What are the treatment options for benign paroxysmal positional vertigo (BPPV)?

From the Guidelines

Treatment for vertigo typically involves the use of canalith repositioning procedures, such as the Epley maneuver, which is highly effective for benign paroxysmal positional vertigo (BPPV) 1. For patients with BPPV, the Epley maneuver can be performed by a healthcare provider or taught for home use, and it works by repositioning displaced calcium crystals in the inner ear. Some key points to consider in the treatment of vertigo include:

• The use of vestibular suppressant medications, such as antihistamines and benzodiazepines, is not recommended as a routine treatment for BPPV due to their potential for significant harm, including drowsiness, cognitive deficits, and increased risk of falls 1.
• Vestibular rehabilitation therapy, consisting of specialized exercises that help the brain compensate for balance problems, is beneficial for many types of vertigo, including BPPV 1.
• Patient education and counseling are essential in the management of BPPV, including discussions about the risk of falls, the importance of follow-up, and the potential for recurrence 1.
• The Gufoni maneuver is another treatment option for lateral semicircular canal BPPV, and it involves a series of specific head movements to help reposition the debris in the canal 1. It's also important to note that the treatment of vertigo should be individualized based on the underlying cause and the patient's specific needs and preferences. In general, the goal of treatment is to alleviate symptoms, improve quality of life, and reduce the risk of complications, such as falls and injuries. By prioritizing the use of effective and safe treatments, such as canalith repositioning procedures and vestibular rehabilitation therapy, and providing patient-centered care, healthcare providers can help patients with vertigo achieve the best possible outcomes.

From the FDA Drug Label

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).

Treatment for Vertigo: Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The recommended dosage is 25 mg to 100 mg daily, in divided doses 2.

• Key Points:
  • Indicated for vertigo treatment
  • Dosage: 25 mg to 100 mg daily
  • Divided doses recommended
• Important Considerations:
  • Contraindicated in patients with hypersensitivity to meclizine or any of the inactive ingredients 2
  • May cause drowsiness, use caution when driving or operating machinery 2

From the Research

Treatment Options for Vertigo

• The Epley manoeuvre is a safe and effective treatment for posterior canal Benign Paroxysmal Positional Vertigo (BPPV) 3.
• Vestibular rehabilitation (VR) can improve balance control and reduce the unpleasantness of vertigo, and can be used in combination with the canalith repositioning procedure (CRP) or as a substitute when CRP is contraindicated 4.
• VR can also reduce the uptake of anti-vertigo drugs post CRP, but does not reduce the recurrence rate of BPPV 4.

Diagnostic Procedures

• A systematic approach to diagnosing the cause of vertigo is essential, and includes categorizing dizziness into one of four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo 5.
• Central vertigo must be differentiated from peripheral vertigo, and the most common cause of peripheral vertigo is BPPV 5.
• Modern vestibular test procedures, such as the video head impulse test and vestibular evoked myogenic potentials, can provide a complex objective assessment of all components of the vestibular organ 6.

Management of Residual Dizziness

• Exercise-based VR has been proven to be an effective method for managing dizziness, and its efficacy in targeting residual dizziness post-BPPV is being investigated in a randomized controlled trial 7.
• The trial aims to compare the efficacy of VR, betahistine, and VR plus betahistine in mitigating residual dizziness and improving balance function in patients with BPPV 7.
• The study will provide valuable insights into the management of residual dizziness post-BPPV and may lead to a general consensus regarding the use of VR as a first-line treatment for residual dizziness in patients with BPPV 7.