Vertigo medical therapy: Difference between revisions
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{{CMG}} {{AE}} {{ZMalik}} | {{CMG}} {{AE}} {{ZMalik}} | ||
==Overview== | |||
Single drug therapy is usually not effective to minimize the [[symptom]], a combination of [[antihistamine]] and [[antiemetic]] are used to control vertigo. Definitive therapy is treating the underlying cause of vertigo. | |||
==Medical Therapy== | |||
*[[Acute]]/severe attacks of vertigo usually subsides in a day or two after brainstem compensation.<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> | |||
*Supportive therapy includes bed rest, [[antihistamine]], [[antiemetic]] ([[prochlorperazine]], [[metoclopramide]]), [[benzodiazepines]] ([[diazepam]],[[lorazepam]]) to relief the [[symptom]]. | |||
*[[Meclizine]] is the common [[antihistamine]] used and is safe in [[pregnancy]]. Other [[antihistamines]] used are [[betahistine]] and [[dimenhydrinate]].<ref> Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.</ref> | |||
*[[Scopolamine]] ([[hyoscine hydrobromide]]) is a common [[anticholinergic]] used to treat the symptom.<ref> Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.</ref> | |||
*Due to the [[sedative]] effect of these drugs they should be used carefully in the elderly. | |||
*These drugs should not be used for a long period of time as it may delay the compensatory mechanism in the [[brainstem]] and result in the prolongation of vertigo [[symptom]]. | |||
*Some patients may be a candidate for [[vestibular]] [[rehabilitation]], it improves balance and decreases [[dizziness]] by exercises that stabilize [[gait]] and [[gaze]]. | |||
==Treatment for Common Causes of Vertigo== | |||
:* | :* | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 20: | Line 33: | ||
*Observe if the [[tumor]] is small, [[asymptomatic]], not growing, or in elderly with comorbidities. | *Observe if the [[tumor]] is small, [[asymptomatic]], not growing, or in elderly with comorbidities. | ||
*For large, [[symptomatic]], growing [[tumor]] one of the following treatment is helpful after weighing risks and benefits: | *For large, [[symptomatic]], growing [[tumor]] one of the following treatment is helpful after weighing risks and benefits: | ||
**[[ | **[[Radiotherapy]] | ||
**[[Radiosurgery]] | **[[Radiosurgery]] | ||
**Surgical removal | **Surgical removal | ||
|- | |- | ||
![[Benign positional | ![[Benign paroxysmal positional vertigo]] | ||
| | | | ||
*Effective [[maneuvers]]:[[Epley maneuver]], [[Semont maneuver]], [[Brandt–Daroff exercises]], [[Roll maneuver]].<ref>{{cite journal| | *Effective [[maneuvers]]:[[Epley maneuver]], [[Semont maneuver]], [[Brandt–Daroff exercises]], [[Roll maneuver]].<ref>{{cite journal|journal=Cochrane Database of Systematic Reviews|issn=14651858</ref> | ||
*Medical: [[Antihistamine]]([[meclizine]]) and [[anticholinergic]]([[scopolamine]]).<ref>"Meclizine Hydrochloride Monograph for Professionals". American Society of Health-System Pharmacists. Retrieved 22 March 2019</ref> | *Medical: [[Antihistamine]]([[meclizine]]) and [[anticholinergic]]([[scopolamine]]).<ref>"Meclizine Hydrochloride Monograph for Professionals". American Society of Health-System Pharmacists. Retrieved 22 March 2019</ref> | ||
*Surgical: For [[resistant]] and severe cases [[occlusion]] of [[semi-circular canal]] may be helpful. | *Surgical: For [[resistant]] and severe cases [[occlusion]] of [[semi-circular canal]] may be helpful. | ||
| Line 38: | Line 51: | ||
![[Acute vestibular neuritis]] | ![[Acute vestibular neuritis]] | ||
| | | | ||
* | *Symptomatic:[[Antiemetic]], [[antihistamine]], [[benzodiazepines]]. These [[medicines]] should not be used for more than three days as the central compensation can get delayed leading to recurrent, [[chronic]] vertigo.<ref name="pmid28145669">{{cite journal| author=Muncie HL, Sirmans SM, James E| title=Dizziness: Approach to Evaluation and Management. | journal=Am Fam Physician | year= 2017 | volume= 95 | issue= 3 | pages= 154-162 | pmid=28145669 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28145669 }} </ref> | ||
*[[Steroid]] efficacy is controversial. <ref name="FishmanBurgess2011">{{cite journal|last1=Fishman|first1=Jonathan M|last2=Burgess|first2=Chris|last3=Waddell|first3=Angus|title=Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)|journal=Cochrane Database of Systematic Reviews|year=2011|issn=14651858|doi=10.1002/14651858.CD008607.pub2}}</ref> | |||
|- | |- | ||
![[Cholesteatoma]] | ![[Cholesteatoma]] | ||
| | | | ||
* | *Surgical removal followed by periodic follow-ups. | ||
|- | |- | ||
![[Otosclerosis]] | ![[Otosclerosis]] | ||
| | | | ||
* | *Medical: [[Sodium]] [[flouride]] can slow the progression. <ref name="de Oliveira Penidode Oliveira Vicente2018">{{cite journal|last1=de Oliveira Penido|first1=Norma|last2=de Oliveira Vicente|first2=Andy|title=Medical Management of Otosclerosis|journal=Otolaryngologic Clinics of North America|volume=51|issue=2|year=2018|pages=441–452|issn=00306665|doi=10.1016/j.otc.2017.11.006}}</ref> | ||
| | *Surgical procedure of choice is [[stapedectomy]].<ref name="pmid24303446">{{cite journal| author=Mahafza T, Al-Layla A, Tawalbeh M, Abu-Yagoub Y, Atwan Sulaiman A| title=Surgical Treatment of Otosclerosis: Eight years' Experience at the Jordan University Hospital. | journal=Iran J Otorhinolaryngol | year= 2013 | volume= 25 | issue= 73 | pages= 233-8 | pmid=24303446 | doi= | pmc=3846245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303446 }} </ref> | ||
| | |||
|+ | |+ | ||
! colspan="2" |Treating Central Vertigo | ! colspan="2" |Treating Central Vertigo | ||
| Line 56: | Line 67: | ||
![[Brainstem]] [[Stroke]] | ![[Brainstem]] [[Stroke]] | ||
| | | | ||
* | * Folow stroke management protocol. | ||
|- | |- | ||
![[Vestibular]] [[Migraine]] | ![[Vestibular]] [[Migraine]] | ||
| | | | ||
* | *[[Antiemetic]] coupled with medicines that relieve symptomatic vertigo.<ref name="Sargent2013">{{cite journal|last1=Sargent|first1=Eric W.|title=The challenge of vestibular migraine|journal=Current Opinion in Otolaryngology & Head and Neck Surgery|volume=21|issue=5|year=2013|pages=473–479|issn=1068-9508|doi=10.1097/MOO.0b013e3283648682}}</ref> | ||
|- | |- | ||
![[Multiple Sclerosis]] | ![[Multiple Sclerosis]] | ||
| | | | ||
* | *Disease-modifying drugs such as [[glatiramer acetate]], [[interferon-beta]], [[natalizumab]], [[mitoxantrone]] are effective in treat relapsing-remitting type. | ||
*For the secondary progressive, progressive-relapsing, and primary progressive type disease-modifying drugs are less effective. | |||
*Acute relapses are managed by treating the triggering cause, symptomatic therapy, [[corticosteroids]], and/or [[rehabilitation]]. | |||
* | |||
|- | |- | ||
![[ | ![[Cerebellopontine angle]] [[tumors]] | ||
| | | | ||
* | *Observation, [[radiotherapy]], or [[microsurgery]] is selected as a plan of treatment after assessing the size/growth of the [[tumor]], age of the patient, and [[comorbidities]].<ref name="HuangVermeulen2003">{{cite journal|last1=Huang|first1=May Y|last2=Vermeulen|first2=Sandra|title=Clinical perspectives regarding patients with internal auditory canal or cerebellopontine angle lesions: Surgical and radiation oncology perspectives|journal=Seminars in Ultrasound, CT and MRI|volume=24|issue=3|year=2003|pages=124–132|issn=08872171|doi=10.1016/S0887-2171(03)90034-5}}</ref> | ||
|} | |} | ||
==Reference== | |||
{{Reflist|2}} | |||
{{WH}} | |||
{{WS}} | |||
Latest revision as of 16:23, 11 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Single drug therapy is usually not effective to minimize the symptom, a combination of antihistamine and antiemetic are used to control vertigo. Definitive therapy is treating the underlying cause of vertigo.
Medical Therapy
- Acute/severe attacks of vertigo usually subsides in a day or two after brainstem compensation.[1]
- Supportive therapy includes bed rest, antihistamine, antiemetic (prochlorperazine, metoclopramide), benzodiazepines (diazepam,lorazepam) to relief the symptom.
- Meclizine is the common antihistamine used and is safe in pregnancy. Other antihistamines used are betahistine and dimenhydrinate.[2]
- Scopolamine (hyoscine hydrobromide) is a common anticholinergic used to treat the symptom.[3]
- Due to the sedative effect of these drugs they should be used carefully in the elderly.
- These drugs should not be used for a long period of time as it may delay the compensatory mechanism in the brainstem and result in the prolongation of vertigo symptom.
- Some patients may be a candidate for vestibular rehabilitation, it improves balance and decreases dizziness by exercises that stabilize gait and gaze.
Treatment for Common Causes of Vertigo
| Treating Peripheral Vertigo | |
|---|---|
| Ménière’s disease |
|
| Acoustic neuroma |
|
| Benign paroxysmal positional vertigo |
|
| Acute labyrinthitis |
|
| Acute vestibular neuritis |
|
| Cholesteatoma |
|
| Otosclerosis |
|
| Treating Central Vertigo | |
| Brainstem Stroke |
|
| Vestibular Migraine |
|
| Multiple Sclerosis |
|
| Cerebellopontine angle tumors |
|
Reference
- ↑ Kuo CH, Pang L, Chang R (2008). "Vertigo - part 2 - management in general practice". Aust Fam Physician. 37 (6): 409–13. PMID 18523693.
- ↑ Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.
- ↑ Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.
- ↑ Phillips, John S; Westerberg, Brian (2011). "Intratympanic steroids for Ménière's disease or syndrome". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008514.pub2. ISSN 1465-1858.
- ↑ Postema, Rolf J.; Kingma, Charlotte M.; Wit, Hero P.; Albers, Frans W.J.; Van Der Laan, Bernard F.A.M. (2009). "Intratympanic gentamicin therapy for control of vertigo in unilateral Menière's disease: a prospective, double-blind, randomized, placebo-controlled trial". Acta Oto-Laryngologica. 128 (8): 876–880. doi:10.1080/00016480701762458. ISSN 0001-6489.
- ↑ Syed, I.; Aldren, C. (2012). "Meniere's disease: an evidence based approach to assessment and management". International Journal of Clinical Practice. 66 (2): 166–170. doi:10.1111/j.1742-1241.2011.02842.x. ISSN 1368-5031.
- ↑ {{cite journal|journal=Cochrane Database of Systematic Reviews|issn=14651858
- ↑ "Meclizine Hydrochloride Monograph for Professionals". American Society of Health-System Pharmacists. Retrieved 22 March 2019
- ↑ Seemungal, B M; Bronstein, A M (2008). "A practical approach to acute vertigo". Practical Neurology. 8 (4): 211–221. doi:10.1136/jnnp.2008.154799. ISSN 1474-7758.
- ↑ Muncie HL, Sirmans SM, James E (2017). "Dizziness: Approach to Evaluation and Management". Am Fam Physician. 95 (3): 154–162. PMID 28145669.
- ↑ Fishman, Jonathan M; Burgess, Chris; Waddell, Angus (2011). "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008607.pub2. ISSN 1465-1858.
- ↑ de Oliveira Penido, Norma; de Oliveira Vicente, Andy (2018). "Medical Management of Otosclerosis". Otolaryngologic Clinics of North America. 51 (2): 441–452. doi:10.1016/j.otc.2017.11.006. ISSN 0030-6665.
- ↑ Mahafza T, Al-Layla A, Tawalbeh M, Abu-Yagoub Y, Atwan Sulaiman A (2013). "Surgical Treatment of Otosclerosis: Eight years' Experience at the Jordan University Hospital". Iran J Otorhinolaryngol. 25 (73): 233–8. PMC 3846245. PMID 24303446.
- ↑ Sargent, Eric W. (2013). "The challenge of vestibular migraine". Current Opinion in Otolaryngology & Head and Neck Surgery. 21 (5): 473–479. doi:10.1097/MOO.0b013e3283648682. ISSN 1068-9508.
- ↑ Huang, May Y; Vermeulen, Sandra (2003). "Clinical perspectives regarding patients with internal auditory canal or cerebellopontine angle lesions: Surgical and radiation oncology perspectives". Seminars in Ultrasound, CT and MRI. 24 (3): 124–132. doi:10.1016/S0887-2171(03)90034-5. ISSN 0887-2171.