What is an overview of vertigo?

From the Guidelines

Vertigo is a sensation of spinning or dizziness that occurs due to problems with the inner ear or brain, and treatment depends on the underlying cause, with the Epley maneuver being a recommended procedure for benign paroxysmal positional vertigo (BPPV) as stated in the 2017 clinical practice guideline update 1. The diagnosis of vertigo involves identifying the underlying cause, which can include conditions like BPPV, Meniere's disease, vestibular neuritis, or migraines.

• The 2017 clinical practice guideline update recommends that clinicians diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver 1.
• The guideline also recommends that clinicians treat patients with posterior canal BPPV with a canalith repositioning procedure, such as the Epley maneuver 1.
• Additionally, the guideline suggests that clinicians may offer observation with follow-up as initial management for patients with BPPV, and that vestibular rehabilitation exercises may be helpful in treating BPPV 1.
• Lifestyle modifications, such as avoiding caffeine, alcohol, and tobacco, can also help reduce symptom frequency, as noted in the guideline update 1.
• It is essential to note that vertigo can be a symptom of a more serious condition, such as a stroke or tumor, and persistent symptoms warrant medical evaluation, as stated in the 2017 clinical practice guideline update 1. The inner ear contains fluid-filled canals with tiny hair cells that detect head movement and send signals to the brain for balance; disruption of this system causes the spinning sensation experienced in vertigo, as defined in the 2017 clinical practice guideline update 1.
• The vestibular system, which includes the inner ear and its connections to the brain, plays a crucial role in maintaining balance and spatial orientation, as described in the guideline update 1.
• The Epley maneuver is a procedure that can help to reposition displaced calcium crystals in the inner ear, which can cause BPPV, as recommended in the 2017 clinical practice guideline update 1.
• Vestibular rehabilitation exercises can help the brain compensate for inner ear problems and improve balance and reduce symptoms of vertigo, as suggested in the guideline update 1.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.

• Vertigo is a condition that can be treated with meclizine hydrochloride tablets.
• The tablets are specifically indicated for vertigo associated with diseases affecting the vestibular system in adults.
• Key use: treatment of vertigo in adults with vestibular system diseases 2

From the Research

Vertigo Overview

• Vertigo is a common condition that can cause dizziness or a spinning sensation, and it can be acute or chronic 3, 4.
• Benign paroxysmal positional vertigo (BPPV) is a very common form of vertigo, and it is an important cause of acute vertigo or dizziness in patients presenting to an emergency department (ED) 3.
• The most efficient management of BPPV is to perform a bedside test (Dix-Hallpike test) and then to treat the patients with a bedside positional (the Epley) maneuver 3.

Causes and Types of Vertigo

• Acute vertigo can be subdivided into two main groups: (1) spontaneous vertigo and (2) provoked vertigo, usually by postural changes, generally called paroxysmal positional vertigo (PPV) 4.
• BPPV is the most common peripheral vestibular system disease causing dizziness, and it occurs more in the 5th decade of life and affects the posterior canal in 90% of the patients 5.

Treatment and Management of Vertigo

• The most effective treatment method for BPPV is canalith repositioning (CRP) maneuver, also known as the Epley maneuver 5, 6.
• Vestibular rehabilitation (VR) has been proven as an effective method for managing dizziness and has been applied in patients with various vestibular disorders, including BPPV 6, 7.
• Pharmacotherapy, such as betahistine and dimenhydrinate, may be used in addition to CRP maneuver, but it did not show superiority to treatment with repositioning maneuvers alone 5.
• Supportive treatment, antiemetic and vestibular blocking agents can help relieve an acute vertigo attack, but the prolonged use of such medications is not recommended 7.

Diagnosis and Assessment

• The Dix-Hallpike test is a bedside test used to diagnose BPPV, and it is an important tool for emergency physicians to diagnose and manage BPPV 3.
• The patient's ability to drive safely should be carefully assessed according to Austroads guidelines, and advice from an ear, nose and throat surgeon should be sought when in doubt 7.