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

From the Guidelines

Treatment for chronic vertigo should prioritize canalith repositioning procedures, such as the Epley maneuver, as initial therapy for patients with posterior canal benign paroxysmal positional vertigo (BPPV) 1.

Key Considerations

• The diagnosis of BPPV should be made based on a thorough history and physical examination, including the Dix-Hallpike maneuver 1.
• Vestibular rehabilitation therapy may be offered as an option for the treatment of BPPV, either self-administered or with a clinician 1.
• Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines 1.
• Patient education is crucial, including information on the impact of BPPV on safety, potential for disease recurrence, and importance of follow-up 1.

Treatment Approach

• Canalith repositioning procedures, such as the Epley maneuver, are recommended as initial therapy for patients with posterior canal BPPV 1.
• Vestibular rehabilitation therapy may be considered as an adjunctive treatment or for patients who do not respond to canalith repositioning procedures 1.
• Lifestyle modifications, such as avoiding trigger foods and getting adequate sleep, may also be beneficial in managing symptoms of chronic vertigo.

Important Notes

• The effectiveness of treatment depends on correctly identifying the underlying cause of vertigo, such as BPPV, Meniere's disease, vestibular neuritis, or migraine-associated vertigo, as each requires a somewhat different approach.
• Clinicians should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms 1.

From the FDA Drug Label

MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). DOSAGE AND ADMINISTRATION Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).

Treatment options for chronic vertigo include meclizine hydrochloride tablets, with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.

• The dosage can be adjusted based on the patient's response to the medication.
• It is essential to follow the prescribed dosage and administration instructions to ensure safe and effective treatment.

From the Research

Treatment Options for Chronic Vertigo

• The Epley maneuver is a commonly used treatment for benign paroxysmal positional vertigo (BPPV), with studies showing its effectiveness in relieving symptoms and converting the Dix-Hallpike test from positive to negative 3, 4, 5.
• Betahistine can be used as a sole modality of treatment for vertigo in BPPV, particularly in patients who are unfit to undergo canal repositioning maneuvers 3.
• Vestibular rehabilitation is another treatment option for BPPV, although its effectiveness compared to the Epley maneuver is inconsistent, with some studies showing equal effectiveness at 1-month follow-up 4.
• The Epley maneuver has been shown to be effective in treating BPPV associated with Meniere's disease, with most patients experiencing elimination of positional nystagmus and vertigo after one or more maneuvers 6.
• Recurrence of BPPV can be resolved using a specific maneuver for the affected canal, highlighting the importance of proper diagnosis and treatment 6.
• A thorough assessment of patients with vertigo is crucial to establish the presence of true vertigo, differentiate between central and peripheral origins, and evaluate the need for urgent investigations and referrals 7.