From the Guidelines
Vertigo treatment depends on the underlying cause, which can be diagnosed through a combination of clinical evaluation, imaging, and laboratory tests.
Causes of Vertigo
- Benign Paroxysmal Positional Vertigo (BPPV): treated with canalith repositioning procedures, such as the Epley maneuver 1
- Central Vertigo: may require imaging, such as MRI, to rule out underlying conditions like stroke or mass lesions 2, 3
- Vestibular Migraine: treated with medications like triptans or preventative medications like topiramate 1
- Meniere's Disease: treated with medications like diuretics or intratympanic injections, and may require imaging to rule out other causes of vertigo 4 ### Diagnostic Approach
- Clinical Evaluation: includes a thorough history and physical examination, including the Dix-Hallpike maneuver and HINTS examination 1, 5
- Imaging: may include MRI, CT, or PET scans, depending on the suspected underlying cause 2, 3, 5, 4
- Laboratory Tests: may include blood work or other tests to rule out underlying conditions like infection or inflammation 5 ### Treatment
- Medications: may include vestibular suppressants, anti-nausea medications, or medications to treat underlying conditions like migraine or Meniere's disease 1, 4
- Rehabilitation: may include vestibular rehabilitation therapy to improve balance and reduce symptoms 5
- Surgery: may be necessary in some cases, such as to treat underlying conditions like vestibular schwannoma or superior semicircular dehiscence 4
From the Research
Treatment Options for Vertigo
The treatment for vertigo depends on the underlying cause and can be divided into several categories:
- Pharmacological treatment: Various medications can be used to treat vertigo, including anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists 6, 7, 8, 9.
- Vestibular rehabilitation therapy: This type of therapy can be useful in promoting compensation for vestibular damage and is often recommended in combination with pharmacological treatment 6, 10.
- Physical therapy: Physical therapy can be beneficial in treating vertigo, particularly in cases of benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis 6, 10.
- Psychotherapy: Psychotherapy may be necessary in cases of psychogenic vertigo, which can be associated with disorders such as panic disorder, anxiety disorder, and agoraphobia 6.
Specific Treatments for Different Causes of Vertigo
- Otological vertigo: Treatment for otological vertigo, which includes disorders such as Ménière's disease, vestibular neuritis, BPPV, and bilateral vestibular paresis, depends on the specific condition. For example, vestibular suppressants such as anticholinergics and benzodiazepines are used in Ménière's disease and vestibular neuritis, while physical therapy is recommended for BPPV and bilateral vestibular paresis 6, 10.
- Central vertigo: Treatment for central vertigo, which is associated with entities such as vertigo associated with migraine and certain strokes, includes prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers 6, 7.
- Psychogenic vertigo: Treatment for psychogenic vertigo includes benzodiazepines and psychotherapy 6.
Emerging Medical Therapies
- Current and emerging medical therapies: Recent studies have explored the use of new medications and therapies for vertigo, including 4-aminopyridine for cerebellar dizziness and oculomotor disorders, and selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants for vestibular migraine, persistent postural perceptual dizziness, and mal de débarquement 8.