From the Guidelines
Treatment for vertigo should prioritize the canalith repositioning procedure for patients with posterior canal Benign Paroxysmal Positional Vertigo (BPPV), as recommended by the strongest and most recent evidence 1. The treatment options for vertigo depend on the underlying cause, and it is crucial to diagnose the specific type of vertigo to provide effective management.
- For Benign Paroxysmal Positional Vertigo (BPPV), the canalith repositioning procedure, such as the Epley maneuver, is the recommended initial therapy 1.
- Vestibular rehabilitation may also be offered as an option for the treatment of BPPV, as stated in the clinical practice guideline 1.
- Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines, according to the guideline 1.
- Lifestyle modifications, such as avoiding sudden head movements and staying hydrated, can also help manage vertigo symptoms.
- It is essential to reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms, and to evaluate patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders 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). DOSAGE AND ADMINISTRATION 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 orally.
- Tablets should be swallowed whole.
- Available tablet strengths are 12.5 mg, 25 mg, and 50 mg.
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, 7
- Vestibular suppressant medications and vestibular rehabilitation for vestibular neuritis 3, 4
- Salt restriction and diuretics for Meniere disease 3, 4
- Intratympanic dexamethasone or gentamicin for Meniere disease 4
- Steroids for vestibular neuritis 4
- Alpha agonists, mineralocorticoids, or lifestyle changes for orthostatic hypotension that causes presyncope 4
Specific Treatment Options for BPPV
For BPPV, the Epley maneuver is a commonly used treatment option. Studies have shown that the Epley maneuver is effective in resolving vertigo symptoms and converting a positive Dix-Hallpike test to a negative test 5, 6, 7. The Epley maneuver has been compared to other treatment options, such as the Semont maneuver and Brandt-Daroff exercises, and has been found to be effective in resolving vertigo symptoms 7.
Recurrence of BPPV
There is a high recurrence rate of BPPV after treatment, with one study reporting a recurrence rate of 19.4% 6. However, the Epley maneuver can be repeated as needed to resolve recurrent symptoms 6.
Adverse Effects of Treatment
Adverse effects of the Epley maneuver are infrequently reported and are generally mild, with some patients experiencing nausea during the procedure 7.