What is the treatment for Vertigo?

From the Guidelines

Vertigo treatment typically involves a combination of vestibular rehabilitation therapy and pharmacological interventions. For acute episodes, antihistamines such as meclizine (25-50mg orally, every 4-6 hours) or anticholinergics like scopolamine (0.3-0.6mg orally, every 4-6 hours) may be prescribed for symptom relief 1. In cases of benign paroxysmal positional vertigo (BPPV), canalith repositioning procedures, such as the Epley maneuver, are often effective, and may be repeated as needed for up to 3 sessions, spaced 1-2 weeks apart 1.

Key Considerations

• The Epley maneuver is a canalith repositioning procedure that utilizes gravity 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 1.
• Vestibular rehabilitation therapy may also be offered, either self-administered or with a clinician, in the treatment of BPPV 1.
• Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines 1.
• Patients should be educated regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up 1.

Treatment Options

• Canalith repositioning procedures: Epley maneuver, Semont maneuver 1
• Vestibular rehabilitation therapy: self-administered or with a clinician 1
• Pharmacological interventions: antihistamines, anticholinergics for acute episodes 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).

The treatment for Vertigo is Meclizine hydrochloride tablets, with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.

• The dosage should be taken as directed by a healthcare professional.
• Meclizine is specifically indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2 2.

From the Research

Treatment Options for Vertigo

The treatment for vertigo can be categorized into several approaches, including:

• Pharmacological treatment: This involves the use of medications such as anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists to manage vertigo symptoms 3.
• Vestibular rehabilitation: This is a type of physical therapy that helps improve balance and reduce vertigo symptoms. It has been shown to be effective in treating benign paroxysmal positional vertigo (BPPV) and other types of vertigo 4, 5, 6.
• Canalith repositioning procedure (CRP): This is a non-invasive procedure that involves a series of maneuvers to help relocate the calcium particles in the inner ear that cause vertigo symptoms. It has been shown to be effective in treating BPPV 5, 7.
• Epley maneuver: This is a type of CRP that involves a series of specific head and body movements to help relocate the calcium particles in the inner ear. It has been shown to be effective in treating BPPV 7.

Specific Treatments for Different Types of Vertigo

• Otological vertigo: This type of vertigo is caused by disorders of the inner ear, such as Ménière's disease, vestibular neuritis, and BPPV. Treatment options include vestibular suppressants, salt restriction, and diuretics for Ménière's disease, and CRP and vestibular rehabilitation for BPPV 3, 5.
• Central vertigo: This type of vertigo is caused by disorders of the central nervous system, such as stroke and multiple sclerosis. Treatment options include prophylactic agents, such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers, as well as vestibular rehabilitation 3.
• Psychogenic vertigo: This type of vertigo is caused by psychological factors, such as anxiety and panic disorder. Treatment options include benzodiazepines and vestibular rehabilitation 3.

Comparison of Treatment Options

• A study comparing the efficacy of vestibular rehabilitation and pharmacological treatment in BPPV found that vestibular rehabilitation resulted in greater improvement in vertigo symptoms and balance parameters than pharmacological therapy 4.
• A study comparing the Epley maneuver with other treatment options, such as the Semont maneuver and Brandt-Daroff exercises, found that the Epley maneuver was more effective in treating BPPV 7.
• A review of the evidence on the effectiveness of vestibular rehabilitation in BPPV found that it improves balance control and reduces vertigo symptoms, and can be used in combination with CRP or as a substitute for CRP in patients with spine comorbidities 6.