What is the treatment for persistent vertigo (dizziness) lasting over 2 weeks following a cruise, potentially related to benign paroxysmal positional vertigo (BPPV) or other inner ear disorders?

From the Guidelines

For vertigo persisting over 2 weeks after a cruise, you should see a healthcare provider as this may be a condition called benign paroxysmal positional vertigo (BPPV) or another vestibular disorder. The healthcare provider will likely perform a Dix-Hallpike test or supine roll test to diagnose BPPV, as recommended by the clinical practice guideline: benign paroxysmal positional vertigo (update) executive summary 1.

Diagnosis and Treatment

• The diagnosis of BPPV is based on a history of vertigo and a positive Dix-Hallpike test or supine roll test, as stated in the guideline 1.
• The treatment of choice for BPPV is a canalith repositioning procedure (CRP), which has a high success rate of 80-90% with only 1-3 treatments, as mentioned in the patient information: frequently asked questions section 1.
• The clinician should treat patients with posterior canal BPPV with a canalith repositioning procedure, as strongly recommended by the guideline 1.
• Vestibular rehabilitation exercises, such as the Epley maneuver, may also be offered as an option for treatment, as stated in the guideline 1.

Management and Follow-up

• Patients with persistent symptoms after initial treatment should be reevaluated for unresolved BPPV and underlying peripheral or central nervous system disorders, as recommended by the guideline 1.
• The clinician should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms, as recommended by the guideline 1.
• Patient education is crucial in managing BPPV, and patients should be counseled regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up, as emphasized in the guideline 1.

Additional Considerations

• The risk of falls associated with BPPV should be assessed, particularly in the elderly and frail, and patients should be counseled regarding home safety and activity restrictions, as discussed in the guideline 1.
• Patients with severe disabling symptoms, history of past falls, or fear of falling should be referred to a healthcare professional for further evaluation and treatment, as recommended by the guideline 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.

The treatment for vertigo that has continued over 2 weeks after a cruise may include meclizine (PO), as it is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2.

From the Research

Treatment Options for Vertigo

• The Epley maneuver is considered the primary treatment for Benign Paroxysmal Positional Vertigo (BPPV) 3, 4.
• Anti-vertigo medications such as betahistine and dimenhydrinate can be effective in reducing residual symptoms of BPPV 3, 4.
• Betahistine may be more effective than dimenhydrinate in improving residual dizziness symptoms 4.
• Vestibular suppressant medications such as diazepam and meclizine can be used to alleviate symptoms of vertigo 5.

Evaluation of Vertigo

• A timing-and-triggers approach should be used to characterize the patient's vestibular symptoms as continuous or episodic 6.
• The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies of vertigo 7.
• Laboratory testing and imaging are not required and are usually not helpful in evaluating vertigo 7.

Specific Treatments

• Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (e.g., Epley maneuver) 7.
• Meniere disease can be treated with salt restriction and diuretics 7.
• Vestibular neuritis can be treated with vestibular suppressant medications and vestibular rehabilitation 7.