From the Guidelines
The treatment for vertigo, specifically Benign Paroxysmal Positional Vertigo (BPPV), is canalith repositioning procedures (CRPs), which have a high success rate of around 80% with only 1-3 treatments.
Treatment Options
- Canalith repositioning procedures (CRPs): These are a group of procedures in which the patient moves through specific body positions designed to relocate dislodged particles within the inner ear for the purpose of relieving symptoms of BPPV 1.
- Vestibular rehabilitation: This may be offered as an option for the initial treatment of BPPV, either self-administered or with a clinician 2.
- Observation: This may be offered as an initial management for patients with BPPV, with assurance of follow-up 2.
Important Considerations
- Medications: Vestibular suppressant medications such as antihistamines and/or benzodiazepines should not be routinely used to treat BPPV 2.
- Radiographic testing: This should not be obtained in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging 2.
- Vestibular testing: This should not be ordered in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing 2.
Follow-up
- Reassessment: Patients should be reassessed within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms 2.
- Evaluation of treatment failure: Patients with persistent symptoms should be evaluated for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders 2.
From the Research
Treatment Options for Vertigo
The treatment for vertigo depends on the underlying cause and can be categorized into different approaches:
- Pharmacological treatment: This includes the use of medications such as anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists to manage vertigo symptoms 3.
- Physical therapy: Vestibular rehabilitation physical therapy is often recommended to promote compensation for vestibular damage 3, 4.
- Psychotherapy: This may be necessary for patients with psychogenic vertigo, which occurs in association with disorders such as panic disorder, anxiety disorder, and agoraphobia 3.
Pharmacological Treatment
The pharmacological treatment of vertigo can be tailored to the specific cause:
- Otological vertigo: Vestibular suppressants such as anticholinergics and benzodiazepines are used in Ménière's disease and vestibular neuritis 3.
- Central vertigo: Prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers are used to treat migraine-associated vertigo 3.
- Psychogenic vertigo: Benzodiazepines are the most useful agents in treating psychogenic vertigo 3.
Acute Vertigo Treatment
For acute vertigo, the treatment approach includes:
- Pharmacotherapy: Levo-sulpiride, methoclopramide, and triethilperazine can be used to reduce neurovegetative symptoms, while diazepam can decrease internuclear inhibition 4.
- Physical therapy: Vestibular electrical stimulation and maneuvers such as the Semont, Epley, or Lempert maneuvers can be effective in treating acute provoked vertigo 4.
Efficacy of Benzodiazepines and Antihistamines
A systematic review and meta-analysis found that single-dose antihistamines provide greater vertigo relief at 2 hours than single-dose benzodiazepines, but there is no evidence to support the use of daily benzodiazepines or antihistamines for acute vertigo 5.