From the Guidelines
For patients with vertigo not responding to meclizine, vestibular rehabilitation therapy is a recommended alternative treatment, as it has been shown to be effective in improving symptoms and quality of life 1. This approach involves specialized exercises to retrain the brain to process balance information correctly and can be self-administered or performed with a clinician. Some key points to consider when recommending alternative treatments for vertigo include:
- The underlying cause of vertigo, as different conditions may require different treatment approaches
- The potential benefits and harms of various treatments, including vestibular suppressant medications and vestibular rehabilitation therapy
- The importance of proper diagnosis through vestibular testing to guide treatment decisions
- The role of patient preferences and values in making treatment decisions, particularly when the evidence is unclear or equivocal In terms of specific treatments, vestibular rehabilitation therapy is a recommended option for patients with benign paroxysmal positional vertigo (BPPV) 1, as it has been shown to be effective in improving symptoms and quality of life. Additionally, the Epley maneuver, a canalith repositioning procedure, is a recommended treatment for posterior canal BPPV 1, as it has been shown to be effective in resolving symptoms. Other treatments, such as betahistine and benzodiazepines, may be considered in certain cases, but their use is not routinely recommended due to the potential for significant harm, including drowsiness, cognitive deficits, and increased risk of falls 1. Overall, the choice of treatment depends on the underlying cause of vertigo and the individual patient's needs and preferences.
From the Research
Alternative Treatments for Vertigo
For patients with vertigo who are not responding to meclizine (Antivert), several alternative treatments are available. These include:
- Vestibular suppressants such as anticholinergics and benzodiazepines 2
- Prophylactic agents like L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers for migraine-associated vertigo 2
- Betahistine, dexamethasone, and gentamicin for Menière's disease 3
- Gabapentin and memantine for different forms of acquired and congenital nystagmus 3
- Corticosteroids for acute vestibular neuritis and Cogan's syndrome 3
- Metoprolol and topiramate for vestibular migraine 3
- Selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo 3
Vestibular Rehabilitation
Vestibular rehabilitation is also a viable option for patients with vertigo, particularly those with benign paroxysmal positional vertigo (BPPV), unilateral vestibular loss or hypofunction, and bilateral vestibular loss/hypofunction 4, 5. This type of rehabilitation can help improve symptoms and reduce the risk of relapse and recurrence 6.
Specific Treatments for BPPV
For patients with BPPV, the Epley's manoeuvre alone or in combination with oral Betahistine can be effective in treating vertigo 6. Betahistine as a sole modality of treatment can be preferred in patients who are unfit to undergo canal repositioning manoeuvres 6.