What are the treatment options for vertigo?

From the Guidelines

Treatment for vertigo, particularly Benign Paroxysmal Positional Vertigo (BPPV), should primarily involve canalith repositioning procedures, such as the Epley maneuver, as initial therapy, as recommended by the strongest and most recent evidence 1. The approach to treating vertigo depends on its underlying cause, which can range from BPPV to more serious conditions like Ménière's disease or vestibular neuritis. For BPPV, the evidence strongly supports the use of repositioning maneuvers to guide the displaced calcium crystals back to their normal location in the inner ear, thereby alleviating symptoms 1. Key points to consider in the management of vertigo include:

• Diagnosis: Accurate diagnosis is crucial, often involving the Dix-Hallpike test or supine roll test for BPPV, and differentiating it from other causes of dizziness or vertigo 1.
• Treatment: For BPPV, canalith repositioning procedures are recommended as the first line of treatment, with a strong recommendation against routine use of vestibular suppressant medications like antihistamines or benzodiazepines 1.
• Vestibular Rehabilitation: This may be offered as an option for the treatment of BPPV, based on controlled observational studies showing a balance of benefit and harm 1.
• Lifestyle Modifications: Patients are advised to avoid sudden head movements, sit down when feeling dizzy, and rise gradually from lying positions, along with staying hydrated and limiting caffeine, alcohol, and salt intake.
• Medical Therapy: While medications like dimenhydrinate, meclizine, or promethazine can provide immediate relief for vertigo symptoms, their use in BPPV is not routinely recommended unless for severe cases or specific conditions like Ménière's disease or vestibular neuritis, where other treatments such as diuretics or corticosteroids may be indicated. Given the potential for serious underlying conditions, persistent or severe vertigo warrants thorough medical evaluation to determine the specific cause and appropriate treatment, prioritizing interventions that improve morbidity, mortality, and quality of life outcomes 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).

The treatment option for vertigo is meclizine hydrochloride tablets, with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.

• The dosage can be administered in divided doses.
• Meclizine is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2 2.

From the Research

Treatment Options for Vertigo

The treatment options for vertigo depend on the underlying cause of the condition. Some of the treatment options include:

• Canalith repositioning procedure (e.g., Epley maneuver) for benign paroxysmal positional vertigo (BPPV) 3, 4, 5, 6
• Salt restriction and diuretics for Meniere disease 3
• Vestibular suppressant medications and vestibular rehabilitation for vestibular neuritis 3
• Epley maneuver for posterior canal BPPV, which has been shown to be effective in resolving vertigo and converting the Dix-Hallpike maneuver from positive to negative 5, 6

Effectiveness of Treatment Options

The effectiveness of these treatment options has been studied in various research papers. For example:

• A study found that the Epley maneuver was effective in eliminating positional nystagmus and vertigo in patients with BPPV associated with Meniere's disease 4
• A systematic review found that the Epley maneuver was more effective than vestibular rehabilitation in treating posterior BPPV at 1-week follow-up, but the evidence was inconsistent at 1-month follow-up 5
• A systematic review of systematic reviews found that the Epley maneuver was associated with higher complete resolution of vertigo and conversion to negative Dix-Hallpike at 1 week, with a moderate certainty of evidence 6

Diagnosis and Treatment Approach

A practical approach to diagnosing the cause of vertigo involves categorizing dizziness into one of four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo, and then differentiating between central and peripheral vertigo 7. The tempo of the vertiginous attacks and other associated symptoms can help differentiate the causes of peripheral vertigo, including BPPV, Meniere's disease, vestibular neuronitis, labyrinthitis, and a perilymph fistula 7.