From the Guidelines
Vertigo treatment should prioritize the canalith repositioning procedure (CRP) for patients with benign paroxysmal positional vertigo (BPPV), as it is highly effective in relieving symptoms, according to the most recent and highest quality study 1.
Key Considerations
- The CRP is a specific head positioning technique that moves the canaliths from the posterior semicircular canal to the vestibule, thereby relieving the stimulus from the semicircular canal that had been producing the vertigo in BPPV.
- The Epley maneuver is a type of CRP that has been shown to be highly effective in treating BPPV, with a strong recommendation for its use in the 2017 clinical practice guideline update 1.
- Vestibular rehabilitation therapy exercises may also be offered as an option for the treatment of BPPV, as they can help train the brain to compensate for balance problems, as stated in the 2017 guideline update 1.
Lifestyle Modifications
- Avoiding sudden head movements, sitting down immediately when feeling dizzy, using good lighting when getting up at night, and avoiding triggers like caffeine, alcohol, and salt can help manage vertigo symptoms.
- Patient education is crucial in managing BPPV, including discussing the impact of BPPV on daily life, the risk of recurrence, and the importance of follow-up, as emphasized in the 2017 guideline update 1.
Treatment Approach
- The treatment approach should be individualized, taking into account the patient's specific condition, medical history, and lifestyle.
- Clinicians should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms, and evaluate patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders, as recommended in the 2017 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 (1). Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).
Vertigo Treatment: Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2. The recommended dosage is 25 mg to 100 mg daily, in divided doses.
- Key Points:
- Indicated for vertigo treatment
- Dosage: 25 mg to 100 mg daily
- Administration: in divided doses
- Important Considerations:
From the Research
Vertigo Treatment Options
- The Epley maneuver is a recommended treatment for benign paroxysmal positional vertigo (BPPV) 3, 4, 5
- The Epley maneuver has been shown to be effective in resolving vertigo symptoms and converting the Dix-Hallpike test from positive to negative 3, 4
- Vestibular rehabilitation is also a treatment option for BPPV, but the Epley maneuver may be more effective at 1-week follow-up 4
- The Epley maneuver can be used to treat BPPV associated with Meniere's disease, with a high success rate in eliminating positional nystagmus and vertigo 5
Diagnostic Procedures
- A systematic approach to diagnosing vertigo can help arrive at a diagnosis, including categorizing dizziness into one of four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo 6
- Central vertigo must be differentiated from peripheral vertigo, with the most common cause of peripheral vertigo being benign paroxysmal positional vertigo 6
- Modern vestibular test procedures, such as the video head impulse test and vestibular evoked myogenic potentials, can provide a complex objective assessment of the vestibular organ 7
Treatment Outcomes
- The Epley maneuver has been shown to have a high success rate in resolving vertigo symptoms, with a number-needed-to-treat of 3 3
- The Epley maneuver can be effective in treating BPPV, with a low risk of serious adverse effects 3
- Recurrence of BPPV can occur, but can often be resolved with a specific maneuver for the affected canal 5