What are alternative treatments for vertigo other than Meclizine (Antihistamine)?

From the Guidelines

The most effective treatment for vertigo, other than meclizine, is the Epley maneuver, a canalith repositioning procedure, which has been shown to be highly effective in resolving symptoms of benign paroxysmal positional vertigo (BPPV) 1.

Key Points

• The Epley maneuver is a non-pharmacological approach that involves a series of head position changes to move free-floating particles through the alignment of the posterior semicircular canal back into the vestibule, thereby relieving the pathologic stimulus that had been producing the vertigo in BPPV.
• A 2010 meta-analysis of the Epley maneuver found that patients treated with this procedure had a 6.5-times greater chance of improvement in clinical symptoms relative to controls, and a similar likelihood of negative Dix-Hallpike maneuver 1.
• The 2014 updated Cochrane review included 11 trials (745 patients) and reported that the Epley maneuver is more effective when compared with sham maneuvers or controls, with complete resolution of vertigo occurring significantly more often in the Epley maneuver treatment group 1.
• Other non-pharmacological approaches, such as vestibular rehabilitation therapy, may also be effective in managing vertigo symptoms, particularly in patients with persistent symptoms or those who have not responded to other treatments 1.
• Lifestyle modifications, such as avoiding sudden head movements, staying hydrated, limiting salt intake, and reducing caffeine, alcohol, and tobacco, can also help manage symptoms of vertigo 1.

Treatment Recommendations

• The Epley maneuver should be considered as the first-line treatment for patients with posterior canal BPPV, as it has been shown to be highly effective in resolving symptoms and has a low risk of adverse effects 1.
• Vestibular rehabilitation therapy and lifestyle modifications may be considered as adjunctive treatments or for patients who have not responded to the Epley maneuver.
• Pharmacological treatments, such as benzodiazepines and antihistamines, may be considered for short-term management of autonomic symptoms, such as nausea or vomiting, but are not recommended as a primary treatment for BPPV due to their potential for significant harm and lack of efficacy in resolving symptoms 1.

From the Research

Vertigo Treatment Options

Other than meclizine, there are several treatment options available for vertigo. These include:

• Dimenhydrinate: an antihistamine that can be used to treat nausea and vomiting associated with vertigo 2, 3, 4
• Betahistine: a medication that can be used to treat Menière's disease and other vestibular disorders 2, 3
• Benzodiazepines: a class of medications that can be used to treat anxiety and nausea associated with vertigo 2
• Scopolamine: a medication that can be used to prevent motion sickness and treat vertigo 2
• Aminopyridines: a class of medications that can be used to treat downbeat nystagmus and episodic ataxia type 2 2
• Carbamazepine: a medication that can be used to treat vestibular paroxysmia and other vestibular disorders 2
• Gabapentin and memantine: medications that can be used to treat acquired and congenital nystagmus 2
• Corticosteroids: medications that can be used to treat acute vestibular neuritis and Cogan's syndrome 2
• Metoprolol and topiramate: medications that can be used to treat vestibular migraine 2
• Selective serotonin reuptake inhibitors: a class of medications that can be used to treat phobic postural vertigo 2
• Epley maneuver: a physical therapy technique that can be used to treat benign paroxysmal positional vertigo (BPPV) 3, 5
• Vestibular rehabilitation: a type of physical therapy that can be used to treat vestibular disorders 5

Comparison of Treatment Options

Some studies have compared the efficacy of different treatment options for vertigo. For example:

• A study found that dimenhydrinate and metoclopramide had similar efficacy in reducing nausea and vertigo symptoms 4
• A study found that betahistine and dimenhydrinate had similar efficacy in treating BPPV, and that the Epley maneuver was more effective than vestibular rehabilitation at 1-week follow-up 3, 5
• A study found that diazepam and meclizine had similar efficacy in treating acute peripheral vertigo 6