The DOI matches its Crossref record; 16 of the 16 references it cites were found in a registry or an index.
Expanding the Differential Diagnosis of Chronic Dizziness
Abstract
OBJECTIVE: To improve treatment outcomes for patients with chronic dizziness by identifying clinical conditions associated with persistent symptoms and delineating key diagnostic features that differentiate its causes and direct attention to specific treatments. DESIGN: Prospective cohort study from 1998 to 2004. SETTING: Tertiary care balance center. PATIENTS: A total of 345 men and women, aged 15 to 89 years, referred for evaluation of chronic dizziness (duration of > or =3 months) of uncertain cause. INTERVENTIONS: Patients were systematically directed through multiple specialty examinations until definitive diagnoses were made. MAIN OUTCOME MEASURE: Final diagnoses associated with dizziness. RESULTS: Nearly all patients with chronic subjective dizziness were diagnosed with psychiatric or neurologic illnesses. These included primary and secondary anxiety disorders (n = 206 [59.7%]) and central nervous system conditions (n = 133 [38.6%]), specifically migraine headaches, mild traumatic brain injuries, and neurally mediated dysautonomias. A small number of patients (6 [1.7%]) had dysrhythmias. Four of 5 patients with migraine or dysrhythmias had comorbid anxiety. CONCLUSIONS: Chronic dizziness has several common causes, including anxiety disorders, migraine, traumatic brain injuries, and dysautonomia, that require different treatments. Key features of the clinical history distinguish these illnesses from one another and from active neurotologic conditions. The high prevalence of secondary anxiety may give a false impression of psychogenicity.
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In the citing paper
“The majority of conditions that precede PPPD are acute or episodic in nature.”
In the citing paper
“The most common precipitating conditions are peripheral or central vestibular disorders (25–30% of cases), attacks of vestibular migraine (15–20%), panic attacks or anxiety that manifest prominent dizziness (15% each), concussive injuries of the brain or whiplash injuries of the neck (10–15%), and autonomic disorders (7%).”
In the citing paper
“Positive results indicate that an anxiety or depressive disorder is likely, either as the sole cause of vestibular symptoms or co-existing with PPPD [12, 58, 75, 79].”
In the citing paper
“The average duration of illness at the time of tertiary consultation was 4.5 years with some patients experiencing symptoms for decades [13, 79].”
In the citing paper
“No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD, and chronic dizziness following acute vestibular syndromes [7, 12, 23, 28, 30, 79].”
In the citing paper
“The average age of patients presenting for evaluation of PPV, CSD, and PPPD is the mid-40 s, with a range from adolescence to late adulthood [10, 79, 100].”
In the citing paper
“Clinical epidemiologic data from tertiary care centers with special interest in PPV [13] and CSD [79] showed their prevalence to be 15–20% among all patients presenting for evaluation of vestibular symptoms, making them the most common diagnoses among young adults and the second most common among all adults, trailing only BPPV.”
In the citing paper
“CSD was a step in that direction based in part on the physical features of PPV [79].”
Citations
Cites
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052
Guidelines on Management (diagnosis and treatment) of syncope ? update 2004
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janousek, J., et al. (2004) · EP Europace · doi:10.1016/j.eupc.2004.08.008 · Cited by 650
Migraine in the United States: Epidemiology and patterns of health care use
Lipton, R. B., Scher, A. I., Kolodner, K., Liberman, J., Steiner, T. J., & Stewart, W. F. (2002) · Neurology · doi:10.1212/wnl.58.6.885 · Cited by 616
Summary of the WHO collaborating centre for neurotrauma task force on mild traumatic brain injury
Holm, L. W., Cassidy, J. D., Carroll, L., & Borg, J. (2005) · Journal of Rehabilitation Medicine · doi:10.1080/16501970510027321 · Cited by 467
Migraine-Related Vestibulopathy
Cass, S. P., Ankerstjerne, J. K. B., Yetışer, S., FURMAN, J. M. R., Balaban, C. D., & Aydoǧan, B. (1997) · Annals of Otology Rhinology & Laryngology · doi:10.1177/000348949710600302 · Cited by 309
Which comes first? Psychogenic dizziness versus otogenic anxiety
Staab, J. P., & Ruckenstein, M. J. (2003) · The Laryngoscope · doi:10.1097/00005537-200310000-00010 · Cited by 265
Self-citationCharacterizing and Treating Dizziness after Mild Head Trauma
Hoffer, M. E., Gottshall, K. R., Moore, R., Balough, B. J., & Wester, D. C. (2004) · Otology & Neurotology · doi:10.1097/00129492-200403000-00009 · Cited by 197
Migraine-anxiety related dizziness (MARD): a new disorder?
Furman, J. M. R. (2004) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.048926 · Cited by 187
Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness
Eckhardt‐Henn, A., Breuer, P., Thomalske, C., Hoffmann, S. O., & Hopf, H. C. (2002) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(02)00226-8 · Cited by 187
GODEMANN, F., SIEFERT, K., HANTSCHKEBRUGGEMANN, M., NEU, P., SEIDL, R., & STROHLE, A. (2005) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2004.12.006 · Cited by 154
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Physical-functional alterations in women with chronic migraine
Fracasso, B. V., Castro, R. B., Brioschi, M. L., & Malysz, T. (2025) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2025.03.013
Heart rate variability biofeedback in patients with functional dizziness
Simon, E. J., Penzlin, A. I., Arndt, M., Siepmann, T., & Barlinn, K. (2025) · Journal of Neurology · doi:10.1007/s00415-025-12988-3 · Cited by 2
“Thus, it can be inferred that psychiatric symptoms and comorbidities, including anxiety disorders and depression, impact a considerable number of patients with PPPD, despite psychiatric disorders not being regarded as the primary cause of vertigo [3, 4].”
Dieterich, M., Strupp, M. L., & Brandt, T. (2025) · Springer eBooks · doi:10.1007/978-3-031-78100-1_8
The role of vestibular laboratory testing
Janky, K. L., Eggers, S. D. Z., & McCaslin, D. L. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198834380.003.0013
Psycho-Neuro-Endocrine-Immunology and Vestibular Disorders: A perspective study
Mucci, V., Beppi, C., & Armato, E. (2025) · PNEI REVIEW · doi:10.3280/pnei2025oa19824
Rehabilitation of Psychogenic Vertigo
Yazla, E. (2025) · Springer eBooks · doi:10.1007/978-3-031-90347-2_57-1
Cholayil, S., Sai, V. H., & Vangipuram, S. (2025) · Neurochirurgie · doi:10.1016/j.neuchi.2025.101731
Rehabilitation of Psychogenic Vertigo
Yazla, E. (2025) · Springer eBooks · doi:10.1007/978-3-032-06268-0_57
Chronic vertigo and dizziness signal unmet needs in stroke recovery
Braadt, L., Naumann, M. K., Freuer, D., Meisinger, C., Linseisen, J., & Ertl, M. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13562-7
“Less specifically, bihemi-spheric small vessel disease [30], peripheral nervous sys-tem disorders, cardiovascular conditions (including cardiac arrhythmias and blood pressure dysregulation), psychiatric disease, or visual impairments [31], can contribute to and exacerbate these symptoms [32].”
Madrigal, J., Olier, P., de la Torre, M. M., Velez, D., Fonseca, M., Vanegas-Munera, J., & Castillo-Bustamante, M. (2023) · Research Square · doi:10.21203/rs.3.rs-2899771/v1
Jang, Y., Hur, H. J., Park, B., & Park, H. Y. (2024) · Figshare · doi:10.6084/m9.figshare.24934339
Jeong, H., Jeon, C. H., & Chang, Y. (2026) · Revista Brasileira de Reumatologia · doi:10.1186/s42358-026-00533-3
Velazquez-Rodriguez, Y., Brown, J., & Gill, K. H. (2026) · Medicine Bulletin · doi:10.1002/mdb2.70041
Shen, J., Xinyu, Z., Yan, H. R., Chen, S., Deng, W., Zheng, W., & Zhang, J. N. (2026) · Journal of Neurology · doi:10.1007/s00415-026-13891-1
“Earlier work on CSD described a psychophysiological framework in which anxiety-related hypervigilance and vestibular symptoms interact bidirectionally, contributing to persistent dizziness and maladaptive avoidance behaviors [39, 40].”
Zhu, Y., Han, Q., Teng, X., Jing, T., & Sun, L. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1921702
“Clinical cohort studies also indicate that migraine or VM and anxiety disorders may coexist with persistent functional dizziness or PPPD and should be differentiated during clinical assessment (10, 64).”
Nada, E., Elsayed, H. A., & Abdelmalak, Y. A. (2026) · The Egyptian Journal of Otolaryngology · doi:10.1186/s43163-026-01204-2
“Based on that, CSD was defined as a particular clinical syndrome characterized by an ongoing, nonspecific dizziness that cannot be attributed to any underlying medical disorders [2].”
Psychiatric risk with dizziness and cognitive decline in patients with sensorineural hearing loss
Nagarapu, A. N., Vayyeti, A., Shah, A. K., Sarva, L., Gowda, R., Zhang, Z., Brittain, K., & Harris, D. A. (2026) · Frontiers in Audiology and Otology · doi:10.3389/fauot.2026.1975143
Metadata
- Authors
- Staab, J. P., & Ruckenstein, M. J.
- Affiliations
- University of Pennsylvania Health System (US)
- University of Pennsylvania (US)
- ORCID
- Staab, Jeffrey P.
- Venue
- Archives of Otolaryngology–Head & Neck Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2007-02-01
- Volume
- 133
- Issue
- 2
- Pages
- 170
- ISSN
- 0886-4470 (ISSN-L)
- OpenAlex
- W2099190753
- Cited by
- 217
- References
- 16
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 12 · 2023: 24 · 2022: 11 · 2021: 20 · 2020: 18 · 2019: 10 · 2018: 10 · 2017: 5 · 2016: 13 · 2015: 12 · 2014: 11 · 2013: 9 · 2012: 9
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Otolaryngology - Head and Neck Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Clinical Neurology › Migraine and Headache Studies
- Keywords
- chronic dizziness, differential diagnosis, anxiety disorders, migraine, mild traumatic brain injury, cardiac arrhythmias, comorbidities, psychogenic dizziness, central nervous system disorders
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anxiety Disorders, Autonomic Nervous System Diseases, Chronic Disease, Diagnosis, Differential, Diagnostic Techniques, Otological, Dizziness, Female, Humans, Male, Middle Aged, Migraine Disorders, Post-Concussion Syndrome
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