From the Guidelines
Vertigo is a sensation of spinning or dizziness that can significantly impact daily life, and for immediate relief, medications like meclizine (25mg every 6-8 hours), diazepam (2-5mg as needed), or promethazine (12.5-25mg every 4-6 hours) can help manage symptoms, as noted in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
Causes of Vertigo
The causes of vertigo can be diverse, including:
- Benign Paroxysmal Positional Vertigo (BPPV): a common inner ear problem that causes brief, intense episodes of vertigo, as described in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
- Vestibular neuritis: an inner ear disorder that causes inflammation of the vestibular nerve, leading to vertigo, as mentioned in the clinical practice guideline: ménière's disease 1.
- Meniere's disease: a disorder of the inner ear that causes episodes of vertigo, hearing loss, and tinnitus, as discussed in the clinical practice guideline: ménière's disease 1.
Diagnosis and Treatment
Diagnosis of vertigo involves a thorough medical history, physical examination, and sometimes imaging tests or vestibular function tests, as outlined in the clinical practice guideline: ménière's disease 1. Treatment for vertigo depends on the underlying cause, but may include:
- The Epley maneuver: a series of head position changes to relocate displaced inner ear crystals, effective for BPPV, as described in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
- Vestibular rehabilitation exercises: to help the brain compensate for balance issues, as mentioned in the clinical practice guideline: ménière's disease 1.
- Medications: to manage symptoms such as nausea and dizziness, as noted in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
Prevention and Management
To prevent and manage vertigo, it is essential to:
- Avoid triggers like alcohol, caffeine, and tobacco, as mentioned in the clinical practice guideline: ménière's disease 1.
- Maintain a healthy lifestyle, including regular exercise and a balanced diet, as discussed in the clinical practice guideline: ménière's disease 1.
- Seek medical attention promptly if vertigo persists, is severe, or is accompanied by other symptoms such as hearing loss or neurological symptoms, as emphasized in the clinical practice guideline: ménière's disease 1. According to the most recent and highest quality study, the clinical practice guideline: benign paroxysmal positional vertigo (update) 1, the Epley maneuver is an effective treatment for BPPV, with a high success rate of around 80% with only 1-3 treatments.
From the Research
Definition and Treatment of Vertigo
- Vertigo is a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position, commonly known as Benign Paroxysmal Positional Vertigo (BPPV) 2, 3, 4.
- The Epley maneuver is a widely used treatment for BPPV, which involves a series of physical movements to help relocate the calcium particles in the inner ear 2, 3, 4, 5, 6.
Efficacy of the Epley Maneuver
- Studies have shown that the Epley maneuver is effective in treating BPPV, with a significant reduction in vertigo symptoms and improvement in balance 2, 3, 4, 5, 6.
- The Epley maneuver has been compared to other treatments such as vestibular rehabilitation, and has been found to be more effective in some cases 2, 3, 6.
- The number-needed-to-treat for the Epley maneuver is 3, indicating that 3 patients need to be treated for 1 patient to experience complete resolution of vertigo symptoms 3.
Comparison with Other Treatments
- The Epley maneuver has been compared to other particle repositioning maneuvers such as the Semont and Gans maneuvers, and has been found to be equally effective 2.
- The Epley maneuver has also been compared to the Brandt-Daroff exercises, and has been found to be more effective in some cases 2.
- Cawthorne-Cooksey vestibular exercises have been found to have no additional effects in improving posterior semicircular canal BPPV symptoms when used in conjunction with the Epley maneuver 5.