Important safety note
HINTS is a clinician-performed examination. It should not be performed, repeated, or interpreted at home. A HINTS report cannot by itself diagnose, exclude, or confirm stroke or an inner-ear cause.
Sudden weakness, facial droop, speech difficulty, new severe imbalance or inability to walk, double vision, fainting, chest pain, severe new headache, or other new neurological symptoms may be an emergency. Seek help from local emergency services or the nearest emergency department. Do not wait for a clinic reply or try to use HINTS to decide whether to wait.
What this guide can help with
This page explains why a clinician may perform a HINTS examination, what the common report terms refer to, and how to prepare for a clinical assessment. It is designed to help you take part in the consultation and ask informed questions.
It does not teach the examination, provide a method for checking your own eyes or head movements, or tell you how to decide whether a result is safe or dangerous.
When might HINTS be considered?
HINTS may be useful in a particular pattern of acute, persistent dizziness or vertigo. The clinician first decides whether this is the right situation for the examination. Brief dizziness with a specific movement, light-headedness on standing, or a long-standing intermittent symptom pattern may need a different assessment.
The decision also depends on the history, neurological examination, walking and balance, hearing symptoms, medicines, medical conditions, and emergency warning signs. If the situation is urgent, emergency assessment takes priority over an outpatient appointment.
What happens during a clinician-performed HINTS assessment?
The clinician asks about when the symptoms began, whether they are continuous or episodic, and whether there are associated hearing, vision, speech, weakness, numbness, headache, chest, or fainting symptoms. They observe eye movements and may assess walking, balance, hearing, and other neurological signs. If appropriate, the clinician performs the HINTS eye-movement examination.
The clinician controls the examination and tells you what to do. Do not attempt to practise the movements beforehand or ask a family member to perform them. If you are very unwell, unable to walk safely, or have emergency symptoms, seek emergency care and do not drive yourself.
Terms that may appear in the report
Head impulse
This refers to a clinician’s observation of how the eyes maintain focus during the examination. It is one part of the report, not a result that should be judged in isolation.
Nystagmus
Nystagmus is involuntary eye movement. The report may describe its direction or behaviour. The clinical meaning depends on the complete examination and cannot safely be established by self-observation or an online video.
Test of skew
This refers to a clinician’s assessment of eye alignment. It is interpreted with the other findings and the neurological examination.
HINTS Plus
In some situations, the clinician may add a hearing assessment. The report may call this HINTS Plus. The term does not provide a diagnosis by itself and does not replace clinical judgement or emergency assessment.
How clinicians interpret the report
A HINTS report is read together with the full clinical picture. The treating clinician may consider symptom timing, the neurological examination, walking ability, hearing, risk factors, and whether imaging or other tests are needed. The same word in a report can have different importance in different clinical settings.
For this reason, do not use one line of a HINTS report to conclude that you have a stroke, that you do not have a stroke, or that the problem is definitely from the inner ear. Ask the clinician what the complete assessment means for you and what next step is recommended.
How to prepare for your assessment
Bring, or write down, the following information if you can do so safely:
- When the symptoms started and whether they are continuous or episodic.
- What you were doing when they began and whether any movement clearly triggers them.
- Associated symptoms, including hearing changes, ear symptoms, headache, double vision, speech difficulty, weakness, numbness, fainting, chest pain, or inability to walk.
- Recent illnesses, injuries, new medicines, and a list of regular medicines and allergies.
- Previous clinic notes, scan reports, hearing tests, or vestibular test reports.
If symptoms are severe or an emergency feature is present, do not delay care to collect documents. Seek emergency assessment first.
Questions you can ask the clinician
- Why was HINTS considered in my situation?
- What does the report mean together with my other examination findings?
- Do I need emergency assessment, imaging, another test, or follow-up?
- What symptoms should make me seek urgent help?
Related HINTS guides
- HINTS Examination: Understanding Peripheral and Central Patterns explains the general role of a trained clinician’s examination.
- HINTS Exam in Acute Vertigo: Stroke Signs and Limits explains central or concerning findings and the limits of HINTS.
References
- Society for Academic Emergency Medicine. GRACE-3: Acute Dizziness and Vertigo in the Emergency Department.
- Gottlieb M, et al. Head impulse, nystagmus, and test of skew examination for diagnosing central causes of acute vestibular syndrome. Cochrane Database of Systematic Reviews. 2023.
- Aldridge S, Krishnan K. Using HINTS in acute vestibular syndrome: a practical guide for the acute care physician. 2025.
Medical disclaimer: This article is for education only and does not provide a diagnosis or emergency triage for an individual. HINTS is a clinician-performed examination and is not a home test. Seek urgent medical care for new or severe warning symptoms.
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