Can a vitamin B12 deficiency cause vertigo and how is it treated?

From the Guidelines

Vitamin B12 deficiency can cause vertigo as part of its neurological manifestations, and treatment involves vitamin B12 supplementation, typically starting with intramuscular injections for severe deficiency, as recommended by the most recent guidelines 1. The standard regimen for treating vitamin B12 deficiency with neurological involvement, such as vertigo, includes hydroxocobalamin 1 mg intramuscularly administered on alternate days until there is no further improvement, then hydroxocobalamin 1 mg intramuscularly every 2 months 1. For people with vitamin B12 deficiency and no neurological involvement, hydroxocobalamin 1 mg intramuscularly should be administered three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months for life 1. It is essential to address the underlying cause of deficiency, whether it's dietary insufficiency, malabsorption issues like pernicious anemia or celiac disease, or medication effects, and to monitor B12 levels regularly during treatment 1. High-dose oral therapy (1000-2000 mcg daily) can also be effective even in malabsorption conditions due to passive diffusion mechanisms, but intramuscular injections are preferred for severe deficiency or neurological involvement 1. Improvement in vertigo symptoms may begin within weeks of starting treatment, though complete neurological recovery can take months, and most patients require lifelong supplementation if the deficiency is due to malabsorption 1.

Some key points to consider in the treatment of vitamin B12 deficiency-related vertigo include:

• Checking and treating for vitamin B12 deficiency before initiating folic acid treatment to avoid precipitation of subacute combined degeneration of the spinal cord 1
• Using hydroxocobalamin instead of cyanocobalamin for intramuscular injections, as it has a longer duration of action and is more effective in correcting deficiency 1
• Monitoring B12 levels regularly during treatment to adjust the dosage and frequency of injections as needed 1
• Addressing the underlying cause of deficiency to prevent recurrence and ensure adequate nutrition and absorption of vitamin B12 1

From the FDA Drug Label

Vitamin B12 deficiency that is allowed to progress for longer than three months may produce permanent degenerative lesions of the spinal cord. Neurologic manifestations will not be prevented with folic acid, and if not treated with Vitamin B12, irreversible damage will result.

A vitamin B12 deficiency can cause neurologic manifestations, but the provided drug labels do not explicitly mention vertigo as a symptom. However, neurologic manifestations can include a wide range of symptoms, and some studies suggest that vitamin B12 deficiency may be related to balance problems and vertigo. Treatment of vitamin B12 deficiency typically involves supplementation with vitamin B12, and the provided drug labels recommend monthly injections of vitamin B12 for patients with pernicious anemia 2 3. It is essential to note that folic acid may mask the symptoms of vitamin B12 deficiency, but it will not prevent the progression of neurologic damage. Therefore, it is crucial to diagnose and treat vitamin B12 deficiency promptly to prevent irreversible damage.

• Key points:
  • Vitamin B12 deficiency can cause neurologic manifestations
  • Treatment typically involves vitamin B12 supplementation
  • Folic acid may mask symptoms but will not prevent neurologic damage
  • Prompt diagnosis and treatment are essential to prevent irreversible damage

From the Research

Vitamin Deficiency and Vertigo

• Vitamin B12 deficiency has been linked to various neurological symptoms, including dizziness and vertigo, as seen in a study of pediatric patients 4.
• The study found that all patients with neurological symptoms of vitamin B12 deficiency, including dizziness and vertigo, recovered within one month after vitamin B12 supplementation 4.
• However, the relationship between vitamin B12 deficiency and vertigo is not fully understood and may require further research.

Vitamin D Deficiency and Vertigo

• Vitamin D deficiency has been associated with an increased risk of benign paroxysmal positional vertigo (BPPV), a common cause of positional vertigo 5, 6, 7, 8.
• Studies have shown that vitamin D supplementation can reduce the recurrence rate of BPPV in patients with subnormal serum vitamin D levels 5, 6, 8.
• A randomized controlled trial found that vitamin D and calcium supplementation reduced the annual recurrence rate of BPPV by 24% compared to the observation group 8.

Treatment of Vitamin Deficiency-Related Vertigo

• Vitamin B12 supplementation has been shown to be effective in treating neurological symptoms, including vertigo, caused by vitamin B12 deficiency 4.
• Vitamin D supplementation, often in combination with calcium, has been found to be effective in reducing the recurrence rate of BPPV in patients with subnormal serum vitamin D levels 5, 6, 8.
• Further research is needed to fully understand the relationship between vitamin deficiencies and vertigo, as well as the most effective treatment strategies.