The evaluation of patients with the complaint of “dizziness” is a frequent occurrence in the ED. It accounts for 3.5–11% of ED visits. The word dizziness is a nonspecific term used by patients and healthcare professionals to describe a disturbed sense of wellbeing, usually perceived as an altered orientation in space. Vertigo is defined as an illusion of movement of oneself or one’s surroundings. It is usually experienced as a sensation of rotation or, less frequently, as undulation, linear displacement (pulsion), or tilt. Although vertigo usually suggests a vestibular disorder that can involve the inner ear or brain, this symptom itself cannot reliably localize the disorder. Dizziness or vertigo can result from numerous disorders of a complex human balance system. Despite the inherent complexities, the ED evaluation of dizziness or vertigo can be simplified by a systematic approach in history-taking, physical examination, and laboratory testing.