Vertigo is a type of dizziness characterized by the sensation of spinning or feeling like the environment is moving, even when stationary. This symptom arises from a disturbance in the vestibular system, which controls balance and spatial orientation. An urgent care center (UCC) provides a timely setting for initial evaluation and treatment. UCC providers quickly determine if the vertigo is caused by a benign inner ear issue or a more serious neurological condition.
Recognizing Emergency Symptoms (When to Bypass Urgent Care)
While UCCs manage most common vertigo causes, certain accompanying symptoms indicate a serious, life-threatening event requiring an immediate emergency room (ER) visit. These “red flag” symptoms suggest a central cause, such as a stroke or brain bleed, rather than a peripheral inner ear problem. A sudden, severe headache, often described as the “worst headache of your life,” requires an immediate trip to the ER.
Any new neurological deficit alongside the vertigo is concerning. This includes double vision, slurred speech, or sudden weakness or numbness on one side of the body. The inability to walk or severe loss of coordination (truncal ataxia) necessitates emergency evaluation. These signs point to an issue with the brainstem or cerebellum that UCCs cannot manage.
Other high-risk symptoms that bypass UCC include chest pain, an irregular heart rhythm, or fainting. UCC facilities lack immediate access to advanced imaging (CT scans or MRIs) or the specialized monitoring required for these acute conditions. If the vertigo is accompanied by any of these severe symptoms, the ER is the correct destination.
Diagnostic Approach in an Urgent Care Setting
The urgent care provider’s initial assessment focuses on differentiating between peripheral (inner ear) and central (brain) causes. This begins with a detailed patient history, examining the onset, duration, and triggers of the spinning sensation. Vertigo lasting only seconds and triggered by head position changes often suggests a benign peripheral issue, while constant, unprovoked vertigo is more concerning.
Physical examination techniques are used to narrow the diagnosis, including observing a patient’s gait and balance using the Romberg test. The clinician will also look for nystagmus, a rhythmic, involuntary movement of the eyes. This eye movement pattern offers clues about the location of the problem within the vestibular system.
A specialized bedside examination, the HINTS exam, is utilized for patients with acute, continuous vertigo. HINTS stands for Head Impulse, Nystagmus, and Test of Skew. The Head Impulse Test assesses eye fixation during rapid head movement, and the Test of Skew looks for vertical eye misalignment. A pattern consistent with a central cause on the HINTS exam is highly accurate for ruling in a stroke, often more sensitive than an early MRI.
Acute Management and Follow-Up
For Benign Paroxysmal Positional Vertigo (BPPV), the most common inner ear cause, UCCs provide a definitive, non-pharmacological treatment. This is the Epley maneuver, a series of precise movements designed to reposition displaced calcium carbonate crystals. The Epley maneuver is a first-line treatment for BPPV that can resolve symptoms in a single visit with a success rate of up to 90%.
Medications provide symptomatic relief for acute vertigo or inner ear inflammation. Providers may prescribe vestibular suppressants, such as meclizine, an antihistamine that calms the inner ear’s response to movement. Anti-nausea medications alleviate the severe nausea and vomiting that accompany an attack. These medications only mask symptoms and are prescribed for short-term use only.
Urgent care addresses the acute problem but is not a setting for chronic disease management. Patients should follow up with their primary care provider (PCP) for ongoing symptoms or recurrence prevention. If the UCC provider suspects a complex inner ear disorder, such as Meniere’s disease or vestibular neuritis, a referral to a specialist (ENT or neurologist) will be arranged for long-term care and specialized testing.