From the Guidelines
To treat vertigo (dizziness) without any underlying structural abnormalities, the most effective approach is to use a canalith repositioning procedure, such as the Epley maneuver, as initial therapy for patients with posterior canal BPPV, as recommended by the 2017 clinical practice guideline 1. This approach is supported by the strongest and most recent evidence, which suggests that canalith repositioning procedures have high success rates, with around 80% of patients experiencing complete symptom resolution after 1-3 treatments 1. The following key points should be considered when treating vertigo without structural abnormalities:
- Lifestyle modifications, such as staying hydrated, avoiding sudden position changes, and reducing caffeine and alcohol intake, can help manage symptoms.
- Vestibular rehabilitation exercises, including habituation exercises and canalith repositioning maneuvers, can be effective for certain types of dizziness.
- Stress reduction techniques, such as deep breathing, meditation, and adequate sleep, may also improve symptoms.
- Over-the-counter medications like meclizine (Antivert) or dimenhydrinate (Dramamine) can provide symptomatic relief for acute episodes.
- Prescription medications like betahistine or low-dose benzodiazepines may be considered under medical supervision for persistent dizziness. It's essential to consult a healthcare provider if dizziness persists, worsens, or is accompanied by other symptoms like hearing loss, headaches, or neurological changes, as these may indicate an underlying condition that requires further evaluation and treatment 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The treatment for vertigo (dizziness) without any underlying structural abnormalities is meclizine (PO), as it is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2.
- Key points:
- Meclizine is used to treat vertigo
- Vestibular system diseases are the target for this treatment However, it is essential to note that the label does not explicitly exclude underlying structural abnormalities, but it does imply that the vertigo is associated with vestibular system diseases.
From the Research
Treatment for Vertigo without Underlying Structural Abnormalities
- The treatment for vertigo without any underlying structural abnormalities can include vestibular rehabilitation therapy (VRT) and cognitive behavioral therapy (CBT) 3.
- Selective serotonin reuptake inhibitors (SSRI) like sertraline have also shown benefits in treating persistent positional perceptual dizziness (PPPD), a common cause of chronic dizziness 3.
- Vestibular rehabilitation is helpful in treating many peripheral and central etiologies of dizziness, including those without underlying structural abnormalities 4.
- Canalith repositioning procedures, such as the Epley maneuver, are specifically used to treat benign paroxysmal positional vertigo (BPPV) 5, 4.
- In some cases, treatment may focus on symptom reduction, as the cause of the dizziness cannot be found or is untreatable 6.
Considerations for Treatment
- It is essential to differentiate the condition from other causes of dizziness, such as bilateral vestibulopathy, to ensure effective management 3.
- A history of traumatic brain injury (TBI) may negatively impact the outcome of vestibular rehabilitation therapy (VRT) in patients with vestibular migraine 7.
- Treatment should be tailored to the specific etiology of the symptoms, and pharmacologic intervention is limited due to its potential to affect the central nervous system's ability to compensate for dizziness 4.