The commonest cause takes about ten minutes to fix — once it is correctly identified.
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"Dizzy" is one of the least precise words in medicine, and sorting out what someone actually means is most of the work. It nearly always turns out to be one of three quite different things:
So the first question is always: does the room spin, or do you feel like you might faint? Those two answers lead in completely different directions, and getting them confused is why dizziness is so often mislabelled as "your ears" and left there.
Two things worth knowing:
A definite sense of movement — spinning, tilting or rocking — usually with nausea and unsteadiness. See our vertigo page, which covers the specific causes and the manoeuvres that treat them.
The commonest cause of dizziness in older adults, and the most fixable:
Persistent postural-perceptual dizziness — a constant, low-level sense of unsteadiness lasting months, typically after an initial episode of genuine vertigo, and worse in busy visual environments like supermarkets. It is a real and recognised condition, not anxiety, and it responds to vestibular rehabilitation rather than to more scans. People are frequently told nothing is wrong.
Dizziness is worked out largely from the history, and a careful conversation achieves more here than most tests. That suits a video consultation well.
Lying and standing blood pressure. Lie flat for five minutes and measure; stand and measure again at one minute and at three. A drop of more than 20 systolic or 10 diastolic confirms postural hypotension — and that single home measurement often explains the whole problem and points straight at the medication list.
We cannot examine your balance, eye movements or nervous system, and we cannot perform the bedside tests that distinguish an inner ear cause from a stroke. Sudden severe vertigo with any neurological symptom is an emergency, not a video consultation — and we will say so immediately.
The highest-yield action in most cases, and the one most often skipped. Reducing or changing a blood pressure tablet, moving a diuretic to the morning, or stopping an unnecessary alpha blocker resolves a great deal of dizziness — and prevents falls.
Anaemia, B12 deficiency, thyroid disease, dehydration and poorly controlled diabetes are all common, all testable, and all fixable.
Where the picture is BPPV, the Epley manoeuvre resolves it in a single session in most people — covered on our vertigo page. Vestibular rehabilitation exercises are the treatment for most other inner ear causes.
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If you have a home monitor: lie flat for five minutes, measure, then stand and measure again at one minute and three minutes. A fall of more than 20 systolic or 10 diastolic confirms postural hypotension — and bringing that reading to an appointment frequently explains everything and directs the medication review.
Before standing up, pump your ankles up and down and clench your calf and buttock muscles for about 30 seconds. This squeezes blood back towards the heart and genuinely raises blood pressure before you rise. It is free, it works, and hardly anyone is taught it.
Then stand in stages — sit on the edge of the bed for a minute first, especially at night.
You must not drive if dizziness or fainting could occur without warning. Depending on the cause and the pattern, there may be a legal duty to inform the DVLA — particularly after unexplained loss of consciousness. We will tell you where that applies rather than leaving you to find out.
The most useful thing about dizziness is that the word covers several completely different problems, and separating them costs nothing but time. Vertigo — a spinning sensation — is a different problem from lightheadedness, which is different again from unsteadiness. Treating them as one thing is why so much dizziness is managed badly.
Your NHS GP assesses dizziness free. For the commonest cause of true vertigo, the treatment is the Epley manoeuvre — free, takes minutes, and needs no medication.
The cheapest useful investigation is a lying and standing blood pressure, which can be done at home with a monitor costing around twenty pounds. Orthostatic hypotension is a very common and frequently missed cause, and is often driven by medication — blood pressure tablets, diuretics, antidepressants — which a medication review can address.
The honest limitation of remote assessment is real: distinguishing causes relies on positional testing and observing eye movements, and neither can be done properly over video. A careful history does a great deal, but where the examination decides it, we will say so.
What needs emergency assessment: dizziness with new headache, double vision, slurred speech, weakness, numbness, difficulty walking, or sudden hearing loss. Those can indicate a stroke.
NICE Clinical Knowledge Summary, Vertigo and Dizziness, are the principal references. They emphasise characterising the symptom — vertigo, presyncope or disequilibrium — as the first diagnostic step, since management differs entirely.
CKS recommends lying and standing blood pressure measurement where presyncopal dizziness is described, and review of contributing medication.
CKS, Benign paroxysmal positional vertigo, recommends the Dix-Hallpike test for diagnosis and the Epley manoeuvre for treatment.
CKS advises that vestibular sedatives should be used only short term, since prolonged use impairs central compensation.
NICE NG128, Stroke and transient ischaemic attack, and the HINTS examination evidence underpin the emergency features listed — acute vestibular syndrome with neurological signs or sudden hearing loss requires urgent assessment for posterior circulation stroke.
Whether the room spins, or whether you feel like you might faint. Those two answers lead down entirely different paths — spinning points at the inner ear, faintness points at blood pressure, blood or the heart. Almost everything else follows from that one distinction, and it is why "dizzy" on its own is such an unhelpful word.
Very possibly — in older adults, medication is the commonest cause. Blood pressure tablets, alpha blockers like tamsulosin, diuretics, antidepressants and codeine are frequent culprits, and several together are worse than any one. A proper medication review is the single most effective step, and the one most often skipped. Bring a written list.
Three features. Fainting or dizziness during exercise. Fainting with no warning whatsoever. Palpitations or chest pain alongside. Any of those needs urgent assessment with an ECG — they are not situations for reassurance. A family history of sudden death under 40 raises the same concern.
Because balance relies on three inputs — inner ear, sensation from the feet, and vision. If one is impaired, vision compensates — and in the dark that compensation disappears. Being noticeably worse in the dark or on uneven ground points towards the nerves in the feet or the balance organs rather than towards fainting.
It may be persistent postural-perceptual dizziness — a constant low-level unsteadiness that often follows an initial vertigo episode, worse in busy visual environments like supermarkets. It is a real, recognised condition, not anxiety, and it responds to vestibular rehabilitation rather than to more scans. Being told nothing is wrong is a common and demoralising experience here.
Two things. Stand up in stages — sit on the edge of the bed for a minute first. And before you rise, pump your ankles and clench your calves and buttocks for 30 seconds, which measurably raises your blood pressure beforehand. Also check whether a lying-and-standing reading confirms it, and get your medications reviewed.
Probably not, if you have been on them for weeks. Prochlorperazine and similar drugs are for short-term use in acute vertigo only. Taken longer, they stop the brain compensating, prolong the dizziness, and cause drowsiness and movement side effects. Long-term use is one of the commonest prescribing problems in this area and is worth reviewing.
Not if dizziness or fainting could happen without warning. Depending on the cause — and particularly after unexplained loss of consciousness — there may be a legal duty to notify the DVLA. It is worth asking directly rather than assuming, and we will tell you where it applies.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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