What are the treatment options for vertigo?

From the Guidelines

Vertigo treatment should prioritize vestibular rehabilitation therapy and the Epley maneuver for benign paroxysmal positional vertigo (BPPV), as these methods have been shown to be highly effective in reducing vertigo symptoms and improving quality of life 1.

Key Treatment Approaches

• Vestibular rehabilitation therapy: involves specific head, eye, and body exercises to help the brain compensate for inner ear problems
• Epley maneuver: a repositioning procedure that can help to relocate calcium crystals in the inner ear, often used for BPPV
• Lifestyle modifications: avoiding sudden head movements, sitting down when feeling dizzy, using good lighting when getting up at night, and reducing consumption of caffeine, alcohol, and salt

Medications

• Meclizine (25mg every 4-6 hours), diazepam (2-5mg every 8 hours), or promethazine (25mg every 4-6 hours) may be used for short-term relief of vertigo symptoms, but should be used with caution due to potential side effects and dependency risks 1

Importance of Medical Evaluation

• If vertigo persists beyond a few weeks or is accompanied by hearing loss, severe headache, or neurological symptoms, medical evaluation is necessary to rule out more serious conditions 1

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).

Vertigo Treatment: Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2. The recommended dosage is 25 mg to 100 mg daily, in divided doses.

• Key Points:
  • Indicated for vertigo treatment
  • Dosage: 25 mg to 100 mg daily
  • Administration: in divided doses
• Important Considerations:
  • Contraindicated in patients with hypersensitivity to meclizine or any of the inactive ingredients 2
  • May cause drowsiness: use caution when driving a car or operating dangerous machinery 2

From the Research

Vertigo Treatment Options

• The treatment of vertigo depends on the underlying cause, which can be otological, central, somatosensory, or visual 3.
• For peripheral vertigo, the most common cause is benign paroxysmal positional vertigo (BPPV), and the Epley maneuver is a recommended treatment 4, 5, 6.
• The Epley maneuver has been shown to be effective in resolving vertigo symptoms in patients with BPPV, with a high success rate and low risk of adverse effects 4, 5, 6.
• Other treatment options for vertigo include medication, physiotherapy, and psychotherapy, as well as surgical treatment in some cases 7.

Treatment of Specific Conditions

• For BPPV, the Epley maneuver is a commonly used treatment, and it has been shown to be effective in resolving vertigo symptoms and converting the Dix-Hallpike test from positive to negative 4, 5, 6.
• For Meniere's disease, treatment options include high-dose, long-term betahistine, as well as other medications and lifestyle modifications 7.
• For vestibular neuritis, the treatment of choice is the administration of corticosteroids 7.

Comparison of Treatment Options

• The Epley maneuver has been compared to vestibular rehabilitation in several studies, and it has been shown to be more effective in treating BPPV at 1-week follow-up 6.
• However, the evidence is inconsistent for the effectiveness of the Epley maneuver compared to vestibular rehabilitation at 1-month follow-up 6.