The Curbsiders Internal Medicine Podcast #505 Demystifying Dizziness with Dr. David Hale
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Nov 17, 2025 Join Dr. David Hale, a neurologist and expert in vestibular disorders from Johns Hopkins, as he unpacks the complexities of dizziness. He clarifies the differences between dizziness and vertigo, emphasizing the importance of timing and triggers. Learn how to effectively perform diagnostic maneuvers like Dix-Hallpike and the HINTS-Plus exam for accurate assessments. Dr. Hale also covers chronic dizziness approaches and treatment strategies for conditions like PPPD, offering practical insights to navigate this often bewildering symptom.
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Categorize By Timing And Triggers
- Categorize dizziness by timing (acute, episodic, chronic) and by triggers to guide diagnosis.
- Use associated symptoms (neurologic, migraine, ear, cardiac) to narrow the differential.
Prioritize BPPV For Positional Episodes
- For episodic positional dizziness suspect BPPV first and orthostatic hypotension second.
- Ask whether episodes are triggered by head movement or occur spontaneously to distinguish causes.
Always Test For BPPV In Clinic
- Always check Dix-Hallpike (posterior canal) and supine roll (horizontal canal) for episodic patients in clinic.
- Test even if history is unclear because BPPV is treatable immediately.