What is the first aid treatment for vertigo?

First Aid for Vertigo

For acute vertigo, the immediate first aid approach depends critically on whether the vertigo is spontaneous (sudden onset without trigger) or positional (triggered by head movements), with positional vertigo requiring canalith repositioning procedures rather than medications, while spontaneous vertigo may warrant short-term vestibular suppressants only for severe nausea/vomiting. 1

Immediate Assessment and Positioning

For spontaneous acute vertigo (sudden onset without positional trigger):

• Have the patient lie on their healthy side (the side that doesn't trigger symptoms) with head and trunk elevated 20 degrees 2
• Keep the room quiet but not darkened 2
• This positioning helps reduce symptoms while determining the underlying cause 2

For positional vertigo (triggered by head movements):

• Avoid having the patient lie flat initially, as this may worsen symptoms 1
• Prepare to perform diagnostic testing (Dix-Hallpike test) to confirm benign paroxysmal positional vertigo (BPPV), which accounts for the majority of vertigo cases 3

Medication Management: When NOT to Use Medications

The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends AGAINST routine use of vestibular suppressant medications (meclizine, antihistamines, benzodiazepines) for BPPV, as they do not address the underlying cause and can cause significant harm. 1, 3, 4

Harms of vestibular suppressants include:

• Drowsiness and cognitive deficits that interfere with driving or operating machinery 1, 3, 5
• Increased fall risk, especially in elderly patients 1, 3, 4
• Interference with the brain's natural vestibular compensation mechanisms 3, 4
• Decreased diagnostic sensitivity during examination 1

Very limited exceptions for medication use:

• Short-term management of severe nausea/vomiting only in severely symptomatic patients 1, 3, 4
• Prophylaxis 30-60 minutes before canalith repositioning procedures in patients with history of severe nausea during diagnostic testing 1, 4
• Patients refusing all other treatment options 1, 3

Definitive First Aid Treatment by Type

For BPPV (Most Common - 80-90% of vertigo cases):

Perform the Epley maneuver (canalith repositioning procedure) immediately, as it has 80% success rate with just 1-3 treatments and is over 10 times more effective than exercises alone. 1, 3

Epley Maneuver steps for posterior canal BPPV (right ear affected):

1. Patient sits upright with head turned 45° toward affected ear 1, 3
2. Rapidly lay patient back to supine head-hanging 20° position, hold 20-30 seconds 1, 3
3. Turn head 90° toward unaffected side, hold 20-30 seconds 1, 3
4. Roll patient onto side with head turned 45° downward, hold 20-30 seconds 1, 3
5. Return patient to upright sitting position 1, 3

Critical post-procedure instructions:

• Patients can resume normal activities immediately - NO postprocedural restrictions are recommended 1, 3, 4
• Warn patients about possible transient falling sensation within 30 minutes after the maneuver 1, 4
• Approximately 12% of patients experience mild, self-limiting adverse effects 1

For Horizontal Canal BPPV (10-15% of cases):

Perform the Barbecue Roll (Lempert) maneuver, which has 50-100% success rates. 3, 4

Steps:

• Patient lies supine, then rolls 360 degrees through sequential 90° turns, holding each position for 30 seconds 1, 3

Common Pitfalls to Avoid

Do not prescribe meclizine or other vestibular suppressants as primary treatment - this delays definitive treatment and exposes patients to unnecessary medication risks 1, 3, 4

Do not impose bed rest restrictions after repositioning procedures - these provide no benefit and may cause unnecessary complications 3, 4

Do not perform repositioning maneuvers without first confirming the diagnosis - treating the wrong canal or performing maneuvers for non-BPPV vertigo will be ineffective 3

Do not assume all vertigo is benign - if the patient has atypical features (continuous vertigo, neurological signs, severe headache, inability to walk), consider central causes requiring emergency evaluation 6, 7, 8

When to Seek Emergency Care

Immediate emergency evaluation is needed if vertigo is accompanied by:

• Severe headache, neck pain, or neurological symptoms 7, 8
• Inability to walk or stand 7, 8
• Double vision, slurred speech, or facial weakness 7, 8
• Continuous vertigo lasting hours without positional trigger 6, 7

Follow-Up

Reassess within 1 month to document symptom resolution or persistence. 1, 3, 4

If symptoms persist after initial repositioning:

• Repeat the diagnostic test to confirm persistent BPPV 3
• Perform additional repositioning maneuvers (success rates reach 90-98% with repeat treatments) 3, 4
• Consider canal conversion (occurs in 6-7% of cases) or multiple canal involvement 3