Vertigo medical therapy: Difference between revisions
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# [[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 | # [[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 [[diuretic]]s to reduce endolymph production | # Meniere’s disease: low-salt diet and [[diuretic]]s to reduce endolymph production | ||
* [[Anticonvulsants]] such as [[topiramate]] or [[valproic acid]] for vestibular migraines | |||
*General management | *General management | ||
Revision as of 17:45, 31 May 2013
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Vertigo Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Vertigo medical therapy On the Web |
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American Roentgen Ray Society Images of Vertigo medical therapy |
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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
- 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
- Anticonvulsants such as topiramate or valproic acid for vestibular migraines
- 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)