Treatment for Acute Vertigo
For acute vertigo, clinicians should offer a limited course of vestibular suppressants only during acute attacks, while addressing the underlying cause based on diagnosis. 1, 2
Diagnosis-Based Treatment Approach
Treatment should be tailored to the specific underlying cause of vertigo:
- For Benign Paroxysmal Positional Vertigo (BPPV): Canalith repositioning procedures are first-line treatment with 80% success rates after 1-3 treatments 1
- For Ménière's disease: Limited course of vestibular suppressants only during acute attacks 3
- For vestibular neuritis: Brief use of vestibular suppressants is recommended 4
Vestibular rehabilitation/physical therapy should not be recommended for managing acute vertigo attacks in patients with Ménière's disease 3
Medication Options for Acute Symptomatic Relief
Meclizine (25-100 mg daily in divided doses) is FDA-approved and most commonly used for treatment of vertigo associated with diseases affecting the vestibular system 5
Benzodiazepines (e.g., diazepam) may be used for short-term management of severe vertigo and can help with psychological anxiety secondary to vertigo 3, 1
Centrally acting anticholinergic drugs (scopolamine and atropine) and glycopyrrolate can suppress acute vertigo attacks but have significant side effects 3
Antiemetics such as prochlorperazine may be used for short-term management of severe nausea/vomiting associated with vertigo 2, 6
Important Cautions and Considerations
Vestibular suppressants have significant side effects including drowsiness, cognitive deficits, and increased fall risk, especially in elderly patients 1, 2
All benzodiazepines carry significant risk for drug dependence 3
Anticholinergics can cause blurring of vision, dry mouth, dilated pupils, urinary retention, and sedation 3
Prolonged use of vestibular suppressants can interfere with central compensation in peripheral vestibular conditions and delay recovery 1, 2
Lifestyle Modifications for Symptom Prevention
Educate patients on dietary and lifestyle modifications that may reduce or prevent symptoms 3, 1:
- Limiting salt/sodium intake
- Avoiding high-sugar beverages
- Managing stress appropriately
- Getting regular exercise and adequate sleep
- Identifying and managing any allergies
Allergies have been shown to contribute to symptoms of Ménière's disease in up to 30% of patients 3
Follow-Up and Long-Term Management
Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms 6
Vestibular rehabilitation is recommended for chronic imbalance but not for acute vertigo attacks in Ménière's disease 3, 1
Transition from medication to vestibular rehabilitation when appropriate to promote long-term recovery 6
For patients with increased bouts of vertigo, assessment for sleep apnea should be considered 3