From the Guidelines
Vagus nerve stimulation is not currently established as an effective treatment for vertigo triggered by head turning. The primary treatments for positional vertigo include canalith repositioning procedures (such as the Epley maneuver), vestibular rehabilitation exercises, and in some cases medications like meclizine (12.5-25mg every 4-6 hours as needed), diazepam (2-5mg as needed), or promethazine (12.5-25mg every 4-6 hours as needed) for symptom management 1. While vagus nerve stimulation has been investigated for various neurological and psychiatric conditions, including some forms of dizziness, there is insufficient clinical evidence supporting its use specifically for benign paroxysmal positional vertigo (BPPV) or other forms of vertigo triggered by head movements.
Key Points to Consider
- The pathophysiology of positional vertigo typically involves displaced calcium carbonate crystals in the inner ear's semicircular canals, which vagus nerve stimulation would not directly address 1.
- BPPV is most commonly clinically encountered as 1 of 2 variants: BPPV of the posterior semicircular canal (posterior canal BPPV) or BPPV of the lateral semicircular canal (also known as horizontal canal BPPV) 1.
- Patients with BPPV experience effects on individual health-related quality of life, and utility measures demonstrate that treatment of BPPV results in improvement in quality of life 1.
Recommendations
- If you're experiencing vertigo with head turning, consult a healthcare provider for proper diagnosis, as this symptom is most commonly associated with BPPV, which responds well to established repositioning maneuvers and does not require vagus nerve intervention.
- Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver 1.
- Clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure 1.
From the Research
Vertigo and Vagus Nerve Stimulation
- Vertigo triggered by head turning is often associated with benign paroxysmal positional vertigo (BPPV) 2, 3, 4.
- BPPV is typically diagnosed using the Dix-Hallpike maneuver or supine roll test, and can be treated with repositioning techniques such as the particle repositioning maneuver 2, 3.
- Vagus nerve stimulation (VNS) is a treatment that involves electrical stimulation of the vagus nerve, and is typically used to treat epilepsy and depression 5.
- There is some evidence to suggest that non-invasive VNS may be effective in treating headache disorders such as migraine and cluster headache 6.
- However, there is no direct evidence to suggest that VNS is effective in treating vertigo triggered by head turning, and more research is needed to fully understand its potential benefits and limitations in this context.
Potential Mechanisms and Applications
- The exact mechanism by which VNS achieves its effects is not fully understood, but it is thought to involve modulation of the autonomic nervous system, inhibition of cortical spreading depression, regulation of neurotransmitters, and modulation of nociceptive pathways 6.
- While VNS has been shown to be effective in treating certain types of headache, its potential application in treating vertigo and other vestibular disorders is still largely theoretical and requires further investigation.
- Further research is needed to determine whether VNS may be a useful treatment option for patients with vertigo triggered by head turning, and to fully understand its potential benefits and limitations in this context.