What is the treatment for non-specific dizziness?

Treatment for Non-Specific Dizziness

The treatment for non-specific dizziness should focus on identifying the underlying cause through a targeted evaluation of timing and triggers rather than symptom quality, followed by appropriate targeted therapy based on the specific diagnosis.1

Diagnostic Approach to Guide Treatment

1. Categorize dizziness based on timing and triggers:

   • Acute vestibular syndrome (persistent vertigo with nausea/vomiting)
   • Spontaneous episodic vestibular syndrome (recurrent episodes without triggers)
   • Triggered episodic vestibular syndrome (episodes provoked by specific movements)
   • Chronic non-specific dizziness (vague, persistent symptoms)

2. Key diagnostic tests:

   • Orthostatic blood pressure measurements
   • Neurological assessment
   • Dix-Hallpike maneuver for suspected BPPV
   • HINTS examination (Head-Impulse, Nystagmus, Test of Skew) for acute vestibular syndrome
   • 12-lead ECG to rule out cardiac causes

Treatment Based on Specific Diagnosis

For Benign Paroxysmal Positional Vertigo (BPPV)

• Canalith Repositioning Procedures (CRPs) are the definitive treatment with success rates of 90-98% 2
• Epley maneuver for posterior canal BPPV
• Semont maneuver as an alternative
• Re-evaluate within 1 month to confirm symptom resolution 2
• Avoid routine use of vestibular suppressant medications 2

For Vestibular Neuritis/Labyrinthitis

• Short course of steroids
• Vestibular rehabilitation
• Limited use of vestibular suppressants (only for acute symptoms)

For Vestibular Migraine

• Migraine-specific medications (triptans)
• Prophylactic therapy for frequent episodes
• Avoidance of triggers

For Menière's Disease

• Low-salt diet
• Diuretics
• Intratympanic dexamethasone or gentamicin for refractory cases

For Medication-Related Dizziness

• Review and modify medication regimens
• Gradual tapering of offending medications

For Chronic Non-Specific Dizziness

• Vestibular rehabilitation is beneficial for many peripheral and central etiologies 3
• Address underlying psychological factors (anxiety, depression)
• Limit use of vestibular suppressants as they can interfere with central compensation 1

Pharmacologic Treatment

• Meclizine is FDA-approved for vertigo associated with vestibular system diseases 4, but should be used short-term only
• Avoid routine use of vestibular suppressant medications such as antihistamines or benzodiazepines for BPPV 2
• For persistent symptoms after initial treatment, reevaluate for:
  1. Persistent BPPV requiring additional maneuvers
  2. Coexisting vestibular conditions
  3. Central nervous system disorders 2

Special Considerations

• For elderly patients, implement fall prevention strategies
• For treatment failures, consider referral to neurology or ENT
• Imaging (MRI brain) is indicated only for:
  • Abnormal HINTS examination
  • Neurological deficits
  • High vascular risk patients
  • Chronic undiagnosed dizziness not responding to treatment 1

Red Flags Requiring Immediate Evaluation

• Sudden severe headache with dizziness
• New neurological symptoms
• Inability to walk or stand
• Persistent vomiting with dizziness
• Altered mental status

By following this approach, clinicians can effectively manage non-specific dizziness while avoiding unnecessary testing and inappropriate medication use.