Ask a dizzy patient to describe the timing before they describe the sensation

The traditional opening question - is it spinning, or light-headedness, or unsteadiness - is the least reliable part of the history. Patients change their answer on re-asking, the categories overlap in most languages, and the same description turns up in vestibular neuritis, orthostatic hypotension and anxiety alike.

Timing and triggers separate the syndromes far better. Ask when it started, whether it is continuous or in episodes, how long an episode lasts, and what brings it on. Continuous for days points one way; seconds on rolling over in bed points another; minutes to hours with hearing symptoms points somewhere else again. That framing is what tells you which examination to do, which is the decision that actually follows.

The habit worth building is asking timing and trigger before sensation, and writing both in the note. It takes no longer, and it is the difference between a bedside examination chosen on purpose and one performed out of reflex.

• Ask when it started, whether it is constant or episodic, and how long episodes last.
• Ask what provokes it - position change, standing, head turning, or nothing.
• Record timing and trigger explicitly; the sensation word adds little.
• Let the timing pattern choose the examination rather than performing every test.
• Ask about hearing change and headache in the same breath, since both redirect the diagnosis.

Why it matters

The examination you choose follows from the timing pattern, and asking for the sensation first sends most clinicians down the wrong one.

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