Vertigo and Dizziness
Novel and Emerging Strategies
Treating Jugular Vein Abnormalities
Structural abnormalities in the jugular vein, which passes very close to sensitive vestibular structures, may contribute to some cases of Ménière’s disease and vertigo. In a report on three cases, jugular bulb abnormalities were corrected with non-surgical placement of coils and stents, resulting in a complete resolution of vertigo symptoms over 12‒24 months of follow up (Park 2015; Hitier 2014).
Flunarizine is a calcium channel blocker and antihistamine drug that is approved in many countries for migraine prevention. As of early 2016, it is not approved for any indication in the United States (NICE 2016; GOSH 2015; Health Canada 2015; Shamliyan 2013). Flunarizine has been demonstrated, in a randomized controlled trial, to be an effective adjunct treatment for migraine-associated vertigo. In 48 patients over 12 weeks, treatment with flunarizine, betahistine, and acetaminophen was compared with betahistine and acetaminophen alone. There was a significant decrease in frequency and severity of episodes of migrainous vertigo in the flunarizine group, and no significant difference in the frequency of adverse effects between the two groups (Lepcha 2014).
Serum Protein S100-beta
In emergency care settings, it is critical to differentiate benign or peripheral vertigo from acute stroke. Serum protein S100-beta is a novel diagnostic biomarker that has been studied for a variety of conditions affecting the central nervous system, including traumatic brain injury, stroke, and mood disorders. This protein is found in greater quantities in serum when neurological damage has occurred, and thus can help identify neurological origins of some symptoms (Yardan 2011). Emerging findings suggest this protein may someday be used in acute care settings to differentiate vertigo caused by vascular stroke from vertigo due to non-vascular causes (Kartal 2014; Purrucker 2014; Lynch 2004; Bouvier 2013; Schroeter 2013; Mercier 2013; Egea-Guerrero 2012).
Ocular and Cervical Vestibular Evoked Myogenic Potentials
Vestibular evoked myogenic potentials are electrical signals that can be measured in the neck or eye muscles and that may provide valuable diagnostic information about the causes of vertigo. In this procedure, the ear is stimulated with sound or vibration, which results in measurable electrical impulses in neck (cervical) or ocular muscles. These tests measure function of the vestibular otoliths in the inner ear. This approach is gaining popularity and may help refine the diagnosis of vertigo (Rosengren 2013; Young 2013; Murofushi 2011; Murofushi 2016; Venhovens 2016; Hong 2008; Burkard 2013).
Physical therapies that induce the movement of crystals out of the semicircular canals are effective for treating positional vertigo. The half somersault maneuver is a novel technique developed for at-home use without assistance. The half somersault maneuver was compared to the Epley maneuver (a well-known technique for crystal repositioning) in 68 people with positional vertigo. Those who used the half somersault experienced less dizziness and other complications during the procedure. They were also more likely to remain in remission six months after treatment (Foster 2012). A how-to guide for performing the half somersault maneuver has been developed by Carol Foster, MD and is available on her website.
Another promising field of research for individuals with vertigo is biofeedback therapy. Specific biofeedback techniques can be integrated into vestibular rehabilitation programs through the use of computer-generated cues about posture and position that encourage adaptation and improved balance (Kornilova 2010). In one study, five weeks of twice-weekly biofeedback therapy reduced swaying and instability and decreased reaction times in 73% of the 37 vertigo-affected participants (Perez 2006). Similar positive results have been observed in several other studies (Mraz 2007; Luchikhin 2002; Shutty 1991).