What are the treatment options for vertigo?

From the Guidelines

Treatment options for vertigo should prioritize vestibular rehabilitation and lifestyle modifications over medications, as medications like antihistamines and benzodiazepines are not recommended for routine treatment of BPPV 1. For immediate relief, medications like dimenhydrinate (Dramamine), meclizine (Antivert) at 25-50mg every 4-6 hours, or benzodiazepines like diazepam (Valium) at 2-5mg can help manage symptoms. However, for vertigo caused by inner ear conditions like BPPV (Benign Paroxysmal Positional Vertigo), the Epley maneuver or other vestibular rehabilitation exercises performed by a physical therapist can be highly effective by repositioning displaced calcium crystals in the inner ear 1. Patients with Ménière's disease may benefit from diuretics like hydrochlorothiazide (12.5-50mg daily) to reduce fluid buildup, salt restriction (less than 2g sodium daily), and avoiding caffeine and alcohol 1. For vestibular neuritis or labyrinthitis, a short course of corticosteroids like prednisone (starting at 60mg daily with taper) may help reduce inflammation. Lifestyle modifications including adequate hydration, regular sleep patterns, and avoiding sudden head movements can help prevent episodes. These treatments work by either addressing the underlying cause of vertigo or by suppressing the vestibular system's abnormal signals to the brain that create the sensation of spinning. Some key points to consider in the management of vertigo include:

• The use of vestibular suppressant medications should be limited to a short course for managing vertigo attacks in Ménière's disease 1
• Vestibular rehabilitation is a recommended treatment option for BPPV 1
• Lifestyle modifications play a crucial role in managing vertigo symptoms and improving quality of life 1

From the FDA Drug Label

MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).

Treatment options for vertigo include meclizine hydrochloride tablets, which are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.

• The recommended dosage is 25 mg to 100 mg daily, in divided doses 2.
• Key considerations when prescribing meclizine hydrochloride tablets include potential anticholinergic action and the risk of increased CNS depression when coadministered with other CNS depressants.

From the Research

Treatment Options for Vertigo

The treatment options for vertigo can be categorized based on the underlying cause of the condition.

• Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and bilateral vestibular paresis.
• Central vertigo includes entities such as vertigo associated with migraine and certain strokes.
• Psychogenic vertigo occurs in association with disorders such as panic disorder, anxiety disorder, and agoraphobia.
• Undetermined and ill-defined causes of vertigo make up a large remainder of diagnoses.

Medications for Vertigo

Medications used to treat vertigo include:

• Anticholinergics
• Antihistamines
• Benzodiazepines
• Calcium channel antagonists
• Dopamine receptor antagonists 3
• Betahistine, which has been shown to be effective and safe in the treatment of Ménière's disease, BPPV, vestibular neuronitis, and other types of peripheral vertigo 4

Treatment of Specific Conditions

• For Ménière's disease, vestibular suppressants such as anticholinergics and benzodiazepines are used, as well as salt restriction and diuretics to prevent flare-ups 3
• For BPPV, canalith repositioning maneuvers (CRP) are effective in treating the condition, with 91% of cases of posterior canal BPPV being effectively treated in 2 maneuvers or less 5
• For vestibular neuritis, only brief use of vestibular suppressants is recommended 3
• For central vertigo, prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers are used to treat migraine-associated vertigo 3

Special Considerations

• Patients with BPPV associated with Meniere's disease may require repeated canalith repositioning procedures and have a higher recurrence rate 6, 7
• The treatment of vertigo is optimized when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought 3