Vertigo and Dizziness
Vitamin D. Low vitamin D status has been observed in patients with positional vertigo, especially in those with chronic recurrent vertigo (Buki 2013; Talaat, Abuhadied 2015). In one study, subjects with vitamin D levels between 10 and 20 ng/mL had 3.8-fold greater odds of having positional vertigo compared with controls whose levels were above 20 ng/mL, while those with vitamin D levels below 10 ng/mL had 23 times the odds of positional vertigo (Jeong 2013).
One study in adults with positional vertigo found vitamin D supplementation eliminated vertigo episodes in all study subjects. Ten study participants with vitamin D levels below 20 ng/mL were treated with 8000 IU of vitamin D daily for two weeks, then 4000 IU daily for two weeks, followed by weekly doses of 8000 IU. Although some of these participants experienced multiple episodes of vertigo in the past, there were no recurrences between the time of initiating vitamin D therapy and the end of the eight-month study period (Buki 2013). Another study of 93 subjects with positional vertigo and severe vitamin D deficiency (≤ 10 ng/mL) found the degree of improvement of severe vitamin D deficiency after treatment predicted symptomatic response. Among those whose vitamin D level improved by less than 10 ng/mL, 43% experienced an episode of vertigo. However, among those whose vitamin D status improved by 10 ng/mL or more, only 14% experienced a vertigo recurrence (Talaat, Kabel 2015).
Ginkgo biloba. Ginkgo biloba, one of the oldest living species of trees in the world, is used in many countries for the treatment for vertigo (Agus 2013; UMMC 2013a). In a 12-week randomized controlled trial in 160 subjects with peripheral vertigo, 240 mg ginkgo extract daily was more effective and better tolerated than 32 mg daily of betahistine, a medication sometimes used to treat vertigo (Sokolova 2014). In an earlier trial, 160 mg of ginkgo extract per day for three months was also as effective as 32 mg per day of betahistine in people with vertigo related to vestibular disorders (Cesarani 1998). Another three-month trial found treatment with a ginkgo extract led to complete symptomatic improvement in 47% of a group of patients with vertigo of unknown origin, compared with 18% of those given placebo (Haguenauer 1986). In 30 individuals with an average age of 33.5 years who suffered from headache and memory and cognitive difficulties, 40 mg of ginkgo extract three times daily reduced vertigo intensity (Naprienko 2014), while another trial found ginkgo extract was successful in speeding rehabilitation in people with vestibular damage (Orendorz-Fraczkowska 2002).
Gastrodin. Gastrodia elata is a type of orchid used in traditional Chinese medicine to treat conditions including vertigo, epilepsy, headache, and pain (Li 2004; Ramachandran 2012). A rigorous analysis of controlled clinical trials that used injections of gastrodin, an extract from the gastrodia plant, to treat vertigo concluded that this treatment was more effective than medication (Ye 2009), and when given with the anti-nausea medication promethazine (Phenergan), can relieve acute emergency vertigo (Xu 2013). Laboratory studies have found gastrodia extract is able to protect nerve cells from inflammatory damage and promote neuroregenerative processes (Kim 2012; Ramachandran 2012).
Vertigoheel. Vertigoheel is a homeopathic product that has been studied for the treatment of vertigo. It is composed of dilute preparations of a combination of the conium and cocculus plants, ambergris, and mineral oil (DailyMed 2016). A laboratory study found Vertigoheel has vasorelaxant properties and appears to stimulate cyclic nucleotide pathways, while a clinical study found that treatment influenced microcirculation and improved oxygenation of the blood (Heinle 2010; Klopp 2005). In an uncontrolled trial in which patients with vertigo took three tablets of Vertigoheel three times daily for 14 days, 57.5% of participants reported improvement, which was confirmed by objective sensory motor tests (Claussen 1984). Another clinical trial treated different types of vertigo with Vertigoheel and found improvement in symptoms in the majority of cases (Morawiec-Bajda 1993). Vertigoheel has been compared to other established vertigo treatments such as Ginkgo biloba, betahistine, and dimenhydrinate, and found to have comparable efficacy (Issing 2005; Schneider 2005).
Coenzyme Q10. Coenzyme Q10 (CoQ10) supplementation has been shown to be of benefit in vertigo (Kumar 2009). CoQ10 is centrally involved in cellular energy production in the mitochondria and has been studied for the treatment of cardiovascular disease (Genova 2011; Yang 2015). In one trial, 2664 patients with congestive heart failure were treated with 50–150 mg per day of CoQ10. After three months of treatment, 73% of participants with vertigo reported improvement in their vertigo (Baggio 1994). CoQ10 is also thought to protect the inner ear structures, potentially preventing vestibular disorders that can lead to vertigo (Someya 2009; Iwasaki 2015).
Glutathione and related nutrients. A study in 22 treatment-resistant patients with Ménière’s disease evaluated 300 mg per day of rebamipide (an oxidative stress medication not available in the United States) along with 600 mg per day of vitamin C and/or 300 mg per day of glutathione. The treatment lasted eight weeks or more. Twenty-one of the 22 patients with vertigo reported complete recovery or substantial improvement 12 months after treatment (Takumida 2003). Based on these results, nutrient supplements that can increase glutathione levels, such as L-cysteine, vitamin C, whey protein, selenium, and N-acetylcysteine, may have a role in the treatment of vertigo and Ménière’s disease (Middleton 2004; Bounous 1989; Kent 2003; Arakawa 2007; Johnston 1993; Ballatori 2009).
Vitamin B12. Vitamin B12 is essential for normal neurological function, and B12 deficiency can cause a wide range of neurological and psychiatric symptoms, including vertigo and dizziness (Clarke 2003; Briani 2013). In a case report, an elderly patient with dizziness and imbalance was found to have vitamin B12 deficiency and elevated homocysteine levels. B12 injection therapy resulted in a dramatic response in this patient (Singh 2010). A study in 100 people with neurological symptoms that included dizziness and instability found that 15% of subjects had low vitamin B12 levels (Mahajan 2015).
Vitamin B6. Vitamin B6 supplementation may be helpful in certain cases of medication-related vertigo. In two separate double-blind clinical trials, 20 healthy individuals took the antibiotic minocycline (Minocin) seven times over three days in order to induce vertigo, nystagmus, and nausea. The addition of 40 mg of vitamin B6 at each dose markedly reduced these side effects (Claussen 1988).
Ginger root. Zingiber officinale (ginger) root has been used traditionally to treat digestive, inflammatory, and infectious ailments (Haniadka 2013). A randomized controlled trial found one gram of powdered ginger strongly prevented symptoms of seasickness, including vertigo (Grontved 1988). Another placebo-controlled clinical trial showed ginger prevented vertigo significantly better than placebo in healthy adult subjects who underwent vestibular stimulation to induce vertigo (Grontved 1986).
Magnesium. Migraine can be effectively treated with oral magnesium supplementation (Obermann 2014; Peikert 1996; Chiu 2016), and magnesium supplementation may be beneficial in migraine-associated vertigo. A thorough analysis of randomized clinical trials found that, in cardiac patients, magnesium orotate supplementation reduced the risk of dizziness by 78% (Torshin 2015). Magnesium modulates smooth muscle tone in blood vessels (Kolte 2014), suggesting it might favorably impact vertigo related to vestibular blood flow restriction.
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