Dizziness medical therapy: Difference between revisions
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{{CMG}} {{AE}} {{FB}} {{Norina Usman}} | {{CMG}} {{AE}} {{FB}} {{Norina Usman}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for dizziness is supportive, medical, and physical therapy. | 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>. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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*Cautious about driving or using machinery. | *Cautious about driving or using machinery. | ||
*Salt restriction (less than 1 to 2 g of sodium per day) | *Salt restriction (less than 1 to 2 g of sodium per day) | ||
===Medication:=== | ===Medication:=== | ||
*Diuretics (such as hydrochlorothiazide/triamterene) | *[[Diuretics]] (such as [[hydrochlorothiazide]]/[[triamterene]]) | ||
*[[Antihistamines]] | *[[Antihistamines]] | ||
*[[Sedatives]] | *[[Sedatives]] | ||
*Intratympanic gentamicin or dexamethasone | *[[Intratympanic]] [[gentamicin]] or [[dexamethasone]] | ||
*[[Methylprednisolone]] | *[[Methylprednisolone]] | ||
*[[Pills]] for [[nausea]] | *[[Pills]] for [[nausea]] | ||
*Migraine prophylaxis [[serotonin]] 5-HT1 receptor agonists [[ | *[[Migraine prophylaxis]] [[serotonin]] 5-HT1 receptor agonists ([[triptans]]) | ||
*[[Midodrine]] | *[[Midodrine]] | ||
*[[Pseudoephedrine]] | *[[Pseudoephedrine]] | ||
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{{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 | 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 | 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 | H01 | | H02 | | H03 | | H04 | | | | | | | H05 | | | | H06 | | | |H01=Positive|H02=Negative|H03=Vestibular Migraine|H04=Panic attack |H05= Barotrauma,Medication |H06= HINTS 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 |!| | | | |!| | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| }} | {{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 | 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 | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |!| | }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |!| | }} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | K01 | | | K02 | |K01=Peripheral etiology|K02=Central etiology }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | K01 | | | K02 | |K01=Peripheral etiology|K02=Central etiology }} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |!| | }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |!| | }} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | L02| | |L01=Vestibular neuritis|L02=Stroke or transient ischemic attack }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | L02| | |L01=[[Vestibular neuritis]]|L02=Stroke or transient ischemic attack }} | ||
{{familytree/end}} | {{familytree/end}} | ||
Latest revision as of 20:22, 20 February 2021
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Dizziness Microchapters |
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Treatment |
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Risk calculators and risk factors for Dizziness medical therapy |
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:
- 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
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]:
- Epley maneuver (canalith repositioning)
- Vestibular rehabilitation
- Breathing control exercises
- Balance therapy
- Psychotherapy
References
- ↑ 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.
- ↑ Hain TC, Uddin M (2003). "Pharmacological treatment of vertigo". CNS Drugs. 17 (2): 85–100. doi:10.2165/00023210-200317020-00002. PMID 12521357.
- ↑ Kuo CH, Pang L, Chang R (2008). "Vertigo - part 2 - management in general practice". Aust Fam Physician. 37 (6): 409–13. PMID 18523693.
- ↑ Post RE, Dickerson LM (2010). "Dizziness: a diagnostic approach". Am Fam Physician. 82 (4): 361–8, 369. PMID 20704166.
- ↑ 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.