What is the treatment for lightheadedness and dizziness (vertigo)?

From the Guidelines

To treat lightheadedness and dizziness, first identify and address the underlying cause, and for vertigo, try the Epley maneuver or seek medical attention for repositioning exercises, as these have high success rates and can improve quality of life 1. When experiencing lightheadedness or dizziness, it is essential to sit or lie down, drink water, and take slow deep breaths to help alleviate symptoms. If dehydration is the cause, drinking 16-32 ounces of water or an electrolyte solution like Pedialyte or Gatorade can help. For vertigo, the Epley maneuver can be an effective treatment, which involves sitting on a bed, turning the head 45 degrees to the affected side, quickly lying back with the head hanging slightly off the edge, waiting 30 seconds, then turning the head 90 degrees to the opposite side, waiting another 30 seconds, and finally turning the body to that side before sitting up 1. Some key points to consider when treating vertigo include:

• The Epley maneuver has a high success rate of around 80% with only 1-3 treatments 1
• Vestibular suppressants, such as meclizine (Bonine, 25mg every 4-6 hours) or dimenhydrinate (Dramamine, 50mg every 4-6 hours), can be used to manage symptoms, but should be limited to a short course during Ménière’s disease attacks 1
• Repositioning exercises, such as the Epley maneuver, can be done at home with supervision or by a healthcare professional, especially for severe or disabling symptoms 1
• It is crucial to seek immediate medical attention if dizziness is accompanied by chest pain, severe headache, difficulty speaking, vision changes, or loss of consciousness, as these may indicate serious conditions requiring emergency care. For chronic dizziness, ensuring adequate hydration, regular meals, and proper sleep, as well as avoiding sudden position changes, alcohol, and caffeine, can help manage symptoms. Additionally, addressing underlying conditions, such as Ménière’s disease, is essential to improve quality of life 1.

From the FDA Drug Label

MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). DOSAGE AND ADMINISTRATION Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).

The treatment for lightheadedness and dizziness (vertigo) is meclizine hydrochloride tablets, with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.

From the Research

Treatment Options for Lightheadedness and Dizziness (Vertigo)

• The treatment for vertigo and dizziness depends on the underlying cause, which can be otological, central, or functional (psychological) in nature 3.
• In some cases, the cause of dizziness cannot be found or is untreatable, and management is directed toward symptom reduction 4.
• Medications such as dimenhydrinate, benzodiazepines, and scopolamine can be used to manage symptoms of nausea and vomiting, while other medications like aminopyridines, carbamazepine, and betahistine can be used to treat specific underlying disorders 5.
• Surgery, including conservative and destructive procedures, may be an option for some patients with vertigo 6.
• Rehabilitation, such as vestibular physiotherapy and ergotherapy, can be a useful adjunct in the treatment of many types of dizziness 3, 7.

Pharmacological Treatment

• Antivertigo agents can be used as a first step in treating acute and severe symptoms, but should be limited to a maximum period of 3 days 7.
• Other medications, such as metoprolol and topiramate, can be used to treat specific conditions like vestibular migraine 5.
• The choice of medication should take into account potential interactions with other drugs and the risk of preventing the development of the central compensatory mechanism that sustains balance after a vertiginous crisis 3.

Non-Pharmacological Treatment

• Vestibular rehabilitation is strongly advised and rarely contraindicated in patients with vertigo 3.
• Repositioning maneuvers, such as the Epley maneuver, can be effective in treating benign paroxysmal positional vertigo 7.
• Ergotherapy and rehabilitation can help improve balance and reduce symptoms of dizziness 7.