What are the treatments for dizziness?

From the Guidelines

Treatment for dizziness, specifically benign paroxysmal positional vertigo (BPPV), should start with the Epley maneuver to reposition displaced inner ear crystals, as it has been shown to be highly effective in resolving symptoms. This approach is supported by the most recent and highest quality studies, including those published in the journal Otolaryngology--head and neck surgery 1.

Key Points for Treatment:

• The Epley maneuver, also known as the canalith repositioning procedure (CRP), is a series of specific head and body movements designed to move the calcium particles (otoconia) out of the semicircular canals of the inner ear, where they are causing the vertigo, and back into an area of the ear where they will not cause symptoms 1.
• Medications such as meclizine (25-50mg every 4-6 hours), dimenhydrinate (50mg every 4-6 hours), or scopolamine patches can help manage symptoms by reducing sensitivity in the balance system, but they are not a substitute for the Epley maneuver in treating BPPV 1.
• Vestibular rehabilitation therapy exercises can also be beneficial in helping the brain to process balance information correctly, especially in cases where symptoms persist after successful repositioning maneuvers 1.
• For other causes of dizziness, such as Ménière's disease, treatment may include salt restriction, diuretics like hydrochlorothiazide (25mg daily), and sometimes steroids. Bacterial infections causing dizziness require antibiotics, while viral infections typically resolve with supportive care 1.

Lifestyle Modifications:

• Staying hydrated, avoiding sudden movements, and getting up slowly can prevent symptom exacerbation.
• Reducing caffeine, alcohol, and tobacco may help as these can affect blood flow and worsen dizziness.
• If dizziness is accompanied by severe headache, difficulty speaking, facial drooping, or loss of consciousness, immediate medical attention is necessary as these could indicate serious conditions like stroke.

Follow-Up:

It is crucial for patients with persistent symptoms after initial treatment to be reevaluated to identify treatment failures, promote the timely diagnosis and management of underlying peripheral or CNS disorders, and reduce the risk of secondary complications related to unresolved or unidentified disease 1. Repeat canalith repositioning maneuvers can be performed if the Dix-Hallpike test remains positive, indicating persistent BPPV.

In conclusion, the Epley maneuver is the first-line treatment for BPPV due to its high success rate and the potential for significant improvement in quality of life for patients suffering from this condition, as supported by recent clinical practice guidelines 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 treatment for dizziness, specifically vertigo, is meclizine hydrochloride tablets. The recommended dosage is 25 mg to 100 mg daily, in divided doses 2.

• Key points:
  • Indication: Treatment of vertigo associated with diseases affecting the vestibular system in adults.
  • Dosage: 25 mg to 100 mg daily, in divided doses.
  • Administration: Tablets should be swallowed whole.

From the Research

Treatments for Dizziness

• The treatment of dizziness, particularly vertigo, can be approached through various methods, including pharmacological treatment and physical therapy maneuvers 3.
• Pharmacological treatment involves the use of medications such as anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists to manage symptoms and underlying conditions 3.
• For specific conditions like Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used, while for Ménière's disease, salt restriction and diuretics are also employed to prevent flare-ups 3.
• In cases of benign paroxysmal positional vertigo (BPPV), physical therapy maneuvers like the Epley and Semont maneuvers have been found to be effective in treating the condition 4, 5, 6, 7.

Physical Therapy Maneuvers

• The Epley maneuver, also known as the canalith repositioning maneuver, is a series of physical movements performed to help treat BPPV by moving calcium particles (otoconia) out of the semicircular canals of the inner ear 4, 5, 6.
• The Semont maneuver is another technique used for the treatment of BPPV, which involves a series of movements designed to liberate the otoconia from the affected canal 4, 7.
• Studies have shown that both the Epley and Semont maneuvers are effective in treating BPPV, with a significant reduction in symptoms and improvement in patient outcomes 4, 5, 7.

Pharmacological and Other Treatments

• For central vertigo, which includes vertigo associated with migraine and certain strokes, prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers are used as the mainstay of treatment 3.
• In cases of psychogenic vertigo, which occurs in association with disorders like panic disorder, anxiety disorder, and agoraphobia, benzodiazepines have been found to be useful 3.
• For undetermined and ill-defined causes of vertigo, an empirical approach incorporating trials of medications, physical therapy, and psychiatric consultation is suggested 3.