From the Guidelines
Vertigo symptoms can be effectively managed with a combination of medications, lifestyle modifications, and vestibular rehabilitation exercises, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. For acute vertigo, medications like meclizine (25mg every 4-6 hours as needed), dimenhydrinate (50mg every 4-6 hours), or promethazine (25mg every 6 hours) can help reduce symptoms, as supported by 1. These antihistamines work by suppressing the vestibular system and reducing the sensation of spinning. For severe nausea accompanying vertigo, ondansetron (4-8mg every 8 hours) may be beneficial. If vertigo is caused by an inner ear infection, a short course of corticosteroids like prednisone (starting at 40-60mg daily and tapering over 10-14 days) might be prescribed, as suggested by 1. For Meniere's disease-related vertigo, a low-salt diet (less than 2g sodium daily) and diuretics like hydrochlorothiazide (25mg daily) can help reduce fluid buildup in the inner ear, as recommended by 1. Vestibular rehabilitation exercises, performed regularly under guidance, can help the brain compensate for balance problems, as noted in 1. During acute episodes, lying down in a quiet, darkened room, avoiding sudden head movements, and gradually resuming activities as symptoms improve can help alleviate symptoms. Persistent or recurrent vertigo warrants medical evaluation to determine the underlying cause, as treatment approaches vary depending on whether vertigo stems from peripheral causes (inner ear) or central causes (brain), emphasizing the importance of accurate diagnosis and treatment to improve patient outcomes and quality of life.
Some key points to consider in managing vertigo include:
- Identifying the underlying cause of vertigo, whether it be benign paroxysmal positional vertigo (BPPV), Meniere's disease, or another condition, to guide treatment decisions, as discussed in 1 and 1.
- Using medications and lifestyle modifications to reduce symptoms and improve quality of life, as supported by 1 and 1.
- Implementing vestibular rehabilitation exercises to help the brain compensate for balance problems, as noted in 1.
- Educating patients on how to manage their symptoms and prevent falls, particularly in older adults, to reduce morbidity and mortality, as emphasized in 1.
By prioritizing the reduction of morbidity, mortality, and improvement of quality of life, healthcare providers can effectively manage vertigo symptoms and improve patient outcomes, as supported by the latest evidence from 1, 1, and 1.
From the Research
Vertigo Symptoms and Diagnosis
- Vertigo is a common condition that can be caused by various factors, including benign paroxysmal positional vertigo (BPPV) 2, 3, 4, 5, 6
- BPPV is the most common peripheral vestibular system disease causing dizziness, and it occurs more frequently in the 5th decade of life 3
- The most effective treatment method for BPPV is the canalith repositioning (CRP) maneuver, also known as the Epley maneuver 2, 3, 4, 5
Treatment Options for Vertigo
- The Epley maneuver is considered the primary treatment for BPPV, and it can be performed in a bedside setting 2, 4, 5
- Anti-vertigo medications such as betahistine and dimenhydrinate may be effective in reducing residual symptoms, but they do not show superiority to the Epley maneuver alone 3, 4
- In severe forms of BPPV, betahistine or dimenhydrinate might effectively reduce symptoms 4
Diagnosis and Management of BPPV
- A practical approach to diagnosing the cause of vertigo involves categorizing dizziness into one of four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo 6
- Central vertigo must be differentiated from peripheral vertigo, and the most common cause of peripheral vertigo is BPPV 2, 6
- The Dix-Hallpike test and the Epley maneuver are essential tools in the diagnosis and management of BPPV 2