Vertigo and dizziness syndromes in children and adolescents: Clinical presentation and diagnostic pathway

Feeling dizzy or experiencing vertigo can make it difficult for children/adolescents to attend school, participate in sports, and enjoy everyday activities. However, diagnosing the cause of dizziness and vertigo in children can be challenging because the symptoms often differ from those seen in adults and many conditions share similar features. In this study, we examined 519 children and adolescents who were assessed at a specialized dizziness clinic. We found that vestibular migraine was the most common cause of dizziness/vertigo, followed by functional dizziness and recurrent vertigo of childhood. We also found that almost one in four children had a less common condition, highlighting the importance of a careful medical assessment. Our results showed that age, symptom occurrence in episodes or continuously, and the presence of headaches were key features that helped distinguish between the most common diagnoses. Functional dizziness had a particularly large impact on daily life, with many children missing school or limiting social and physical activities. We also found that serious brain abnormalities were uncommon and, in our cohort, were almost always accompanied by clear neurological signs on examination. This suggests that extensive investigations, such as MRI scans, are not necessary for most children when the neurological examination, including eye-movement assessment, is normal.