From the Guidelines
The best treatment for vertigo is the Epley maneuver for benign paroxysmal positional vertigo (BPPV), which involves specific head movements to reposition displaced calcium crystals in the inner ear, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1.
Treatment Options
- For BPPV, the Epley maneuver is the first-line treatment, with a high success rate of around 80% with only 1-3 treatments 1.
- Vestibular rehabilitation therapy is highly effective for many types of vertigo, involving exercises that train the brain to compensate for balance problems 1.
- For vestibular neuritis or labyrinthitis, medications like meclizine (Antivert) 25mg every 4-6 hours, dimenhydrinate (Dramamine) 50mg every 4-6 hours, or diazepam (Valium) 2-5mg as needed can help manage symptoms during the acute phase, typically for 3-5 days.
- For Ménière's disease, a low-salt diet (less than 2g sodium daily), diuretics like hydrochlorothiazide 25mg daily, and avoiding caffeine and alcohol can help reduce fluid buildup in the inner ear.
Important Considerations
- During acute vertigo episodes, it's essential to sit or lie down in a safe place, avoid sudden head movements, and gradually resume normal activities as symptoms improve.
- The Epley maneuver and vestibular rehabilitation therapy work by either correcting the mechanical problem in the inner ear, reducing inflammation, decreasing sensitivity to motion, or helping the brain adapt to balance disturbances.
- Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, as stated in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
- The guideline update group classified the role of patient preference based on consensus among the group as “none, small, moderate, or large” and recommended that clinicians provide patients with clear and comprehensible information on the benefits to facilitate patient understanding and shared decision making 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).
The best treatment for vertigo is meclizine hydrochloride tablets, with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.
- The dosage should be taken as directed, with tablets swallowed whole.
- Key considerations for treatment include potential side effects such as drowsiness, dry mouth, and headache, as well as potential interactions with other CNS depressants or CYP2D6 inhibitors.
From the Research
Treatment Options for Vertigo
The treatment for vertigo depends on the underlying cause, which can be peripheral or central 3. Peripheral etiologies are usually benign, while central etiologies often require urgent treatment.
Peripheral Vertigo
For benign paroxysmal positional vertigo (BPPV), a canalith repositioning procedure (e.g., Epley maneuver) can be effective 3, 4. Vestibular rehabilitation (VR) can also be beneficial in improving balance control and reducing the unpleasantness of vertigo symptoms 5.
Medications
Diazepam and meclizine are oral medications that can be used to alleviate vertigo symptoms, with no significant difference in effectiveness between the two 6.
Vestibular Rehabilitation
Exercise-based vestibular rehabilitation has been shown to be effective in improving symptoms of chronic dizziness, including vertigo, with benefits in balance, fall risk, and emotional status 7. VR can be used alone or in combination with other treatments, such as canalith repositioning procedures.
Key Points
- The Epley maneuver is a effective treatment for BPPV 3, 4
- Vestibular rehabilitation can improve balance control and reduce vertigo symptoms 5
- Diazepam and meclizine are equally effective in treating peripheral vertigo 6
- Exercise-based vestibular rehabilitation is beneficial for adult patients with chronic dizziness 7