From the Guidelines
Treatment for dizziness should prioritize the Epley maneuver for Benign Paroxysmal Positional Vertigo (BPPV), as it has a high success rate of 80-90% in resolving symptoms. The Epley maneuver is a series of head position changes designed to move free-floating particles in the inner ear back into the vestibule, relieving the pathologic stimulus that produces vertigo in BPPV 1.
For medication, antihistamines like meclizine (25-50mg every 4-6 hours) or dimenhydrinate (50mg every 4-6 hours) can help reduce vertigo symptoms. Benzodiazepines such as diazepam (2-5mg) may be prescribed for severe cases but should be used short-term due to addiction risk. For motion sickness-related dizziness, scopolamine patches (1.5mg applied behind the ear every 72 hours) can be effective.
Non-medication treatments include vestibular rehabilitation therapy, which involves exercises to help the brain compensate for balance problems. Lifestyle modifications are also important:
- Staying hydrated
- Avoiding sudden head movements
- Getting up slowly from sitting or lying positions
- Reducing caffeine, alcohol, and salt intake
It is essential to note that BPPV can recur, and patients should be counseled about the risk of recurrence and the importance of follow-up after initial treatment 2. The Dix-Hallpike test should be repeated to confirm the diagnosis of BPPV, and repeat canalith repositioning maneuvers can be performed as a preferred treatment for persistent BPPV 3.
Overall, the goal of treatment is to alleviate symptoms, improve quality of life, and reduce the risk of falls and other complications associated with dizziness. By prioritizing the Epley maneuver and incorporating medication and non-medication approaches as needed, clinicians can provide effective treatment for patients with dizziness.
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). DOSAGE AND ADMINISTRATION Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).
The treatment option for dizziness, specifically vertigo associated with diseases affecting the vestibular system, is meclizine hydrochloride tablets with a recommended dosage of 25 mg to 100 mg daily, in divided doses 4.
From the Research
Treatment Options for Dizziness
The treatment for dizziness is dependent on the etiology of the symptoms 5. Some of the treatment options include:
- Canalith repositioning procedures, such as the Epley maneuver, which are helpful in treating benign paroxysmal positional vertigo (BPPV) 5, 6, 7, 8
- Vestibular rehabilitation, which is helpful in treating many peripheral and central etiologies of dizziness 5, 9
- Pharmacologic intervention, although its use is limited due to its effect on the central nervous system's ability to compensate for dizziness 5
- Treatment of underlying conditions, such as Meniere disease, which includes salt restriction and diuretics 9
- Vestibular suppressant medications and vestibular rehabilitation for symptoms of vestibular neuritis 9
Specific Treatments for BPPV
For BPPV, the Epley maneuver is a highly effective treatment, with a significant improvement in symptoms and conversion of the Dix-Hallpike test from positive to negative 6, 7, 8. The Epley maneuver is more effective than vestibular rehabilitation at 1-week follow-up, although the evidence is inconsistent at 1-month follow-up 6. Other treatments, such as the Semont and Gans maneuvers, may also be effective, but the Epley maneuver is generally considered the first-line treatment for posterior canal BPPV 8.
Importance of Accurate Diagnosis
Accurate diagnosis is crucial in determining the appropriate treatment for dizziness 5, 9. A thorough physical examination, including orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver, can help identify the underlying cause of dizziness 5, 9. Laboratory testing and imaging are usually not required, but may be helpful in certain cases 5, 9.