What criteria should I use to decide whether to refer a patient with dizziness to a specialist?

Refer a patient with dizziness to a specialist if they have severe nausea and vomiting and are unable to tolerate oral fluids or symptomatic drug treatment, or if they have very sudden onset of vertigo that is not provoked by positional change and is persistent, or if they exhibit central neurological symptoms or signs such as new headache, gait disturbance, truncal ataxia, or vertical nystagmus, or if they have acute deafness without typical features of Meniere's disease ⁴.

Refer immediately adults with sudden-onset acute vestibular syndrome if benign paroxysmal positional vertigo or postural hypotension do not account for the presentation, or if the HINTS test indicates stroke, or if there are focal neurological deficits such as vertical or rotatory nystagmus, new unsteadiness, or deafness ⁵.

Refer adults with recurrent dizziness and a fixed symptom pattern if initial treatments like canalith repositioning have failed twice, or if symptoms are atypical (e.g., hearing loss, tinnitus, neurological signs) ², ³, ⁴.

In cases of dizziness with features suggestive of specific conditions such as vestibular neuronitis, BPPV, or vestibular migraine, refer to a specialist if the diagnosis is uncertain, if symptoms persist despite treatment, or if there are complicating factors ¹, ², ³, ⁴.