussion.

Epidemiological studies from specialised vertigo referral centers usually report specific diagnosis of vestibular vertigo. Their figures might well be different from an outpatient population. In line with these two reports (Neuhauser et al., 2005; Kruschinski et al., 2008) from different working groups investigating dizziness/vertigo in an outpatient population, we have come to the conclusion that 80% of all dizziness/vertigo (R42) cases present with unspecific symptoms. The symptoms might be feeling unsteady, a tendency to fall or feeling of staggering.

To date, little data are available on how to proceed further with this large group of patients presenting with unspecific vertigo symptoms. Undoubtedly referral to a specialist is mandatory if warning symptoms like additional neurologic findings or the new onset of symptoms suggest emergency cases. However, in most elderly patients the symptoms prevail for a longer time and daily activities might be restricted because of that. Given the multifactorial origin in most of the cases (visual, vestibular and somatosensoric disturbances) the dizziness with unspecific symptoms is a therapeutic challenge not well included in treatment guidelines.

Treatment strategies to date reach from ignorance from the physicians’ side over physiotherapeutic measures to complementary alternative medical approaches or drug-based therapies derived from experience with vestibular symptoms.

However, as most drugs prescribed for vestibular symptoms will have anticholinergic side effects, current guidelines do not recommend this group of antivertiginosa in the dizzy patient. Therefore there is still the quest for a safe, effective therapy. A complementary alternative medical approach might be an option in this unsolved problem for the practitioner.

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