What are the treatment options for vertigo?

Treatment Options for Vertigo

For vertigo treatment, vestibular suppressants like meclizine (25-100 mg daily in divided doses) are recommended for short-term symptom management, while specific interventions such as canalith repositioning procedures for BPPV offer 80-96% success rates. 1, 2

Diagnosis-Based Treatment Approach

Benign Paroxysmal Positional Vertigo (BPPV)

• First-line treatment: Canalith Repositioning Procedures (CRPs) with success rates of 80-96% after just 1-3 treatments 1
  • Epley maneuver: 90.7% success rate after initial attempt, 96% after second attempt
  • Gufoni maneuver: 93% success rate for geotropic type BPPV
  • Barbecue Roll (Lempert): 75-90% effectiveness for lateral canal BPPV
• Avoid: Long-term vestibular suppressants as they interfere with vestibular compensation 1

Vestibular Neuritis/Labyrinthitis

• Acute phase: Short-term vestibular suppressants only (less than 1 week) 1
  • Meclizine 25-100 mg daily in divided doses 2
  • Diazepam for severe symptoms
• Recovery phase: Vestibular rehabilitation exercises to promote compensation 1

Ménière's Disease

• Dietary modifications: Sodium restriction (1500-2300 mg/day) 1
• Medications:
  • Diuretics to reduce endolymphatic hydrops 3
  • Vestibular suppressants during acute attacks 4
• For refractory cases: Consider more aggressive interventions based on symptom severity 4

Vestibular Migraine

• Prophylactic medications:
  • L-channel calcium channel antagonists
  • Tricyclic antidepressants
  • Beta-blockers 1, 5
• During attacks: Vestibular suppressants and antiemetics 1

Pharmacological Options

Vestibular Suppressants

• Antihistamines:
  • Meclizine (FDA-approved for vertigo): 25-100 mg daily in divided doses 2
  • Dimenhydrinate, cinnarizine: Effective for motion-induced vertigo 1

Antiemetics

• For nausea/vomiting:
  • Metoclopramide 10 mg for significant nausea/vomiting 1
  • Prokinetic antiemetics as adjuncts during vertigo attacks 1

Benzodiazepines

• For severe vertigo or anxiety-related dizziness:
  • Short-term use only (<1 week) to avoid interfering with vestibular compensation 1
  • Particularly useful for psychogenic vertigo 6

Important Considerations

Monitoring and Follow-up

• Document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss after treatment 4
• Reassess within 1 month after treatment to evaluate effectiveness 1
• Keep a daily symptom journal to track triggers and patterns 1

Cautions and Contraindications

• Medication side effects:
  • Meclizine may cause drowsiness; use caution when driving or operating machinery 2
  • Anticholinergic effects: Use with care in patients with asthma, glaucoma, or prostate enlargement 2
• Drug interactions:
  • Avoid coadministration of vestibular suppressants with other CNS depressants, including alcohol 2
  • Be aware of potential interactions with CYP2D6 inhibitors when using meclizine 2

Special Populations

• Elderly patients:
  • Higher risk of falls, medication side effects, and adverse outcomes 1
  • Consider lower medication doses and modified repositioning techniques 1
  • Increased risk of depression and impairments in daily activities with untreated vestibular disorders 1

Prevention of Recurrence

• Educate patients about 36% recurrence rate of BPPV 1
• Regular physical activity to improve balance and coordination 1
• Take precautions to prevent falls, especially in elderly patients 1

Remember that vestibular suppressants should be limited to short-term use (less than 1 week) to avoid interfering with the brain's natural compensation mechanisms, and specific treatments should be tailored to the underlying cause of vertigo for optimal outcomes.