What can I do to relieve persistent vertigo symptoms?

Management of Persistent Vertigo

For your persistent vertigo symptoms, you should undergo canalith repositioning procedures rather than continuing to use vestibular suppressant medications like Dramamine, which should not be used routinely for vertigo treatment. 1

Diagnosis and Initial Assessment

• Your symptoms suggest possible Benign Paroxysmal Positional Vertigo (BPPV), which is characterized by brief episodes of vertigo triggered by changes in head position 1
• The timing of onset after activities like golfing and alcohol consumption is consistent with BPPV, which can be triggered by various activities 1
• The fact that you've tried some maneuvers without success doesn't rule out BPPV, as proper technique is essential for effectiveness 1

Recommended Treatment Approach

First-line Treatment

• Canalith repositioning procedures (CRPs) such as the Epley maneuver should be your primary treatment rather than medications 1
• These procedures have substantially higher treatment success rates (78-93%) compared to medication alone (30%) 2
• If self-administered maneuvers haven't worked, seek a healthcare provider who can properly perform these procedures 1

Medication Considerations

• Vestibular suppressant medications like Dramamine (dimenhydrinate) and other antihistamines should not be used routinely for BPPV treatment 1
• These medications:
  • Only mask symptoms rather than treating the underlying cause 2
  • Can cause significant side effects including drowsiness and cognitive impairment 1
  • May increase fall risk, especially when combined with alcohol (which you mentioned consuming) 1
  • Can interfere with the brain's natural compensation mechanisms 3

Appropriate Short-term Medication Use

• If symptoms are severe and causing significant distress:
  • Meclizine 25-100 mg daily in divided doses may be used for short-term symptom management 4
  • Limit use to the shortest duration possible to avoid interference with compensation 3
  • Avoid combining with alcohol as this increases CNS depression 4

Follow-up and Monitoring

• You should be reassessed within 1 month after treatment to document resolution or persistence of symptoms 1
• If symptoms persist despite appropriate treatment, further evaluation is needed to rule out other causes of vertigo 1
• Persistent symptoms may indicate:
  • Incorrect diagnosis
  • Incorrect treatment technique
  • Multiple canal involvement
  • Other underlying vestibular or neurological disorders 1

Important Cautions

• Combining ibuprofen, Dramamine, and alcohol (as you mentioned) increases risk of:
  • Gastrointestinal bleeding from ibuprofen
  • Enhanced sedation and impaired cognition from the combination of vestibular suppressants and alcohol 1, 4
• The high dosage of ibuprofen you're taking (800mg every 8 hours) should not be continued long-term without medical supervision due to risk of gastrointestinal, renal, and cardiovascular adverse effects 1

Additional Supportive Measures

• Vestibular rehabilitation exercises may be beneficial, either self-administered or with a clinician 1
• Maintain adequate hydration and avoid triggers that may worsen symptoms (excessive caffeine, alcohol) 3
• Be aware that BPPV has a recurrence rate of approximately 15% per year, so knowing proper management techniques is important 1