Vertigo medical therapy: Difference between revisions

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{{Vertigo}}
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==Medical Therapy==
==Medical Therapy==
===Central disorders===
===Central disorders===
*:* ''Treat underlying disease''
* Treat underlying disease
*:* Vertebrobasilar ischemia
* Vertebrobasilar ischemia
*:*:* Vertigo usually resolves on its own
# Vertigo usually resolves on its own
*:*:* Risk factor modification to decrease recurrence
# Risk factor modification to decrease recurrence
*:*:* +/- Revascularization or anticoagulation
# Revascularization or anticoagulation
*:* Migraine:  adequate treatment of headache improves vertigo in 90%
* Migraine:  adequate treatment of headache improves vertigo in 90%
*:* Multiple sclerosis (MS):  Therapy for MS alleviates vertiginous symptoms as well
* Multiple sclerosis (MS):  Therapy for MS alleviates vertiginous symptoms as well
*:* Drugs:  discontinue offending agents
* Drugs:  discontinue offending agents
* '''Peripheral disorders'''  
===Peripheral disorders===  
*:* ''General management''
* General management
*:* Physical therapy 
* Physical therapy 
*:*:* Beneficial in patients with permanent peripheral vestibular dysfunction
# Beneficial in patients with permanent peripheral vestibular dysfunction
*:*:* Unknown benefit in patients with central disorders
# Unknown benefit in patients with central disorders
*:*:* Vestibular rehabilitation
# Vestibular rehabilitation
*:*:*:* Activity enables CNS adaptation to loss of vestibular input
* Activity enables CNS adaptation to loss of vestibular input
*:*:*:* Visual compensation during head motion
* Visual compensation during head motion
*:*:*:* Balance shown to improve in randomized controlled trials of vestibular exercises
* Balance shown to improve in randomized controlled trials of vestibular exercises
*:*:*:* Unclear if long-term benefits or if decreased fall risk
* Unclear if long-term benefits or if decreased fall risk
*:* Avoidance of inactivity
* Avoidance of inactivity
*:*:*:* Avoid deconditioning and loss of postural reflexes
* Avoid deconditioning and loss of postural reflexes


=== Acute Pharmacotherapies ===  
=== Acute Pharmacotherapies ===  
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*:* Surgical patch if no resolution after several weeks
*:* Surgical patch if no resolution after several weeks
* Acoustic neuroma: surgical therapy
* Acoustic neuroma: surgical therapy
==References==
{{Reflist|2}}
[[Category:Neurology]]
[[Category:Otolaryngology]]
[[Category:Signs and symptoms]]
[[Category:Primary care]]
[[Category:Needs Overview]]
{{WH}}
{{WS}}

Revision as of 00:32, 2 March 2013

Vertigo Microchapters

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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
  • 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
  • BPPV
  • Epley maneuver --> in a randomized controlled trial, symptoms resolved in 50% vs. 19% sham therapy by mean 10 days
  • 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
  • Meniere’s disease: low-salt diet and diuretics to reduce endolymph production
  • Peripheral disorders
  • General management
  • Pharmacologic therapy
  • For acute episodes: Avoid long-term therapy if symptoms last > few days (will reduce CNS adaptation)
  • Anticholinergics
  • Scopolamine: Side effect urinary retention, dry mouth
  • Antihistamines
  • Meclizine, dimenhydrinate, diphenhydramine (anti-Ach effects)
  • Meclizine is drug of choice in pregnancy. Side effect: sedation
  • Phenothiazines
  • prochlorperazine, promethazine (anti-Ach effects): More sedating, but also have antiemetic effects. Risk: extrapyramidal side effect (second-line)
  • Benzodiazepines
  • Diazepam, lorazepam, clonazepam (GABA-ergic effects): For patients with contraindications to anti-Ach prescription (benign prostatic hypertrophy)

Surgery and Device Based Therapy

  • Perilymphatic fistula
    • Bed rest, head elevation, avoidance of straining
    • Surgical patch if no resolution after several weeks
  • Acoustic neuroma: surgical therapy

References


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