What is the best treatment for vertigo?

From the Guidelines

The best treatment for vertigo is the Epley maneuver for benign paroxysmal positional vertigo (BPPV), which involves a series of head movements to reposition displaced calcium crystals in the inner ear, as supported by the most recent and highest quality study 1.

Key Considerations

• For BPPV, the Epley maneuver is the first-line treatment, with a high success rate of 80-90% after 1-3 treatments 1.
• For Ménière's disease-related vertigo, diuretics like hydrochlorothiazide (25-50mg daily) or a low-salt diet may help reduce fluid buildup, as suggested by recent guidelines 1.
• Vestibular suppressant medications such as meclizine, diazepam, or promethazine can provide symptomatic relief for acute vertigo episodes, but should be used short-term to avoid dependence and delay central compensation 1.
• Vestibular rehabilitation therapy is beneficial for many types of vertigo, particularly those caused by vestibular neuritis or labyrinthitis, as it helps the brain compensate for inner ear deficits 1.

Important Factors

• Proper diagnosis is essential, as vertigo treatments vary based on the specific cause, and persistent or severe vertigo could indicate a serious underlying condition requiring immediate attention.
• Patient education and preference-centered care are crucial in managing vertigo, as patients tend to feel better when vertigo symptoms are alleviated, and treatment approaches should aim to improve quality of life 1.

Treatment Approaches

• The Epley maneuver is a non-invasive and effective treatment for BPPV, with a high success rate and minimal side effects 1.
• Diuretics and low-salt diets may be beneficial for Ménière's disease-related vertigo, but their effectiveness may vary depending on individual patient factors 1.
• Vestibular rehabilitation therapy can be tailored to individual patient needs and may involve a combination of exercises and techniques to improve balance and reduce vertigo symptoms 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 best treatment for vertigo is meclizine hydrochloride, with a recommended dosage of 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: swallow whole, or chew/crush before swallowing for chewable tablets

From the Research

Treatment Options for Vertigo

The treatment of vertigo depends on the underlying cause and can be categorized into different approaches, including pharmacological treatment, physical therapy, and surgery.

• Pharmacological treatment: This includes the use of medications such as anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists to manage vertigo symptoms 3.
• Physical therapy: Vestibular rehabilitation physical therapy is often recommended to promote compensation for vestibular damage 3.
• Surgery: In some cases, surgery may be necessary to treat underlying conditions such as Ménière's disease or vestibular neuritis 4.

Specific Treatments for Different Causes of Vertigo

The treatment of vertigo varies depending on the cause, which can be categorized into four broad groups: otological vertigo, central vertigo, psychogenic vertigo, and undetermined causes.

• Otological vertigo: This includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and bilateral vestibular paresis. Treatment options include vestibular suppressants, salt restriction, diuretics, and physical therapy 3.
• Central vertigo: This includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers are the mainstay of treatment for migraine-associated vertigo 3.
• Psychogenic vertigo: This occurs in association with disorders such as panic disorder, anxiety disorder, and agoraphobia. Benzodiazepines are the most useful agents in treating psychogenic vertigo 3.
• Undetermined causes: An empirical approach to treatment is suggested, incorporating trials of medications, physical therapy, and psychiatric consultation 3.

Acute Vertigo Treatment

Acute vertigo can be subdivided into two main groups: spontaneous vertigo and provoked vertigo.

• Spontaneous vertigo: Treatment options include Levo-sulpiride, methoclopramide, triethilperazine, diazepam, sulfate magnesium, and piracetam to reduce neurovegetative symptoms and decrease vestibular damage 5.
• Provoked vertigo: The first therapeutic approach should be by means of maneuvers such as the Epley maneuver, Semont, or Lempert and their modifications 5.

Comparative Studies

Comparative studies have been conducted to evaluate the effectiveness of different treatment options for vertigo.

• A prospective study compared the Epley maneuver, betahistine, and dimenhydrinate in the treatment of benign paroxysmal positional vertigo (BPPV) and found that betahistine or dimenhydrinate might effectively reduce symptoms in severe forms of BPPV 6.