From the Guidelines
A vertigo workup should begin with a detailed history and physical examination, including the Dix-Hallpike maneuver and head impulse test, to differentiate between peripheral and central causes of vertigo, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1. The history should focus on onset, duration, triggers, and associated symptoms like hearing loss or neurological complaints.
- The physical examination should include vital signs, otoscopic examination, and specific tests like the Dix-Hallpike maneuver for benign paroxysmal positional vertigo (BPPV) and the head impulse test for vestibular function.
- Basic laboratory tests including complete blood count, metabolic panel, and thyroid function may be ordered.
- Audiometry is recommended to assess hearing loss.
- Imaging studies like MRI brain with contrast should be considered for suspected central causes, persistent symptoms, or neurological findings, as suggested by the Journal of the American College of Radiology 1.
- Vestibular function tests such as electronystagmography or videonystagmography may be necessary for persistent cases. The diagnosis of BPPV can be made using the Dix-Hallpike maneuver, and treatment with a canalith repositioning procedure is effective, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
- For vestibular neuritis, short-term vestibular suppressants like meclizine 25mg every 4-6 hours for 3-5 days may be required.
- Ménière's disease often responds to low-salt diet, diuretics like hydrochlorothiazide 25mg daily, and sometimes betahistine 16mg three times daily, as suggested by the Otolaryngology--head and neck surgery journal 1. This systematic approach helps differentiate between peripheral causes (inner ear problems) and central causes (brain issues), which is crucial for appropriate management.
- The HINTS examination can be used to distinguish AVS of benign cause from posterior circulation infarct, as suggested by the Journal of the American College of Radiology 1.
- Imaging is not required to diagnose vestibular migraine, but may be required to rule out stroke, as suggested by the Journal of the American College of Radiology 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Vertigo Workup
The workup for vertigo typically involves a combination of medical history, physical examination, and diagnostic tests.
- The initial evaluation of a patient with vertigo should focus on determining whether the vertigo is acute or chronic, episodic or continuous, and whether it is evoked by or brought on by an event or circumstance 2.
- A thorough medical history is essential in identifying the underlying cause of vertigo, as it can be a symptom of various conditions, including benign paroxysmal positional vertigo (BPPV), inner ear disorders, and neurological conditions.
Diagnostic Tests
- The Dix-Hallpike test is a commonly used diagnostic test for BPPV, which involves a series of maneuvers to assess the patient's response to changes in head position 3, 4, 5, 6.
- The Epley maneuver, also known as the canalith repositioning maneuver, is a treatment for BPPV that involves a series of specific head and body movements to help relocate the calcium particles in the inner ear 3, 4, 5, 6.
Treatment Options
- The Epley maneuver has been shown to be an effective treatment for posterior canal BPPV, with a significant reduction in vertigo symptoms and improvement in Dix-Hallpike test results 3, 5, 6.
- Other treatment options for vertigo may include rehabilitative exercises, physical maneuvers, and medical or surgical therapy, depending on the underlying cause of the condition.
Key Findings
- Studies have demonstrated the efficacy and safety of the Epley maneuver in treating BPPV, with a low risk of adverse effects and a high success rate in resolving vertigo symptoms 3, 4, 5, 6.
- However, there is limited evidence on the long-term effectiveness of the Epley maneuver and its comparison with other treatment options for BPPV 5, 6.