What patients do when they feel dizzy: behavioural signatures reveal diagnostic clues in common vestibular disorders

What You Do When You’re Dizzy May Help Doctors Understand Why

New research suggests that asking patients how they respond to dizziness—not just what their symptoms feel like—could provide valuable clues for diagnosing vestibular disorders.

Understanding the Whole Patient Experience

If you live with a vestibular disorder, you’ve probably learned to make adjustments to manage your symptoms. Maybe you avoid turning your head too quickly, find bright lights uncomfortable, or need to rest in a quiet room when dizziness strikes.

These adjustments are often practical responses to very real physical symptoms. But could they also help healthcare providers better understand what’s causing your dizziness?

A 2026 study published in the Journal of Neurology suggests that they might.

Researchers found that people with different vestibular conditions often report distinct patterns in what triggers their dizziness, which activities they avoid, and how they cope with symptoms. Asking about these experiences during a medical appointment could provide additional information to help clinicians distinguish between conditions that sometimes have overlapping symptoms.

Importantly, the study does not suggest that vestibular disorders are caused by a patient’s behavior. Rather, it explores how people’s natural responses to their symptoms may reflect differences in the underlying conditions.

What Did the Researchers Study?

Researchers at University College London studied 109 adults who visited a specialized dizziness clinic in London between April 2025 and April 2026.

Before their medical consultations, participants answered 10 structured questions about their dizziness, including:

• When their symptoms occurred and how long they lasted.
• Which activities or situations triggered their symptoms.
• What they tended to avoid because of dizziness.
• What they did to manage or relieve their symptoms.

A vestibular neurologist then independently evaluated the patients and established their diagnoses using recognized clinical criteria, without knowing their questionnaire responses.

The researchers compared the answers with the diagnoses to see whether certain patterns were associated with particular vestibular conditions.

What Did the Study Find?

The researchers identified several patterns that were more common among people with specific diagnoses.

Vestibular Migraine (VM)

People with vestibular migraine were more likely to report dizziness when reading while riding in a moving vehicle. They also frequently described avoiding bright lights or loud environments and seeking relief in dark, quiet spaces.

These responses may reflect the sensitivity to visual motion, light, and sound that often accompanies migraine.

Persistent Postural-Perceptual Dizziness (PPPD)

People with PPPD commonly reported increased dizziness in visually complex environments, such as crowded stores or busy streets. They were also more likely to avoid these settings.

This is consistent with what clinicians already know about PPPD, which can involve difficulty processing visual and movement information, particularly in environments with a lot of sensory activity.

Benign Paroxysmal Positional Vertigo (BPPV)

People with BPPV frequently identified changes in head position as a trigger. They often avoided quick head movements or tried to remain still during episodes of vertigo.

This makes sense because BPPV occurs when displaced calcium carbonate crystals in the inner ear interfere with normal balance signals during certain head movements.

Orthostatic Dizziness

People with orthostatic dizziness often reported symptoms when standing up quickly. Some described modifying how they stood up or sitting or lying down to manage their symptoms.

These responses may be related to changes in blood pressure or blood flow when moving into an upright position.

Although these patterns were associated with particular conditions, they are not unique to those diagnoses. A person may experience several of these triggers, and some people have more than one vestibular disorder.

Why Does This Matter for Diagnosis?

Diagnosing vestibular disorders can be challenging. Many conditions share symptoms such as dizziness, unsteadiness, nausea, and sensitivity to movement. Patients may also find it difficult to describe exactly what they’re experiencing.

Healthcare providers typically ask about the type, timing, duration, and triggers of dizziness. They may also perform physical examinations and specialized vestibular tests.

This research suggests that asking patients what they do in response to dizziness could add another useful piece to the diagnostic puzzle.

For example, a clinician might ask:

• Are there activities or environments you’ve stopped participating in because of your symptoms?
• What do you do when dizziness begins?
• Are there particular movements or situations you try to avoid?
• Have you discovered anything that helps you feel more comfortable or stable?

These questions may reveal patterns that help clinicians decide which diagnoses to consider and what additional examinations or tests might be appropriate.

Understanding how patients manage their symptoms can also help providers recognize the impact of vestibular disorders on daily life and develop treatment plans that address each person’s needs.

Does This Mean Dizziness Is Behavioral?

No. This is an important distinction.

People living with vestibular disorders often make changes to their routines because certain movements, environments, or activities cause or worsen their symptoms.

These adjustments may be necessary for safety, comfort, and day-to-day functioning. They are not evidence that someone is causing their own dizziness.

For example, someone with BPPV may avoid turning their head because that movement triggers vertigo. Someone with vestibular migraine may seek a dark room because light and sound worsen their symptoms.

In both cases, the person’s response provides information about the condition rather than explaining its cause.

At the same time, some avoidance patterns can affect long-term recovery. Depending on the diagnosis, gradually returning to certain activities with appropriate treatment and professional guidance may help improve function and confidence.

The goal is not to judge how patients cope with dizziness, but to better understand their experiences and identify approaches that can improve their quality of life.

What Are the Study’s Limitations?

While the findings are promising, several limitations are important to understand.

Small sample size: The study included 109 participants, with relatively few patients representing some diagnoses. Larger studies are needed to determine whether the same patterns appear consistently across different patient populations.

Single specialty clinic: All participants were evaluated at one specialized clinic in London. The findings may not apply equally to patients seen in primary care, emergency departments, or other healthcare settings.

Questionnaire not validated: The 10-question interview had not undergone formal validation to establish its reliability or accuracy as a diagnostic tool. Additional research is needed before it could be recommended for widespread clinical use.

Patterns are not diagnostic tests: Although certain responses were associated with particular conditions, they cannot establish a diagnosis on their own. The findings do not demonstrate that using these questions improves diagnostic accuracy or reduces the time patients spend seeking a diagnosis.

Further research could help determine whether a standardized set of questions about coping and avoidance would be a useful addition to routine vestibular evaluations.

What Can Patients Take Away From This Research?

One of the most encouraging messages from this study is that your everyday experiences with dizziness matter.

When preparing for a medical appointment, consider sharing not only what your symptoms feel like, but also how they affect what you do.

Tell your healthcare provider about the activities you’ve changed, the environments you find challenging, and the strategies you’ve developed to manage your symptoms.

These details may help your provider better understand your condition, select appropriate testing, and recommend treatments that address your individual challenges.

For researchers, the findings offer another opportunity to explore ways to improve the diagnosis of vestibular disorders. With further study, structured questions about patients’ experiences could become a useful part of clinical assessments.

The bottom line: Listening to patients means understanding more than their symptoms. It also means understanding how those symptoms shape their lives. This research reinforces the value of a thorough medical history and suggests that patients’ everyday experiences may offer important clues to more accurate diagnoses and better care.

Original Research

Ozdemir, H. N., Klopotovska, I., & Kaski, D. (2026). What patients do when they feel dizzy: Behavioural signatures reveal diagnostic clues in common vestibular disorders. Journal of Neurology, 273, Article 587. https://doi.org/10.1007/s00415-026-14133-0