Vertigo medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Central | ===Central Disorders=== | ||
* Treat underlying disease | * Treat underlying disease | ||
* Vertebrobasilar ischemia | * Vertebrobasilar ischemia | ||
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* 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 | ===Peripheral Disorders=== | ||
* General management | * General management | ||
* Physical therapy | * Physical therapy | ||
| Line 28: | Line 28: | ||
=== Acute Pharmacotherapies === | === Acute Pharmacotherapies === | ||
==== Peripheral | ==== Peripheral Disorders==== | ||
* Specific management | * Specific management | ||
# BPPV | # BPPV | ||
| Line 36: | Line 36: | ||
*General management | *General management | ||
=====Pharmacologic | =====Pharmacologic Therapy===== | ||
*For acute episodes: | *For acute episodes: | ||
#Avoid long-term therapy if symptoms last > few days (will reduce CNS adaptation) | #Avoid long-term therapy if symptoms last > few days (will reduce CNS adaptation) | ||
| Line 45: | Line 45: | ||
#Meclizine is drug of choice in pregnancy. Side effect: sedation | #Meclizine is drug of choice in pregnancy. Side effect: sedation | ||
#Phenothiazines | #Phenothiazines | ||
# | #Prochlorperazine, promethazine (anti-Ach effects): More sedating, but also have antiemetic effects. Risk: extrapyramidal side effect (second-line) | ||
#Benzodiazepines | #Benzodiazepines | ||
#Diazepam, lorazepam, clonazepam (GABA-ergic effects): For patients with contraindications to anti-Ach prescription (benign prostatic hypertrophy) | #Diazepam, lorazepam, clonazepam (GABA-ergic effects): For patients with contraindications to anti-Ach prescription (benign prostatic hypertrophy) | ||
Revision as of 15:34, 4 March 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Central Disorders
- Treat underlying disease
- Vertebrobasilar ischemia
- Vertigo usually resolves on its own
- Risk factor modification to decrease recurrence
- 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
- Beneficial in patients with permanent peripheral vestibular dysfunction
- Unknown benefit in patients with central disorders
- 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
- 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)