Disorders of Vestibular Function: Medical History

The medical history (history of the patient) represents an important component in the diagnosis of disorders of vestibular function. Family history

Social history

• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• When does the dizziness occur?
  • Motion-dependent staggering vertigo
  • Lying down
  • Sitting
  • Standing
  • Height
• What is the nature of the vertigo?
  • Turning
  • Sway
• How long does the dizziness last? e.g.:
  • Seconds to minutes
  • Minutes to hours
  • Spinning attacks lasting no longer than 30 seconds (when lying down, when turning the head, when looking up or down)
  • Short-lasting spinning/swiveling dizziness attacks (up to one hundred times per day)
  • Continuous spinning/twisting dizziness, acute onset; may last for days to weeks
• Are there triggering factors (= triggers) for the vertigo?
  • Dizziness already at rest
  • When walking
  • When lying down, when turning the head, when looking up or down (Are there specific head or body positions?).
  • Turning the head can trigger a seizure (especially in the morning).
  • When the head is turned horizontally
    • During head position change relative to gravity.
    • When coughing or pressing
  • Depending on the situation
• Are there any other symptoms (accompanying symptoms) besides dizziness?
  • Nausea
  • Involuntary but rapid rhythmic eye movements (nystagmus).
  • Falling tendencies*
  • Gait disturbances*
  • Hearing disorders
    • Hearing loss/hearing loss: do you hear worse in one ear than you used to?
    • Sounds are perceived higher or lower in the affected ear (diplacusis).
  • Positional instability (uncertainty, a tendency to sway).
  • Unilateral ringing in the ears (tinnitus)
  • Pressure / feeling of fullness in the affected ear
  • Oscillopsia (apparent movements of the environment).
  • Black before eyes – does the feeling intensify when standing up?
  • Disturbances of spatial memory
• How long have you suffered from vertigo

Vegetative anamnesis incl. nutritional anamnesis

• Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
• Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
• Do you use drugs? If yes, what drugs and how often per day or per week?

Self history incl. medication history.

• Do you wear glasses?
• Pre-existing conditions (cardiovascular disease, neurological disease (migraine), ear disease).
• Injuries (traumatic brain injury, TBI).
• Operations
• Allergies

Medication history

• Alpha-2 agonist (tizanidine)
• Alpha blocker (doxazosin, yohimbine).
• Alpha-sympatholytics (phenoxybenzamine).
• Analgesics
  • Coxibs (COX-2 inhibitors) – celecoxib, parecoxib
  • Non-opioid analgesics (flupirtine).
  • Non-acidic non-opioid analgesics (metamizole).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – acetylsalicylic acid (ASA), diclofenac, ibuprofen, indometacin, meloxicam, naproxen, piroxicam.
  • Opiates or opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, nalbuphine, naloxone, naltrexone, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tapentadol, tilidine, tramadol)
• Angiotension II receptor antagonists (AT-II-RB; ARB; angiotensin II receptor subtype 1 antagonists; angiotensin receptor blockers; AT1 receptor antagonists, AT1 receptor blockers, AT1 antagonists, AT1 blockers; angiotensin receptor blockers, sartans) – eprosartan, candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan.
• Anthelmintics (albendazole, diethylcarbamazine, mebendazole, niclosamide).
• Antiarrhythmics
  • Class Ic antiarrhythmics (flecainide, propafenone).
  • Ib antiarrhythmics (lidocaine).
  • Class II antiarrhythmics (esmolol, metoprolol).
  • Class IV antiarrhythmic drugs (diltiazem, verapamil).
  • Nonclassified (adenosine).
• Antibiotics
  • Aminoglycosides (amikacin, apramycin, geneticin, gentamycin (gentamicin), gentamicins, hygromycin B, kanamycin, netilmicin, neomycin, paromomycin, spectinomycin, streptomycin, tobramycin).
  • Quinolones (cinoxacin, ciprofloxacin clioquinol, danofloxacin, difloxacin, enrofloxacin, fleroxacin, flumequin, gatifloxacin, grepafloxacin, ibafloxacin levofloxacin, Marbofloxacin moxifloxacin, nalidixic acid, norfloxacin, ofloxacin, orbifloxacin, oxolinic acid, pipemidic acid, sarafloxacin, sparfloxacin, temafloxacin, nadifloxacin).
  • Nitroimidazoles (metronidazole, tinidazole).
  • Sulfonamides
  • Tuberculostatics (rifampicin)
• Anticholinergics (atropine, butylscopolamine).
  • Aclidinium, biperidene, darifenacin, glycopyrronium, ipratropium bromide, metixene, methanthelinium bromide, oxybutynin, phenoxybenzamine, propiverine, scopolamine, solifenacin, tiotropium, tolterodine, trihexyphenidyl, trospium chloride, umeclidinium
• Antidepressants
  • Atypical antipsychotics (neuroleptics) – quetiapine
  • Bupropion
  • Selective serotonin reuptake inhibitors (SSRIs = Selective Serotonin Reuptake Inhibitor) – citalopram, dapoxetine, escitalopram, fluvoxamine, paroxetine, sertraline.
  • Serotonin receptor agonists – triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, triptans, zolmitriptan).
  • Tricyclic antidepressants (amitriptyline, amitriptyline oxide, clomipramine, desipramine, doxepin, imipramine, opipramol, nortriptyline, trimipramine).
• Antidiabetic drugs (glimepiride, insulin, repaglinide).
• Antidiarrheal drugs (loperamide)
• Antiepileptic drugs
  • AMPA receptor antagonist (perampanel).
  • Carboxamide derivatives (eslicarbazepine acetate).
  • Functionalized amino acids (lacosamide).
  • KCNQ2/3 opener (retigabine)
  • Classical antiepileptic drugs (carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, topiramate).
• Antifibrinolytic (tranexamic acid).
• Antihistamines (cetirizine, clemastine, dimetindene, ketotifen).
• Antimalarials (artemether, artesunate, atovaquone, quinine, chloroquine, dihydroartemisinin, hydroxychloroquine, lumefantrine, proguanil).
• Antifungals (amphotericin B, griseofulvin, ketoconazole).
• Antiparkinsonian agents (amantadine).
• Antivertiginosa (e.g., dimenhydrinate, scopolamine).
• Antisympathicotonics (urapidil).
• Antitussives
  • Opioids (codeine, dihydrocodeine, hydrocodone).
  • Non-opioid antitussives (levodropropizine, noscapine, pentoxyverine).
• Benzodiazepine-like substances (buspirone).
• Beta-blockers, systemic
  • Nonselective beta-blockers (e.g., carvedilol, pindolol, propranolol, soltalol).
  • Selective beta blockers (e.g., atenolol, acebutolol, betaxolol, bisoprolol, celiprolol, nebivolol, metoprolol).
• Betamimetics (synonyms: β2-sympathomimetics, also β2-adrenoceptor agonists) – fenoterol, formoterol, hexoprenaline, indaceterol, olodaterol, ritodrine, salbutamol, salmeterol, terbutaline.
• Calcium antagonists (amlodipine, cinnarizine, diltiazem, felodipine, fendiline, gallopamil, lacidipine, lercanidipine, nitrendipine, nifedipine, nimodipine, nicardipine, isradipine, nisoldipine, nilvadipine, manidipine, verapamil).
• Calcium sensitizer (levosimendan).
• Intestinal therapeutics (antiphlogistic) – mesalazine.
• Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors; gliptins) – saxagliptin, sitagliptin, vildagliptin).
• Direct factor Xa inhibitor – rivaroxaban.
• Diuretics
  • Potassium-sparing diuretics (triamterene).
• Dopamine antagonists (promethazine, levomepromazine).
• Hormones
  • Dopamine agonists (bromocriptine, cabergoline, lisuride).
  • Dopamine antagonists (domperidone, metoclopramide (MCP).
  • Progestogens (etonogestrel, medroxyprogesterone acetate, medrogestone, norelgestromin, norethisterone/norgestrel derivative).
  • Glucocorticoids (prednisolone).
  • Contraceptives (estrogen-progestin combination)
  • Estrogens
  • Prolactin inhibitors (bromocriptine, cabergoline, lisuride, metergoline, quinagolide).
  • Prostanoids (prostacyclins) – epoprostenol, iloprost, treprostinil.
  • Thyrostatic drugs (carbimazole, thiamazole).
• Hypnotics (phenobarbital)
• Immunotherapeutics (natalizumab)
• Local anesthetics (lidocaine, mepivacaine, procaine).
• Magnesium
• MAO inhibitor (tranylcypromine)
• Monoclonal antibodies – pertuzumab, trastuzumab.
• Mucolytic (guaifenesin)
• Multi-tyrosine kinase inhibitor (vandetanib).
• Muscle relaxants (baclofen, tizanidine).
• Neurokinin antagonists (aprepitant, fosaprepitant).
• Nicotinic acid
• Nitrates (glycerol nitrate, glycerol trinitrate, isosorbide dinitrate (ISDN), isosorbide 5-mononitrate, molsidomine, nitroglycerin, nitroprusside sodium).
• Norepinephrine reuptake inhibitor (atomoxetine).
• N-methyl-D-aspartate recptor antagonist (Memantine).
• Opioid antagonists (loperamide, nalmefene, naltrexone).
• Phosphodiesterase V inhibitors (PDE-5 inhibitors) – sildenafil, tadalafil, vardenafil.
• Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
• Rheologics (naftidrofuryl, pentoxifylline).
• Sedatives (barbiturates, benzodiazepines).
• Selective α1-adrenoceptor antagonists (selective alpha-1-adrenoceptor antagonists; α1-blockers) – alfuzosin, doxazosin, tamsulosin, terazosin.
• Sinus node inhibitor (ivabradine).
• Sympathomimetics (norepinephrine, epinephrine).
• Tranquilizers (diazepam)
• Tyrosine kinase inhibitors (vandetanib).
• Vasoactive substances (cilostazol, naftidrofuryl, diazoxide).
• Antivirals
  • Fusion inhibitors (enfuvirtide)
  • Nucleos(t)idic polymerase (NS5B) inhibitors (sofosbuvir).
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, nevirapine, rilpivirine.
  • Nucleoside analogues (aciclovir, brivudine, cidofovir, entecavir, famciclovir, foscarnet, ganciclovir, telbivudine, valaciclovir).
  • Nucleotide analogues (adefovir, tenofovir).
  • Nucleoside reverse transcriptase inhibitors (NRTIs) – abacavir, didanosine, entecavir, lamivudine, stavudine, zidovudine).
  • Protease inhibitors (PI; protease inhibitors) – boceprevir.
• Cytostatic drugs (methotrexate (MTX))

See also under “Anticholinergic effects due to drugs” if applicable. Environmental history

• Carbon monoxide
• Carbon tetrachloride
• Mercury

* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Information without guarantee)