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Health Protocols

Vertigo and Dizziness


The treatment approach to a patient with a history or presentation of dizziness can vary considerably. Dizziness is not a disease outright, but a possible manifestation of many diseases. Therefore, how a patient with dizziness is treated depends on the cause of his or her dizziness.

For vertigo, specific treatment approaches are more well delineated and are based upon the cause:

Positional Vertigo

With no treatment, over 60% of positional vertigo patients recover within four weeks; however, an estimated 58% of women and 39% of men experience recurrent episodes (Strupp 2013). Maneuvers designed to move debris out of the semicircular canals are frequently used to treat positional vertigo (Holmes 2011). The Semont and Epley maneuvers are among the most widely used and are effective in the majority of cases (Agrawal 2013; Strupp 2013; Iwasaki 2015; Agus 2013).

Antihistamines and benzodiazepines may delay resolution of symptoms in positional vertigo, and the American Academy of Otolaryngology recommends against their routine use in this condition (Foster 2015; Lin 2013; Wetmore 2013; VDA 2016a; Bhattacharyya 2008).

Vestibular Migraine

Vestibular migraine (sometimes called migraine-associated vertigo) is managed similarly to migraine headaches (VDA 2016c). This includes the use of migraine medications including triptans (eg, zolmitriptan [Zomig]); beta-blockers (eg, propranolol [Inderal] or metoprolol [Lopressor]); and anti-seizure medications (eg, topiramate [Topamax] and valproic acid [Depakene]) (Obermann 2014; Wetmore 2013; Strupp 2013). Other medical treatments may include antihistamines, anticholinergics, benzodiazepines, or anti-emetics (Hain 2003; VDA 2016a; Hain 2008).

Ménière’s Disease

Diuretic medications are commonly used to treat Ménière’s disease. However, one thorough literature review found little evidence from controlled clinical trials supporting the use of medications to treat Ménière’s, prevent attacks, or delay progression (Berlinger 2011; Foster 2015; Burgess 2006; Syed 2012; James 2007).

Oral steroids have been used to treat Ménière’s, with one study finding that 18 months of treatment reduced the frequency of vertigo spells by 50% (Foster 2015). The corticosteroid dexamethasone and the antibiotic gentamicin (Garamycin) can be injected past the eardrum into the middle and inner ear in patients who do not respond to more conservative treatment (Foster 2015; Berlinger 2011; Syed 2012; Wetmore 2013). Other medical treatments may include antihistamines, anticholinergics, benzodiazepines, or anti-emetics (Hain 2003; VDA 2016a; Hain 2008).

Other Treatment Considerations

Vestibular rehabilitation. Vestibular rehabilitation may improve balance and stability in people with intractable peripheral or central vertigo by encouraging the nervous system to adapt to changes in nerve signaling within the balance control network (Fernandez 2015; Iwasaki 2015; Kornilova 2010; Barona de Guzman 1994). These exercises address stabilization of vision, coordination of head and eye movement, and postural control through biofeedback techniques, and can be tailored to the individual (Barona de Guzman 1994; Mraz 2007).

Surgery. Surgery is available as a last resort to treat intractable peripheral vertigo (Sennaroglu 2001; Sismanis 2010). In rare cases, surgery is used to address vertigo caused by structural vestibular problems, including tumors (Holmes 2011).