What is the treatment for vertigo?

From the Guidelines

The treatment for vertigo, specifically for benign paroxysmal positional vertigo (BPPV), should primarily involve the Epley maneuver or other repositioning exercises performed by a healthcare provider, as these have been shown to be highly effective in moving displaced calcium crystals back to their proper location in the inner ear 1.

Key Considerations

• The Epley maneuver is recommended as the initial therapy for patients with posterior canal BPPV, with a strong recommendation based on the evidence that it is effective in resolving symptoms 1.
• Vestibular rehabilitation therapy may also be offered as part of the treatment for BPPV, as it can help train the brain to compensate for balance problems, although the evidence for its use is based on controlled observational studies and a balance of benefit and harm 1.
• Medications such as vestibular suppressants (e.g., meclizine, diazepam, promethazine) are not recommended for the routine treatment of BPPV but may be used for short-term management of severe symptoms like nausea or vomiting 1.

Diagnosis and Assessment

• Diagnosis of BPPV should involve a thorough clinical history, physical examination, and specific tests such as the Dix-Hallpike maneuver for posterior semicircular canal BPPV and the supine roll test for lateral semicircular canal BPPV 1.
• It is crucial to differentiate BPPV from other causes of imbalance, dizziness, and vertigo, and to assess for modifying factors that may impact management, such as impaired mobility or central nervous system disorders 1.

Management Approach

• The management approach should be individualized, taking into account the patient's specific condition, preferences, and the potential benefits and harms of different treatments.
• Patient education on the impact of BPPV, potential for recurrence, and importance of follow-up is essential 1.
• Long-term management may include lifestyle modifications such as avoiding triggers like caffeine, alcohol, and stress, and vestibular rehabilitation therapy to improve balance and reduce the risk of falls.

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

• The dosage should be taken as directed by a healthcare professional.
• Meclizine hydrochloride tablets are specifically indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.

From the Research

Treatment Options for Vertigo

The treatment for vertigo depends on the underlying cause and can be categorized into different approaches:

• Pharmacological treatment: This includes the use of medications such as anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists to manage symptoms 3.
• Physical therapy: Vestibular rehabilitation physical therapy is often recommended to promote compensation for vestibular damage 3.
• Specific treatments for different causes of vertigo:
  • Otological vertigo: Treatment for disorders such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and bilateral vestibular paresis may involve vestibular suppressants, salt restriction, diuretics, and physical therapy 3.
  • Central vertigo: Prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers are used to treat migraine-associated vertigo 3.
  • Psychogenic vertigo: Benzodiazepines are commonly used to treat vertigo associated with panic disorder, anxiety disorder, and agoraphobia 3.

Efficacy of Specific Treatments

• The Epley maneuver is a highly effective treatment for benign paroxysmal positional vertigo (BPPV), with a success rate of 90.7% after the initial maneuver and 96% after the second maneuver 4.
• Diazepam and meclizine are equally effective in treating acute peripheral vertigo, with no significant difference in mean improvement in visual analog scale scores between the two groups 5.
• Betahistine add-on therapy has been shown to improve treatment outcomes in subjects with posterior BPPV, with significant reductions in visual analog scale scores and dizziness handicap inventory values 6.

Acute Vertigo Treatment

• Pharmacotherapy for acute spontaneous vertigo includes medications such as Levo-sulpiride, methoclopramide, and triethilperazine to reduce neurovegetative symptoms, and diazepam to decrease internuclear inhibition 7.
• Physical therapy for acute vertigo includes vestibular electrical stimulation and maneuvers such as the Epley maneuver to reduce antigravitary failure and increase proprioceptive cervical sensory substitution 7.