What medications are used to treat vertigo caused by neck herniated discs?

Medications for Vertigo Caused by Neck Herniated Discs

For vertigo caused by neck herniated discs, vestibular suppressants such as meclizine (25-100 mg daily in divided doses) may be used for symptomatic relief, but they should not be used long-term as they can delay vestibular compensation. 1, 2

Understanding Vertigo Related to Cervical Spine Issues

Vertigo associated with neck herniated discs is often related to vertebrobasilar insufficiency, where symptoms can include:

• Dizziness and vertigo
• Diplopia (double vision)
• Perioral numbness
• Blurred vision
• Tinnitus
• Ataxia (lack of coordination)
• Bilateral sensory deficits 1

Medication Options

First-line Medications:

1. Vestibular Suppressants:
   • Meclizine (25-100 mg daily in divided doses) - FDA-approved for vertigo associated with vestibular system diseases 2
   • Antihistamines with anticholinergic properties - help reduce vestibular symptoms 1, 3
   • Benzodiazepines (e.g., diazepam) - reduce internuclear inhibition and anxiety associated with vertigo 4, 5

Second-line Options:

1. Antiemetics for Neurovegetative Symptoms:

   • Dopamine receptor antagonists (e.g., prochlorperazine, metoclopramide) - help control nausea and vomiting 1, 6
   • Prokinetic antiemetics (e.g., domperidone) - useful adjuncts without significantly interfering with vestibular compensation 1

2. For Inflammatory Component:

   • Short course of oral corticosteroids (e.g., prednisone or methylprednisolone) for 7-14 days with tapering dose 1

Important Considerations and Cautions

Medication Side Effects:

• Meclizine may cause drowsiness, dry mouth, headache, fatigue, and rarely blurred vision 2
• Benzodiazepines can cause sedation, dependence, and may impair driving 1, 4
• Anticholinergics should be used with caution in patients with glaucoma, asthma, or prostate enlargement 2

Key Warnings:

• Vestibular suppressants should be used for short-term symptomatic relief only, as long-term use can delay vestibular compensation 7, 3
• Avoid driving or operating dangerous machinery while taking these medications due to sedative effects 2
• Co-administration with other CNS depressants, including alcohol, may increase CNS depression 2

Comparative Efficacy:

A randomized controlled trial found that diazepam 5 mg and meclizine 25 mg were equally effective in treating acute vertigo, with similar improvements in visual analog scale scores after 60 minutes 5

Adjunctive Approaches

1. Physical Therapy:

   • Vestibular rehabilitation may be beneficial, particularly for elderly patients 1
   • Regular physical activity (cardio-exercise for at least 30 minutes twice weekly) is recommended 1

2. Lifestyle Modifications:

   • Home safety assessment to prevent falls, especially important for elderly patients 1
   • Patient education about increased fall risk and recognition of symptom recurrence 1

Treatment Algorithm

1. For acute symptomatic relief:

   • Start with meclizine 25 mg orally up to 3-4 times daily as needed
   • If inadequate relief, consider adding a benzodiazepine such as diazepam 5 mg 1-2 times daily

2. For persistent symptoms:

   • Refer for vestibular rehabilitation
   • Consider short course of oral corticosteroids if inflammatory component is suspected
   • Address underlying cervical disc herniation through appropriate orthopedic or neurosurgical consultation

3. For accompanying nausea/vomiting:

   • Add antiemetic such as metoclopramide 10 mg or ondansetron 4-8 mg as needed

Remember that while these medications can provide symptomatic relief, addressing the underlying cervical disc herniation is essential for long-term management of vertigo symptoms.