Is betahistine (histamine H1 receptor agonist) effective for treating peripheral vertigo?

From the Guidelines

Betahistine is not effective for treating peripheral vertigo, as the most recent and highest quality study, the BEMED trial, found no significant difference in vertigo attacks between betahistine and placebo groups 1. The BEMED trial, a well-designed double-blind RCT, evaluated the effect of betahistine on vertigo attacks in patients with Ménière's disease and found a significant decline in vertigo attacks across all groups, but no significant differences between the placebo and betahistine groups 1. This study's findings are in contrast to previous meta-analyses, but its high quality and recent publication make it the most reliable evidence currently available. Key points to consider when treating peripheral vertigo include:

• The lack of efficacy of betahistine in reducing vertigo attacks, as shown in the BEMED trial 1
• The potential side effects of betahistine, such as headache, balance disorder, nausea, and upper gastrointestinal symptoms 1
• The need for caution when using betahistine in patients with asthma, history of peptic ulcer disease, and avoidance in patients with pheochromocytoma 1
• The importance of reassessing patients regularly for symptom improvement or stabilization, as well as monitoring for intolerance or side effects 1 Other treatment options for peripheral vertigo, such as vestibular rehabilitation exercises, lifestyle modifications, and other medications like diuretics or anti-emetics, may be considered, and patients should consult with their healthcare provider for proper diagnosis and treatment.

From the Research

Effectiveness of Betahistine in Treating Peripheral Vertigo

• Betahistine has been demonstrated to be effective and safe in the treatment of peripheral vertigo, including Ménière's disease, BPPV, vestibular neuronitis, and other types of peripheral vertigo 2, 3, 4, 5.
• Clinical studies and meta-analyses have shown that betahistine can reduce the frequency, intensity, and duration of vertigo attacks, as well as improve associated symptoms and quality of life 2, 5, 6.
• The optimal dosage of betahistine for treating peripheral vertigo is 48 mg daily for 3 months, which has been shown to be effective and safe in several studies 3, 4.

Mechanism of Action and Safety Profile

• The precise mechanism of action of betahistine is not completely understood, but it is believed to work by improving blood flow to the inner ear and stimulating vestibular compensation 2, 3.
• Betahistine has an excellent safety profile, with a low risk of adverse events, mostly gastrointestinal symptoms and headache 5, 6.
• The safety profile of betahistine has been confirmed in numerous clinical trials, with no significant differences in adverse events compared to placebo 5, 6.

Clinical Evidence and Studies

• A systematic review of 17 studies, including 1025 participants, found that betahistine was more effective than placebo in reducing vertigo symptoms, with a risk ratio of 1.30 (95% CI 1.05 to 1.60) 6.
• A real-life study in primary care found that betahistine (48 mg daily) had a positive effect in controlling symptoms associated with benign paroxysmal vertigo, with a cumulative incidence of complete improvement of 73% after 12 weeks 4.
• Other studies have also demonstrated the effectiveness of betahistine in treating peripheral vertigo, including a study that found betahistine to be superior to placebo in reducing vertigo symptoms in patients with Ménière's disease and paroxysmal positional vertigo 5.