What are the treatment options for vertigo (dizziness)?

From the Guidelines

For the treatment of vertigo, also known as dizziness, the most effective approach is to first identify the underlying cause, and then apply targeted interventions such as the Epley maneuver for those with benign paroxysmal positional vertigo (BPPV) 1. The Epley maneuver is a series of movements that help move the calcium particles out of the semicircular canals of the inner ear, where they can cause vertigo. Key points to consider in managing vertigo include:

• Identifying and managing the underlying cause, which could range from inner ear disturbances to more serious conditions like stroke or heart problems.
• For immediate relief, sitting or lying down in a quiet, dark room and avoiding sudden movements can help.
• Over-the-counter medications like meclizine (Antivert) or dimenhydrinate (Dramamine) may be used to manage symptoms, but their use should be limited due to potential side effects and the recommendation against routine use of vestibular suppressant medications 1.
• Vestibular rehabilitation exercises can be beneficial for some patients, especially those with persistent symptoms, as they can improve balance and reduce dizziness 1.
• Avoiding alcohol, caffeine, and tobacco is advisable as these substances can worsen symptoms.
• If dizziness is accompanied by severe symptoms such as headache, difficulty speaking, chest pain, or fainting, immediate medical attention is necessary.

In terms of specific treatment options for BPPV, the canalith repositioning procedure (CRP) is strongly recommended as the initial therapy for patients with posterior canal BPPV 1. This procedure has been shown to be highly effective in resolving symptoms of BPPV. Additionally, vestibular rehabilitation may be offered as an option for the treatment of BPPV, based on controlled observational studies and a balance of benefit and harm 1. It's also important to note that clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines 1, and that radiographic imaging and vestibular testing are not recommended unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing 1.

Overall, the management of vertigo requires a careful approach to identify the underlying cause and apply the most appropriate treatment, which may include the Epley maneuver, vestibular rehabilitation, and avoidance of exacerbating factors, while minimizing the use of vestibular suppressants and diagnostic tests unless clearly indicated 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). Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).

The treatment option for vertigo (dizziness) 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 Vertigo (Dizziness)

• The treatment for dizziness is dependent on the etiology of the symptoms 3
• Canalith repositioning procedures (e.g., Epley maneuver) are the most helpful in treating benign paroxysmal positional vertigo 3, 4
• Vestibular rehabilitation is helpful in treating many peripheral and central etiologies 3, 4, 5
• Treatment of Meniere disease includes salt restriction and diuretics 4
• Symptoms of vestibular neuritis are relieved with vestibular suppressant medications and vestibular rehabilitation 4
• Pharmacologic intervention is limited because it often affects the ability of the central nervous system to compensate for dizziness 3
• Surgery for vertigo includes conservative and destructive procedures 6
• Visually induced dizziness (VID) treatment is mostly empiric and includes pharmacologic, desensitization, cognitive behavioral therapies, visual rehabilitation, and treatment of the underlying cause whenever present 7
• Treatment of dizziness and anxiety disorders in the elderly encompasses a few areas: vestibular rehabilitation, drug therapy, and psychotherapy 5
• Medications may suppress symptoms if the cause of dizziness cannot be found or treated directly 6