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ENT · OPD · Locked · first month free
By Dr Javed Akhtar · Last reviewed 2 October 2026
Drugs on this card
Prochlorperazine, Cinnarizine, Betahistine (Ménière's), Ondansetron (vomiting)
Advice and when to refer BPPV (Dix-Hallpike positive): Epley manoeuvre — not drugs (AAO-HNS 2017, latest)Red flags — think stroke: New headache or neck pain, double vision, slurred speech, cannot walk, abnormal HINTS — urgent CT/MRI (GRACE-3 2023)Investigations
First visit Dix-Hallpike test — Positional vertigo (BPPV) — treat with Epley; no tests.HINTS examination — Continuous vertigo: an abnormal test means stroke until proven otherwise.Blood glucose and BP — Every patient.Only if indicated MRI brain — Red flags: new headache, double vision, slurred speech, cannot walk, abnormal HINTS.Audiometry — Hearing loss or tinnitus (Ménière’s, acoustic neuroma).ECG — Presyncope or palpitations.
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