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{{Dizziness}}
{{Dizziness}}
 
{{CMG}} {{AE}} {{FB}} {{Norina Usman}}
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==Overview==
 
The mainstay of treatment for dizziness is supportive, medical, and [[physical therapy]]<ref name="pmid11904109">{{cite journal| author=Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D | display-authors=etal| title=Water drinking as a treatment for orthostatic syndromes. | journal=Am J Med | year= 2002 | volume= 112 | issue= 5 | pages= 355-60 | pmid=11904109 | doi=10.1016/s0002-9343(02)01025-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11904109  }} </ref><ref name="pmid12521357">{{cite journal| author=Hain TC, Uddin M| title=Pharmacological treatment of vertigo. | journal=CNS Drugs | year= 2003 | volume= 17 | issue= 2 | pages= 85-100 | pmid=12521357 | doi=10.2165/00023210-200317020-00002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521357  }} </ref><ref name="pmid18523693">{{cite journal| author=Kuo CH, Pang L, Chang R| title=Vertigo - part 2 - management in general practice. | journal=Aust Fam Physician | year= 2008 | volume= 37 | issue= 6 | pages= 409-13 | pmid=18523693 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18523693  }} </ref>.
{{CMG}}; {{AE}} {{MUT}}


==Medical Therapy==
==Medical Therapy==
Treatment for lightheadedness can include drinking plenty of water or other fluids (unless the lightheadedness is the result of [[water intoxication]]in which case drinking water is quite dangerous), eating something sugary, and lying down or sitting and reducing the elevation of the head relative to the body (for example by positioning the head between the knees).
===Supportive therapy:===
If you tend to get [[light-headed]] when you stand up, avoid sudden changes in posture.
*Treatment for lightheadedness can include drinking plenty of water or other fluids (unless the lightheadedness is the result of [[water intoxication]]in which case the drinking water is quite dangerous)
*Eating something sugary
*Lying down or sitting and reducing the elevation of the head relative to the body (for example by positioning the head between the knees).
*[[Intravenous]] fluids in case of nausea and vomiting from drinking too much liquid.
*During attacks of [[vertigo]] from any cause, rest and lie still. Avoiding sudden changes in position as well as bright lights.  
*Cautious about driving or using machinery.
*Salt restriction (less than 1 to 2 g of sodium per day)


If you are thirsty or [[light-headed]], drink fluids. If you are unable to keep fluids down from [[nausea]] or [[vomiting]], you may need [[intravenous]] fluids. These are delivered to you at the hospital.
===Medication:===
*[[Diuretics]] (such as [[hydrochlorothiazide]]/[[triamterene]])
*[[Antihistamines]]
*[[Sedatives]]
*[[Intratympanic]] [[gentamicin]] or [[dexamethasone]]
*[[Methylprednisolone]]
*[[Pills]] for [[nausea]]
*[[Migraine prophylaxis]] [[serotonin]] 5-HT1 receptor agonists ([[triptans]])
*[[Midodrine]]
*[[Pseudoephedrine]]  
*[[Beta blockers]]
*[[Antianxiety agents]]


Most times, [[benign positional vertigo]] and [[labyrinthitis]] go away on their own within a few weeks. During attacks of [[vertigo]] from any cause, try to rest and lie still. Avoid sudden changes in your position as well as bright lights. Be cautious about driving or using machinery.
===Approach to the Patient with Dizziness:===
 
Some [[vertigo]] can be reduced by working with a [[physical therapist]]. [[Medications]] from your doctor may help you feel better.
 
Such [[medications]] include [[antihistamines]], [[sedatives]], or [[pills]] for [[nausea]]. For [[Meniere's disease]], [[surgery]] may be necessary.
{{familytree/start |summary=PE diagnosis Algorithm.}}  
{{familytree/start |summary=PE diagnosis Algorithm.}}  
{{familytree | | | | | | | | | | | | | | | | A01 |A01= Patient with [[dizziness]]s}}
{{familytree | | | | | | | | | | | | | | | | A01 |A01= Patient with [[dizziness]]s<ref name="pmid20704166">{{cite journal| author=Post RE, Dickerson LM| title=Dizziness: a diagnostic approach. | journal=Am Fam Physician | year= 2010 | volume= 82 | issue= 4 | pages= 361-8, 369 | pmid=20704166 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20704166  }} </ref>}}
{{familytree | | | | | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | | | | | | | | A01 |A01= Presentation episodic or countinuous?}}
{{familytree | | | | | | | | | | | | | | | | A01 |A01= Presentation episodic or countinuous?}}
{{familytree | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | | | | }}
{{familytree | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | | }}
{{familytree | | | F01 | | | | | | | | | | | | | | | | | | | | | | | | | F02 |F01= [[Episodic]]|F02= [[Countinuous]]}}
{{familytree | | | F01 | | | | | | | | | | | | | | | | | | | | F02 |F01= [[Episodic]]|F02= [[Countinuous]]}}
{{familytree | |,|-|^|-|-|.| | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | }}
{{familytree | |,|-|^|-|-|-|.| | | | | | | | | | | | | | | | | |!| | | | | }}
{{familytree | | | | | | F01 | | | | | | | | F02 | | | | | | | | | | | | | | | | | | | | | F03 |F01=Triggered |F02=Spontaneous |F03=Is it associated with trauma or toxins or spontaneous? }}
{{familytree | F01 | | | | F02 | | | | | | | | | | | | | | | | F03 |F01=Triggered |F02=Spontaneous |F03=Is it associated with [[trauma]] or [[toxins]] or spontaneous? }}
{{familytree | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | }}
{{familytree | |!| | |,|-|-|-|+|-|-|-|.| | | | | | | | | |,|-|-|^|-|-|.| }}
{{familytree | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | | | | | | F03 | | | | | | F04 | | |F01= Provoked |F02= Unprovoked |F03= History of [[intoxication]] |F04= Unknown }}
{{familytree | G01 | | G02| | G03 | | G04 | | | | | | | | G05 | | | | G06 | |G01=[[Dix-Hallpike]] maneuver|G02=Hearing loss|G03=Migraine|G04=Psychiatric Symptoms|G05=Trauma or toxin|G06=Spontaneous }}
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | }}
{{familytree |,|^|-|-|.| | | |!| | | |!| | | | | | | | | |!| | | | | | |!| | | | }}
{{familytree | | | | | F01 | | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |,|-|-|^|-|-|.| | | | F02 | | |F01= Apply [[Dix-Hallpike]] maneuver |F02= [[Physical examination]] }}
{{familytree | H01 | | H02 | | H03 | | H04 | | | | | | | H05 | | | | H06 | | | |H01=Positive|H02=Negative|H03=Vestibular Migraine|H04=Panic attack |H05= [[Barotrauma]],Medication |H06= HINTS Examination }}
{{familytree | | | | | |!| | | | | | F01 | | | F02 | | | F03 | | | | | | | | F04 | | | | F05 | | | |!| |F01= [[Deafness]] |F02= Headache |F03= [[Psychiatric]] symptoms |F04= Barotrauma  |F05= Drugs }}
{{familytree |!| | | | |!| | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| }}
{{familytree | | |,|-|-|^|-|-|.| | | |!| | | | |!| | | | |!| | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| }}
{{familytree | I01 | | I02 | | | | | | | | | | | | | | | | | I03 | | | | I04 |I01=Benign Paroxysml Vertigo|I02=Access for orthostatic hypotension|I03=[[Saccade]] present<br>Undirectional horizontal nystagmus<br>Normal test of skew|I04=No saccade,[[Nystagmus]] dominantly vertical<br>torsional or gaze-evoked bidirectional,Abnormal test of skew }}
{{familytree | | F01 | | | | F02 | | F03 | | | F04 | | | F05 | | | | | | | | | | | | | | | F06 | | | | | | F07 | | | |F01= Positive |F02= Negative |F03= [[Meniere disease]] |F04= Vestibular migraine|F05= [[Panic attack]], [[psychiatric]] condition |F06= [[Nistagmus]] dominantly horizontal, direction-fixed, [[saccade]] present |F07= [[Nistagmus]] dominantly vertical, no [[saccade]], torsion or [[gaze]] evoked bidirectionaly }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |!| | }}
{{familytree | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | |!| }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | K01 | | | K02 | |K01=Peripheral etiology|K02=Central etiology }}
{{familytree | | F01 | | | | F02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | F03 | | | | | | F04 | | | |F01= [[Benign paroxysmal positional vertigo]] |F02= [[Orthostatic hypotension]] |F03= [[Vestibular neuritis]] |F04= [[Stroke]], [[transient ischemic attack]] }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |!| | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | L02| | |L01=[[Vestibular neuritis]]|L02=Stroke or transient ischemic attack }}
{{familytree/end}}
{{familytree/end}}
===Physical therapy:===
Therapies for dizziness include<ref name="pmid17676355">{{cite journal| author=Holmberg J, Karlberg M, Harlacher U, Magnusson M| title=One-year follow-up of cognitive behavioral therapy for phobic postural vertigo. | journal=J Neurol | year= 2007 | volume= 254 | issue= 9 | pages= 1189-92 | pmid=17676355 | doi=10.1007/s00415-007-0499-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17676355  }} </ref>:
*[[Epley maneuver]] (canalith repositioning)
*[[Vestibular rehabilitation]]
*Breathing control exercises
*[[Balance therapy]]
*[[Psychotherapy]]


==References==
==References==

Latest revision as of 20:22, 20 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2] Norina Usman, M.B.B.S[3]

Overview

The mainstay of treatment for dizziness is supportive, medical, and physical therapy[1][2][3].

Medical Therapy

Supportive therapy:

  • Treatment for lightheadedness can include drinking plenty of water or other fluids (unless the lightheadedness is the result of water intoxicationin which case the drinking water is quite dangerous)
  • Eating something sugary
  • Lying down or sitting and reducing the elevation of the head relative to the body (for example by positioning the head between the knees).
  • Intravenous fluids in case of nausea and vomiting from drinking too much liquid.
  • During attacks of vertigo from any cause, rest and lie still. Avoiding sudden changes in position as well as bright lights.
  • Cautious about driving or using machinery.
  • Salt restriction (less than 1 to 2 g of sodium per day)

Medication:

Approach to the Patient with Dizziness:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient with dizzinesss[4]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presentation episodic or countinuous?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Episodic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Countinuous
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Triggered
 
 
 
Spontaneous
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is it associated with trauma or toxins or spontaneous?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dix-Hallpike maneuver
 
Hearing loss
 
Migraine
 
Psychiatric Symptoms
 
 
 
 
 
 
 
Trauma or toxin
 
 
 
Spontaneous
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
Negative
 
Vestibular Migraine
 
Panic attack
 
 
 
 
 
 
Barotrauma,Medication
 
 
 
HINTS Examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Benign Paroxysml Vertigo
 
Access for orthostatic hypotension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Saccade present
Undirectional horizontal nystagmus
Normal test of skew
 
 
 
No saccade,Nystagmus dominantly vertical
torsional or gaze-evoked bidirectional,Abnormal test of skew
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral etiology
 
 
Central etiology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vestibular neuritis
 
 
Stroke or transient ischemic attack
 
 

Physical therapy:

Therapies for dizziness include[5]:

References

  1. ↑ Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D; et al. (2002). "Water drinking as a treatment for orthostatic syndromes". Am J Med. 112 (5): 355–60. doi:10.1016/s0002-9343(02)01025-2. PMID 11904109.
  2. ↑ Hain TC, Uddin M (2003). "Pharmacological treatment of vertigo". CNS Drugs. 17 (2): 85–100. doi:10.2165/00023210-200317020-00002. PMID 12521357.
  3. ↑ Kuo CH, Pang L, Chang R (2008). "Vertigo - part 2 - management in general practice". Aust Fam Physician. 37 (6): 409–13. PMID 18523693.
  4. ↑ Post RE, Dickerson LM (2010). "Dizziness: a diagnostic approach". Am Fam Physician. 82 (4): 361–8, 369. PMID 20704166.
  5. ↑ Holmberg J, Karlberg M, Harlacher U, Magnusson M (2007). "One-year follow-up of cognitive behavioral therapy for phobic postural vertigo". J Neurol. 254 (9): 1189–92. doi:10.1007/s00415-007-0499-6. PMID 17676355.

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