Vestibular migraine: an update.

PURPOSE OF REVIEW: We performed a narrative review of the recent findings in epidemiology, clinical presentation, mechanisms and treatment of vestibular migraine. RECENT FINDINGS: Vestibular migraine is an underdiagnosed condition that has a high prevalence among general, headache and neuro-otology clinics. Vestibular migraine has a bimodal presentation probably associated with a hormonal component in women. These patients could have a complex clinical phenotype including concomitant autonomic, inflammatory or connective tissue conditions that have a higher prevalence of psychological symptoms, which may mistakenly lead to a diagnosis of a functional neurological disorder. A high proportion of patients with postural perceptual persistent dizziness have a migraine phenotype. Independently of the clinical presentation and past medical history, patients with the vestibular migraine phenotype can respond to regular migraine preventive treatments, including those targeting the calcitonin gene-related peptide pathways. SUMMARY: Vestibular migraine is an underdiagnosed migraine phenotype that shares the pathophysiological mechanisms of migraine, with growing interest in recent years. A thorough anamnesis is essential to increase sensitivity in patients with unknown cause of dizziness and migraine treatment should be considered (see supplemental video-abstract).

[Dizziness from an internistic perspective]. / Schwindel aus internistischer Sicht.

Dizziness is a common symptom with many potential causes. Medical and especially cardiac aetiologies are associated with a poor overall prognosis such that identification of the underlying cause is essential. This article gives an overview of possible causes of dizziness, how the differential diagnoses should be investigated, and describes potential therapeutic approaches to the treatment of the most important underlying conditions.

[Structured ABEV Exercises for the Treatment of vestibular dysfunction]. / Strukturierte ABEV-Übungen zur Behandlung vestibulärer Funktionsstörungen.

INTRODUCTION: In addition to medication, the standard clinical treatment for vestibular vertigo primarily includes physical therapy in the form of regular exercises. Vertidisan is a future digital health application (DiGA) for structured dizziness therapy. Its content is multimodal and consists of Adaptive Balance and Eye Movements and Visual Stimulation (ABEV) exercises, which are expected to have an anti-vertigo effect through neural learning. METHODS: A cohort study with 104 patients with intra-individual control was conducted to examine the clinical efficacy of solely 16 ABEV exercises for the treatment of peripheral vestibulopathies which are also used digitally in the future DiGA Vertidisan. Using the short version vertigo symptom scale short form1 vertigo and related symptoms (VSS-sf1-VER) of the vertigo-specific and validated VSS rating scale (Vertigo Symptom Scale) as the primary outcome variable, the vertigo scores before therapy (time T0) were compared with the corresponding data at the end of a period of 12-16 weeks (time T1). RESULTS: Complete datasets on T0 and T1 were available for N=104 patients. The mean VSS-sf1-V score decreased from 3.80 (median 4, SD 0.47) to 0.92 (median 1, SD 1.19) from T0 to T1 (weeks 12-16). The result is statistically significant (p=0.001) and shows a high clinical effect size. CONCLUSION: In summary, the analysis of the dizziness score shows a statistically and clinically significant reduction in dizziness through the use of the 16 ABEV exercises.

We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the World Falls Guidelines.

Benign paroxysmal positional vertigo (BPPV) is amongst the commonest causes of dizziness and falls in older adults. Diagnosing and treating BPPV can reduce falls, and thereby reduce fall-related morbidity and mortality. Recent World Falls Guidelines recommend formal assessment for BPPV in older adults at risk of falling, but only if they report vertigo. However, this recommendation ignores the data that (i) many older adults with BPPV experience dizziness as vague unsteadiness (rather than vertigo), and (ii) others may experience no symptoms of dizziness at all. BPPV without vertigo is due to an impaired vestibular perception of self-motion, termed 'vestibular agnosia'. Vestibular agnosia is found in ageing, neurodegeneration and traumatic brain injury, and results in dramatically increased missed BPPV diagnoses. Patients with BPPV without vertigo are typically the most vulnerable for negative outcomes associated with this disorder. We thus recommend simplifying the World Falls Guidelines: all older adults (>60 years) with objective or subjective balance problems, irrespective of symptomatic complaint, should have positional testing to examine for BPPV.

Non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD).

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic balance disorder, which is characterised by subjective unsteadiness or dizziness that is worse on standing and with visual stimulation. The condition was only recently defined and therefore the prevalence is currently unknown. However, it is likely to include a considerable number of people with chronic balance problems. The symptoms can be debilitating and have a profound impact on quality of life. At present, little is known about the optimal way to treat this condition. A variety of medications may be used, as well as other treatments, such as vestibular rehabilitation.  OBJECTIVES: To assess the benefits and harms of non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD).  SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 21 November 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs in adults with PPPD, which compared any non-pharmacological intervention with either placebo or no treatment. We excluded studies that did not use the Bárány Society criteria to diagnose PPPD, and studies that followed up participants for less than three months.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vestibular symptoms (assessed as a dichotomous outcome - improved or not improved), 2) change in vestibular symptoms (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) generic health-related quality of life and 6) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We planned to use GRADE to assess the certainty of evidence for each outcome.  MAIN RESULTS: Few randomised controlled trials have been conducted to assess the efficacy of different treatments for PPPD compared to no treatment (or placebo). Of the few studies we identified, only one followed up participants for at least three months, therefore most were not eligible for inclusion in this review.  We identified one study from South Korea that compared the use of transcranial direct current stimulation to a sham procedure in 24 people with PPPD. This is a technique that involves electrical stimulation of the brain with a weak current, through electrodes that are placed onto the scalp. This study provided some information on the occurrence of adverse effects, and also on disease-specific quality of life at three months of follow-up. The other outcomes of interest in this review were not assessed. As this is a single, small study we cannot draw any meaningful conclusions from the numeric results.  AUTHORS' CONCLUSIONS: Further work is necessary to determine whether any non-pharmacological interventions may be effective for the treatment of PPPD and to assess whether they are associated with any potential harms. As this is a chronic disease, future trials should follow up participants for a sufficient period of time to assess whether there is a persisting impact on the severity of the disease, rather than only observing short-term effects.

Persistent positional perceptual dizziness in clinical practice: a scoping review.

INTRODUCTION: Dizziness is an important symptom presenting in routine practice and the life time prevalence ranges from 17 to 30%. Persistent positional perceptual dizziness (PPPD) is a common cause of chronic dizziness and has often been labeled as psychogenic dizziness in the past. DISCUSSION: PPPD is diagnosed based on clinical criteria laid down by the Barany society. The vestibular function tests and imaging of the brain and the inner ear are often normal. Most of the patients have an underlying anxiety trait and most cases of PPPD arise following an attack of acute vertigo like Meniere's disease and vestibular neuritis. It is important to differentiate the condition from bilateral vestibulopathy. There is no role of vestibular sedative in the treatment of such condition. Vestibular rehabilitation therapy (VRT), cognitive behavioral therapy (CBT), and selective serotonin reuptake inhibitors (SSRI) like sertraline have shown benefits. However, long-term outcome is not known. CONCLUSION: PPPD is a relatively new entity in the ever-expanding field of neurotology that requires a multimodality approach for effective management. The otologists and general physicians must identify the condition so that favorable outcome can be achieved. The long-term effects of treatment with CBT and VRT are not known. It is important to formulate standard guidelines for treatment. Further research is necessary to identify the role of endogenous biomarkers in the outcome of treatment.

Dizziness: Evaluation and Management.

Dizziness is a common but often diagnostically difficult condition. Clinicians should focus on the timing of the events and triggers of dizziness to develop a differential diagnosis because it is difficult for patients to provide quality reports of their symptoms. The differential diagnosis is broad and includes peripheral and central causes. Peripheral etiologies can cause significant morbidity but are generally less concerning, whereas central etiologies are more urgent. The physical examination may include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver (for patients with triggered dizziness), and the HINTS (head-impulse, nystagmus, test of skew) examination when indicated. Laboratory testing and imaging are usually not required but can be helpful. The treatment for dizziness is dependent on the etiology of the symptoms. Canalith repositioning procedures (e.g., Epley maneuver) are the most helpful in treating benign paroxysmal positional vertigo. Vestibular rehabilitation is helpful in treating many peripheral and central etiologies. Other etiologies of dizziness require specific treatment to address the cause. Pharmacologic intervention is limited because it often affects the ability of the central nervous system to compensate for dizziness.

Neurotological emergencies: a narrative review.

INTRODUCTION: Vestibular symptoms, including vertigo, dizziness, and gait unsteadiness, are a frequent reason of urgent medical assistance. Their causes are numerous and diverse, including neurological, otorhinolaryngological, and systemic diseases. Therefore, following a systematic approach is essential to differentiate striking but benign conditions from others that can compromise the patient's life. This study is intended to review vestibular disorders from a practical perspective and provide guidance to physicians involved in the emergency care of patients with vestibular symptoms. MATERIALS AND METHODS: A narrative review was performed, revisiting the main causes of vestibular disorders. RESULTS: Based on the speed of onset, duration, and history of similar episodes in the past, vestibular disorders can be categorized into three syndromic entities (acute, recurrent, and chronic vestibular syndromes). The most representative conditions pertaining to each group were reviewed (including their diagnosis and treatment) and a practical algorithm was proposed for their correct management in the acute care setting. CONCLUSIONS: Carrying out a correct categorization of the vestibular disorders is essential to avoid diagnostic pitfalls. This review provides useful tools for clinicians to approach their patients with vestibular symptoms at the emergency room.

Is Biofeedback for Vertigo Effective in Ordinary Medical Centers? A Controlled Trial in Northern Italy.

The aim of this study was to assess the therapeutic effectiveness of biofeedback, in a medical center's routine for treating vestibular disorders, reducing emotional, functional, and physical disability at three-month follow-up. A total of 197 outpatients were recruited from a medical center to treat vestibular disorders. Patients in the control group received treatment as usual, consisting of one monthly visit with an otolaryngologist and pharmacological treatment specific for vertigo, while the experimental group attended biofeedback training. Patients in the experimental group received pharmacological therapy only in the phase before the start of biofeedback in order to stabilize the acute phase. During the three-month follow-up, the experimental group did not receive any booster sessions of biofeedback. At three-month follow-up there was a statistically significant difference between the groups, both in the mean total score of the dizziness handicap inventory and in the three subscales: physical, emotional, and functional. Moreover, the biofeedback group had reduced psycho-physiological parameters for all average values at three-month follow-up compared to the baseline. This is one of few studies assessing the effectiveness of biofeedback in a naturalistic setting for vestibular disorder treatment. The data confirmed that biofeedback can impact illness course, in terms of self-perceived disability reduction, assessed on emotional, functional, and physical aspects of daily living.

Fifteen-minute consultation: The dizzy child.

Vestibular disorders are often overlooked in children and may cause significant morbidity. About a third of children presenting with problems in balance show a vestibular pathology and the overall prevalence of paediatric vertigo is about 5%. Appropriate diagnosis and holistic management can have a significantly positive impact on a child's quality of life and can be very rewarding. We present a structured approach to the assessment and management of a child presenting with dizziness in a general, non-neurological specialty or community paediatric outpatient setting.

[Vertigo and dizziness : functional disorders ?] / La symptomatologie vertigineuse : un trouble fonctionnel ?

Symptoms of vertigo and dizziness may arise from a dysfunction of the vestibular system in the inner ear but many or even most of them don't. The medical interrogatory is a key step for the diagnosis, combined with functional tests. Around 10 % of patients with vertigo are referred to specialists. They are a lot of psychogenic dizzy symptoms. The importance of a reassuring dialogue with the patient is of prime importance to avoid the development of functional or psychological imbalance.

La pathologie vertigineuse peut être séparée en deux grandes entités. Le vertige vrai, sensation rotatoire, «vertigo¼ des auteurs anglo-saxons et l'instabilité, «dizziness¼ des mêmes auteurs. L'anamnèse est la clé du diagnostic, précisée par des explorations fonctionnelles. En pratique, 10 % des patients vertigineux sont référés aux médecins spécialistes. Une mauvaise explication de la pathologie au patient peut entraîner des troubles fonctionnels importants qui peuvent évoluer en troubles psychologiques.

[FIRST YEAR EXPERIENCE OF TERTIARY MULTIDISCIPLINARY NEUROTOLOGY (DIZZINESS AND BALANCE) CLINIC].

BACKGROUND: Dizziness is a common condition that accounts for an estimated 5% of primary care clinic visits. The differential diagnosis is extensive, which may involve the inner ear, central and peripheral nervous system and the cardiovascular system among others. While routine cases can be diagnosed and treated with primary (general practitioner) or secondary (otolaryngologists (medicine in the community, there are many cases in which it is advisable to refer patients to a tertiary dizziness clinic. These cases include: unclear diagnosis, lack of improvement after medication or physiotherapy, medical comorbidities in which the central compensation process has been affected, chronic dizziness, bilateral vestibular disorder and more. Therefore, we established a multidisciplinary clinic (MDC) in a tertiary referral center at the Rambam Healthcare Campus. OBJECTIVES: To investigate the first year of the tertiary MDC neurotology clinic. METHODS: Retrospective cohort of all patients examined at the tertiary MDC. RESULTS: The first 123 consecutive patients (62% women) aged 56 years on average (19-85years, ±16) seen in the MDC from October 1, 2020 to October 31, 2021 are reported. Prior to assessment, 79 (64%) patients had been referred by an ENT doctor in the community with an unclear cause of dizziness; 49 (40%) patients experienced ongoing symptoms for years and 61 (50%) patients had dizziness on a daily basis. A total of 56 )46%) patients were found to have a peripheral vestibular cause for their dizziness and 67 (54%) patients had a central or other causes. More than one cause of dizziness and/or imbalance was noted in 20 (36%) of patients. Among the common peripheral vestibular causes were benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and the central and functional disorders included vestibular migraine and persistent postural perceptual dizziness (PPPD). The frequency and intensity of symptoms were reduced in 29 patients of the 33 (88%) who underwent vestibular physiotherapy in the MDC as opposed to 8 (50%) patients in the community (p <0.05). Physiotherapy was found to be more effective in patients younger than 65 years old, and with less than six months of symptoms (p <0.05). However, patients with a medical history of neurological or cardiovascular problems are less likely to improve (p <0.05). CONCLUSIONS: A tertiary neurotology clinic of a multidisciplinary team can provide proper care in persistent dizziness and/or unclear diagnosis. Vestibular physiotherapy plays a crucial role in the management of a dizzy patient, and hence it should be started as soon as possible.

Evaluating patients with vertigo.

ABSTRACT: Dizziness and vertigo are among the most common complaints in medicine. Patients often provide vague descriptions of symptoms, making clinicians' jobs challenging. However, a patient with vertigo also can be one of the most rewarding encounters of a clinician's day. In most cases, a focused history and bedside vestibular testing provide enough information to make a diagnosis and identify patients for appropriate referral. Canalith repositioning maneuvers often resolve symptoms, leaving patients and clinicians satisfied.

Effect of betahistine treatment on dizziness and anxiety symptoms of BPPV patients.

Background: Patients with benign paroxysmal positional vertigo (BPPV) may experience significant deterioration in their quality of life due to dizziness and anxiety symptoms. Aim: To evaluate the effect of betahistine add-on therapy on dizziness and anxiety symptoms of BPPV patients. Materials and Methods: Eighty-four patients who were diagnosed as having posterior canal BPPV were included in the study. Patients were divided into two groups according to the treatment regimen: Group 1 included 42 subjects who were treated with the Epley maneuver alone and Group 2 included 42 subjects who received betahistine 48 mg/day for ten days with the Epley maneuver. Dizziness handicap inventory (DHI) and Beck anxiety inventory (BAI) were evaluated at the time of diagnosis and at the control examination on the tenth day. Results: The mean before and after treatment DHI scores were 38.8 ± 14.6 and 5.47 ± 6.4 for Group 1 (P < 0.001), and 45.8 ± 21.1 and 10.3 ± 12.9 for Group 2 (P < 0.001). The mean before and after treatment BAI scores were 11.8 ± 6 and 1.33 ± 1.8 for Group 1 (P < 0.001), and 13.6 ± 8.3 and 2.9 ± 3.8 for Group 2 (P < 0.001). There was no significant difference between the before and after treatment DHI and BAI score differences of the two groups (P = 0.27, P = 0.43). Conclusion: Canalith repositioning maneuvers (CRMs) should be the main treatment modality in the management of BPPV patients and adding on betahistine treatment to CRMs have no impact in the relieving of dizziness and anxiety symptoms.

[Persistent Postural-Perceptual Dizziness (PPPD) - A clinical case and essentials for the primary care medicine]. / Vertiges posturaux-perceptuels persistants (VPPP) - Cas clinique et notions essentielles pour le généraliste.

Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional disorder that manifests with symptoms of dizziness, unsteadiness or non-spinning vertigo that lasts for at least three months. These symptoms are exacerbated by upright posture, active or passive motion, and exposure to complex or moving visual stimuli. This -pathology has been known for a long time ago. Still, after an expert's consensus in 2017, this term was born, and some precise diagnostic criteria have been defined based on identifying key symptoms in the patient's clinical history. Treatment is multimodal, incorporating -vestibular rehabilitation, cognitive-behavior therapy, and serotonergic medication.

Les VPPP ou vertiges posturaux-perceptuels persistants (Persistent Postural-Perceptual Dizziness (PPPD)) sont une pathologie fonctionnelle chronique, caractérisée par une sensation de déséquilibre, d'instabilité ou de vertige non rotatoire. Les symptômes peuvent être exacerbés par la position debout, la mobilisation active ou passive et l'exposition à des stimuli visuels complexes ou en mouvement. Si la pathologie est connue de longue date, c'est suite à un consensus d'experts qu'est né ce terme en 2017, et que des critères diagnostiques clairs ont été définis, qui se basent sur l'identification de symptômes clés dans l'histoire ­clinique du patient. Le traitement est multimodal, ­comprenant une réhabilitation vestibulaire, des thérapies cognitivo-comportementales et une médication sérotoninergique.

Visually induced dizziness.

PURPOSE OF REVIEW: Visually induced dizziness (VID) is a common phenomenon in vestibular disorders of both peripheral and central causes. This article provides a review of the most updated understandings of definition, pathophysiology, and treatment options. RECENT FINDINGS: The pathophysiology is complex and its severity or persistence may be related both to the underlying cause and heritable factors. Environmental and psychological factors may influence the degree of impact of VID on daily life function. Treatment is mostly empiric at this point but includes pharmacologic, desensitization, cognitive behavioral therapies, visual rehabilitation, and treatment of the underlying cause whenever present. Additional research is needed to clarify the best management of this vestibular symptom as well as some of the other conditions with which it is commonly associated. SUMMARY: VID is a fairly common vestibular syndrome constitutng spatial disorientation without illusory motion. As it is seen in both peripheral and central vestibular disorders, it should be considered a syndrome or constellation of symptoms rather than a discrete disorder. In some cases, it may be the presenting symptom with no other clear disorder linked to it.

Treatment of Vestibular Disorders (Inner Ear Balance Problems): How Does Your Physical Therapist Treat Dizziness Related to Inner Ear Balance Problems?

Dizziness is very common, but it is never normal. Dizziness can make performing daily activities, work, and walking difficult. Inner ear balance problems can make people dizzy when they turn their head, which can cause problems during walking and make people more likely to fall. Most of the time dizziness is not from a life-threatening disease. Often, dizziness is related to a problem of the vestibular (or inner ear balance) system. Vestibular disorders can be caused by infections in the ear, problems with the immune system, medications that harm the inner ear, and rarely from diabetes or stroke because of a lack of blood flow to the inner ear. Stress, poor sleep, migraine headaches, overdoing some activities, and feeling anxious or sad can increase symptoms of dizziness. Updated guidelines for the treatment of inner ear disorders are published in this issue of the Journal of Neurologic Physical Therapy. The guideline recommends which exercises are best to treat the dizziness and balance problems commonly seen with an inner ear problem.

The influence of cerebral small vessel diseases on the efficacy of repositioning therapy and prognosis of benign paroxysmal positional vertigo.

Background: Although vascular risk factors have been found to be closely related to the development of benign paroxysmal positional vertigo (BPPV), the relationship between BPPV and cerebral small vessels diseases (CSVDs) has rarely been discussed in literature. This study set out to investigate the efficacy of repositioning therapy and prognosis among BPPV patients with CSVDs. Methods: We enrolled 553 BPPV patients who had undergone brain MRI, and categorized them into two groups based on the presence or absence of CSVDs. After controlling for other confounders using a propensity score matching (PSM) approach, we compared the incidence of recurrence and residual dizziness (RD). Then, we analyzed the recurrence rate and RD incidence in 176 BPPV patients with CSVDs, and assessed potential risk factors. Results: White matter hyperintensity (WMH, 72.2%) and lacunar infarction (LI, 65.9%) were the two CSVDs that were present in the highest proportion among the BPPV patients. The incidence of RD in patients with CSVDs was significantly higher compared to subjects without CSVDs. Patients with RD (n=100, 56.8%) were older, had more severe WMH, and had a higher incidence of brain atrophy; age and higher Fazekas score were independent risk factors. Among the recurrent patients (n=61, 34.7%), the ages were older, the Fazekas score of WMH was higher, and number of LIs was increased; age was the sole independent risk factor. Conclusion: BPPV patients with a combination of CSVD comorbidities, especially elderly patients with WMHs, are more likely to develop RD, which needs to be paid more attention.

Dizziness and benign paroxysmal positional vertigo among retirement home residents: a cross-sectional descriptive and interventional study.

BACKGROUND: The prevalence of dizziness increases with age. We aimed to determine the point prevalence of dizziness and, in particular, of benign paroxysmal positional vertigo (BPPV) among retirement home residents. Furthermore, we aimed to evaluate the efficacy of a 2-axis turntable based BPPV treatment. METHODS: We contacted all large retirement homes in or around the city of Zurich (Switzerland). 10 retirement homes (with a total of 536 residents) agreed to participate in this study. 83 rejected inquiries by residents led to a potential study population of 453 residents. After a structured interview evaluating the presence and characteristics of dizziness, all willing patients were tested for positional vertigo and nystagmus on a portable and manually operated 2-axis turntable that was transported to the retirement home. Testing consisted of the Dix-Hallpike and supine roll maneuvers to both sides. Participants were immediately treated with the appropriate liberation maneuver whenever BPPV was diagnosed. Otherwise, taking the resident's medical history, a neuro-otological bedside examination, and a review of the available medical documentation was used to identify other causes of dizziness. RESULTS: Out of the 453 residents, 75 (16.6%; average age: 87.0 years; 68% female) were suffering from dizziness presently or in the recent past and gave their consent to participate in this study. Among the participants tested on the turntable (n = 71), BPPV was present in 11.3% (point prevalence). Time-related properties, triggering factors and qualitative attributes of vertigo or dizziness were not significantly different between the dizzy participants with and those without BPPV. In all BPPV patients, appropriate liberation maneuvers were successful. CONCLUSIONS: BPPV could be demonstrated in about one tenth of retirement home residents with dizziness or recent dizziness. Such point prevalence of BPPV translates to a much higher yearly prevalence if one assumes that BPPV is not present on every day. Our finding suggests that retirement home residents suffering from dizziness should be regularly tested for BPPV and treated with appropriate liberation maneuvers, ideally on turntable to reduce strain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03643354 .

Dizziness in older persons at high risk of future hospitalization: prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention.

BACKGROUND: Dizziness is a common reason for seeking care, and frequently affects older persons. The aims were to determine the prevalence of dizziness in older persons at high risk of hospitalization, to compare subjects with and without dizziness, and to examine the effects on dizziness of a proactive primary care intervention in comparison with conventional care after one year. METHODS: Data were derived from a prospective multicentre clinical trial in persons aged 75 and older and at high risk of hospitalization. A baseline questionnaire included demographic data, use of aids, questions about everyday physical activity and exercise, pain (intensity, frequency, and duration), activities of daily living measured using the ADL Staircase, and health-related quality of life measured using the EQ-5D-3L vertical visual analogue scale. Both at baseline and after one year, subjects were asked about dizziness, and those with dizziness answered the Dizziness Handicap Inventory - Screening version. Subjects in the intervention group were evaluated by a primary care team and when needed proactive care plans were established. Groups were compared using the Mann Whitney U-test or chi-squared test. RESULTS: Of the 779 subjects, 493 (63%) experienced dizziness. Persons with dizziness differed regarding sex, homecare service, aids, activities of daily living, health-related quality of life, physical activity, and pain. The intervention did not significantly reduce the level of dizziness. CONCLUSIONS: Dizziness is common in vulnerable older persons, and individuals with dizziness differ in several respects. Further studies are needed employing more dizziness-specific assessment and individually tailored interventions. TRIAL REGISTRATION: ClinicalTrials.gov 170608, ID: NCT03180606.