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

Abstract Background Diagnosis of vestibular disorders relies heavily on clinical history, yet how patients adapt their behaviour in response to dizziness remains relatively unexplored. We investigated whether adopted avoidance behaviours and coping strategies provide additional diagnostic information and insights into disease mechanisms. Methods Consecutive patients attending a specialist dizziness clinic underwent a structured interview before clinical assessment. Participants reported dizziness triggers, avoidance behaviours, and coping responses. Final diagnoses were established independently by a vestibular neurologist, and associations between behavioural patterns and diagnosis were examined using logistic regression. Results One hundred and nine patients were included (mean age 55.3 years; 71.5% female), including thirty-three with vestibular migraine (VM), thirty-three with persistent postural-perceptual dizziness (PPPD), fourteen with benign paroxysmal positional vertigo (BPPV), and fifteen with orthostatic dizziness (OD). Reading whilst travelling predicted VM (OR 20.99), visually stimulating environments predicted PPPD (OR 12.45), head movements predicted BPPV (OR 11.51) and standing quickly was associated with OD. Avoidance and coping behaviours were similarly diagnosis-specific, including avoidance of bright or noisy environments and resting in dark or quiet settings in VM, avoidance of visually complex environments and maintaining activity in PPPD, and avoidance of head movements and remaining still during attacks in BPPV; OD patients avoided sudden standing. Conclusion Patients with common causes of dizziness exhibit distinct behavioural signatures that reflect the underlying mechanisms of their disorders. These intuitive adaptations may provide valuable clinical clues beyond conventional symptom descriptions. Questions about avoidance behaviours and coping strategies may improve diagnostic accuracy and understanding of vestibular disorders.