Vertigo is a common but complex challenge. In one postal survey of  patients from general practice, 7% reported at least one episode of vertigo in the past year. A full-time GP may expect to encounter 10-20 cases of vertigo each year and it is often seen as a potentially difficult symptom to diagnose and manage. The first problem is that the terms vertigo, dizziness, giddiness and imbalance are used in different ways by different clinicians. Dizziness and vertigo are often used interchangeably by both patients and clinicians (including the authors). The second problem is that the control of balance is complicated and diagnosing the cause of a balance disorder can take time which is usually at a premium in most clinics. Third, vertigo can be caused by many different pathologies, some of which are potentially life threatening, and it is managed by several specialties. However, much of this can be overcome by using a logical, systematic approach to the diagnosis and subsequent referral or management of the patient.