Dizziness Questionnaire

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Work with your child to answer these questions so you can give accurate information to your physician.

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1. What does dizziness mean to you: whirling, movement up and down or side to side, faintness, light headedness? Do you spin or does the world spin.
2. How does it start? Is it sudden or gradual?
3. How often does it occur?
4. How long does it last? Seconds, minutes, hours, days, weeks?
5. Is it influenced by your head or body movements?
6. Which of the following, if any, are associated with the dizziness? Nausea, vomiting, fainting, ringing in the ears, deafness, vision changes, convulsions, numbness?
7. Is your child taking any of these drugs: aspirin or pain killers, sedatives, tranquilizers, alcohol, hallucinogens?
8. Is your child exposed to any fumes at home or school?
9. Has your child had any recent illness, accident, or emotional upset?
10. Does your child have any ear complaints: ringing, drainage, sense of fullness, hearing loss?
11. Does your child have any palpitation of the heart?