This chapter highlights the detailed history that has to be taken for any patient with acute vertigo. A box that lists the differential diagnosis of acute vertigo informs the reader regarding the various conditions that can present with acute vertigo. The specific history that distinguishes central from peripheral vertigo is highlighted. Conditions that produce “vertigo like symptoms” are also mentioned as they can mimic acute vertigo. The systematic examination of patients with acute vertigo has been detailed and illustrated with pictorial representation of commonly done clinical tests like head impulse test, Dix-Hallpike test, and tests of skew. The interpretation of the results of these tests is also provided. The differentiation between peripheral and central nystagmus is crucial to the diagnosis of acute vertigo, and these details have been provided in a tabular form. Once a diagnosis of acute peripheral vertigo is established, it is also important to establish the cause and tests that enable this have also been described. Finally, the chapter details the stepwise treatment of acute vertigo. Specific clinical maneuvers which may be performed in the Emergency Room itself once a proper diagnosis is established and which are beneficial in the management of acute benign paroxysmal positional vertigo are described. These include the six-step Epley maneuver and log-roll maneuver which have been described with appropriate clinical pictures. Based on the clinical diagnosis established, the medical and surgical management of other causes of acute vertigo is also described.