From the Guidelines
Treatment for vertigo should prioritize the use of canalith repositioning procedures, such as the Epley maneuver, for patients with posterior canal Benign Paroxysmal Positional Vertigo (BPPV) 1. The choice of treatment depends on the underlying cause of vertigo, which can include BPPV, Ménière's disease, or other conditions.
- For BPPV, the Epley maneuver is a highly effective treatment, with success rates ranging from 80% to 90% after a single session 1.
- Vestibular rehabilitation therapy may also be offered as an option for the treatment of BPPV, involving specific head, eye, and body exercises to help the brain compensate for balance problems 1.
- For Ménière's disease, treatment may include diuretics like hydrochlorothiazide and a low-salt diet, as well as lifestyle modifications such as avoiding caffeine, alcohol, and tobacco.
- In general, clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines 1.
- Lifestyle modifications, including avoiding sudden head movements and getting up slowly from lying positions, can also help prevent triggering symptoms.
- Clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution and evaluate for potential underlying conditions if symptoms persist 1.
From the FDA Drug Label
Meclizine hydrochloride is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. Recommended dosage: 25 mg to 100 mg daily, in divided doses
The treatment option for vertigo is meclizine hydrochloride, which can be taken orally with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.
- The dosage form can be either tablets (12.5 mg, 25 mg, and 50 mg) or chewable tablets (25 mg).
- Key considerations for treatment include potential drowsiness and anticholinergic action, which should be taken into account when prescribing the medication.
From the Research
Treatment Options for Vertigo
The treatment options for vertigo can be categorized based on the cause of the condition.
- Peripheral vertigo: This type of vertigo is caused by problems in the inner ear, and treatment options include:
- Central vertigo: This type of vertigo is caused by problems in the brain, and treatment options include:
- Prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers for migraine-associated vertigo 5
- Eclectic approach incorporating trials of vestibular suppressants and physical therapy for individuals with stroke or other structural lesions of the brainstem or cerebellum 5
- Psychogenic vertigo: This type of vertigo is caused by psychological factors, and treatment options include:
Pharmacological Treatment
Pharmacological treatment of vertigo includes the use of various medications such as:
- Anticholinergics and benzodiazepines as vestibular suppressants 5
- Calcium channel antagonists for vestibular migraine 5
- Dopamine receptor antagonists for vertigo associated with migraine 5
- Levo-sulpiride, methoclopramide, and triethilperazine for acute spontaneous vertigo 6
- Gabapentine for reducing nystagmus and stabilizing the visual field 6
Physical Therapy
Physical therapy plays an important role in the treatment of vertigo, particularly for peripheral causes.