Vertigo medical therapy

Vertigo Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Vertigo from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Vertigo medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Vertigo medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Vertigo medical therapy
CDC on Vertigo medical therapy
Vertigo medical therapy in the news
Blogs on Vertigo medical therapy
Directions to Hospitals Treating Vertigo
Risk calculators and risk factors for Vertigo medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Central Disorders

• Treat underlying disease
• Reassurance and time important for treatment of vertigo
• Vertebrobasilar ischemia

1. Vertigo usually resolves on its own
2. Risk factor modification to decrease recurrence
3. Revascularization or anticoagulation

• Migraine: Adequate treatment of headache improves vertigo in 90%.
• Multiple sclerosis (MS): Therapy for MS alleviates vertiginous symptoms as well
• Drugs: Discontinue offending agents

Peripheral Disorders

• General management
• Physical therapy

1. Beneficial in patients with permanent peripheral vestibular dysfunction
2. Unknown benefit in patients with central disorders
3. Vestibular rehabilitation

• Activity enables CNS adaptation to loss of vestibular input
• Visual compensation during head motion
• Balance shown to improve in randomized controlled trials of vestibular exercises
• Unclear if long-term benefits or if decreased fall risk
• Avoidance of inactivity
• Avoid deconditioning and loss of postural reflexes

Acute Pharmacotherapies

Peripheral Disorders

• Specific management

1. BPPV
2. Epley maneuver --> in a randomized controlled trial, symptoms resolved in 50% vs. 19% sham therapy by mean 10 days
3. Meclizine (12.5-50 mg every 6 hours as often as necessary) or promethazine (25 mg every 6 hours as often as necessary) for severe symptoms
4. Meniere’s disease: low-salt diet and diuretics to reduce endolymph production

• Anticonvulsants such as topiramate or valproic acid for vestibular migraines

• General management

Pharmacologic Therapy

• For acute episodes:

1. Avoid long-term therapy if symptoms last > few days (will reduce CNS adaptation)
2. Anticholinergics
3. Scopolamine: Side effect urinary retention, dry mouth
4. Antihistamines such as betahistine, dimenhydrinate, diphenhydramine, or meclizine, which may have antiemetic properties (anti-Ach effects)
5. Meclizine is drug of choice in pregnancy. Side effect: sedation
6. Phenothiazines
7. Prochlorperazine, promethazine (anti-Ach effects): More sedating, but also have antiemetic effects. Risk: extrapyramidal side effect (second-line)
8. Benzodiazepines
9. Diazepam, lorazepam, clonazepam (GABA-ergic effects): For patients with contraindications to anti-Ach prescription (benign prostatic hypertrophy)
10. Calcium channel antagonists, specifically Verapamil and Nimodipine
11. Beta blockers such as metoprolol for vestibular migraine
12. GABA modulators, specifically gabapentin and baclofen
13. Neurotransmitter reuptake inhibitors such as SSRI's, SNRI's and Tricyclics
14. Diuretics for Meniere's Disease