Vertigo Treatments and Medications

Vertigo is a feeling of dizziness with a spinning or rocking sensation. It is often accompanied by lightheadedness or feeling off-balance. Common causes of vertigo are typically due to problems in the inner ear and, less commonly, problems in the brain. Knowing the cause of your vertigo is the first step in determining what home treatments and medications you can use to help treat your vertigo. If you think you have vertigo, consult your healthcare provider so they can evaluate you, provide a diagnosis, and determine the best way to treat your symptoms. 

How is vertigo diagnosed?

Vertigo is diagnosed by a healthcare provider, and since there are many underlying conditions that cause vertigo, there are a variety of questions and tests that your healthcare provider may perform to diagnose the cause of vertigo. Be prepared for questions from your healthcare provider, such as:

• What medications are you currently taking? The healthcare provider will likely ask for a list of current medications since dizziness is a common side effect of many medications. 

• What type of dizziness are you experiencing? Vertigo that feels like being on a merry-go-round is found in disorders such as vestibular neuritis (inflammation of the vestibular nerve). However, dizziness that feels like being on a boat is found in bilateral vestibulopathy (damage in both inner ears). Dizziness without the sensation of movement is not considered vertigo.

• How long does your vertigo last? Shorter-lasting vertigo attacks (for seconds or minutes) indicate vestibular paroxysmia (compression of the vestibulocochlear nerve), while vertigo attacks lasting hours may indicate Meniere’s disease or vestibular migraine (migraine with vertigo). Attacks lasting days or weeks are more common with conditions such as vestibular neuritis. Vertigo with certain head movements lasting a few minutes to a few hours could indicate mini-strokes. 

• What triggers your vertigo attacks? If you get vertigo attacks while at rest, this could be a cause of vestibular neuritis, while attacks triggered by walking could be a sign of bilateral vestibular paroxysm. If vertigo is triggered while turning while lying down, this is more common in benign paroxysmal positional vertigo (BPPV).

• What other symptoms are you experiencing? Other symptoms caused by inner ear problems include tinnitus (ringing in the ears), difficulty hearing, or pressure in the ears. While symptoms like double vision, difficulty swallowing, or paralysis in the arms or legs may indicate issues in the brain or central nervous system. Headaches or migraines are symptoms that may indicate vestibular migraines.

These questions will likely be asked by your primary care physician. However, if more extensive testing is needed and an inner ear condition is suspected, your healthcare provider will likely send you to an otolaryngologist (ear, nose, and throat specialist), or if a brain disorder is suspected, they may send you to a neurologist or neurosurgeon for evaluation and medical advice. When seeing the specialty healthcare providers, there are a few tests they may run depending on your symptoms, these include:

• Routine tests: Testing of blood pressure, blood sugar levels, and oxygen levels will be reviewed to ensure these areas are not causing dizziness.

• Test of balance and gait: A Romberg test, in which a person stands with their feet close together and then closes their eyes, is a test of balance that your healthcare provider may perform. They may also have you try to walk in a straight line. 

• Hearing test: If you or your healthcare provider notices a change in hearing abilities, they may send you for a formal hearing test with an audiologist.

• Rotary chair testing: This test checks for abnormal eye movements while the patient is rotated in a chair.

• Dix-Hallpike Maneuver: This test, also known as the head-hanging test, is the recommended test of the American Academy of Otolaryngology - Head and Neck Surgery to confirm the presence of BPPV.

Vertigo treatment options

Treatment for vertigo depends on the underlying cause. Some cases of vertigo will resolve on their own since the brain is able to adapt to changes in the inner ear. However, moderate to severe vertigo is often treated with physical therapy/repositioning maneuvers or medication. In rare cases, surgery may be required.  

Types of vertigo medication

Antihistamines are commonly used to treat vertigo. However, depending on the cause, other medications may be required. The best treatment for you can be determined by your healthcare provider, who will take into account your symptoms and specific diagnosis. 

Antihistamines

Antihistamines, such as Antivert (meclizine) or Phenergan (promethazine), may be prescribed to treat nausea and vomiting associated with vertigo. There are also over-the-counter antihistamines such as meclizine, diphenhydramine, and dimenhydrinate. These decrease the feelings of motion sickness associated with vertigo. 

Other medications

• Other medications may be prescribed, depending on the cause of vertigo and the exact symptoms. 

• Benzodiazepines, such as Valium (diazepam) or Ativan (lorazepam), may be used in low doses to help with sudden vertigo attacks or to calm anxiety that comes with vertigo.

• Antiemetics, such as Zofran (ondansetron) or prochlorperazine, may be used to help with nausea and vomiting due to vertigo. 

• Diuretics, or water pills, such as hydrochlorothiazide, may be prescribed to people with Meniere’s disease. They can help remove inner ear fluid and prevent bouts of vertigo. 

• If vestibular migraine is causing vertigo, healthcare providers may prescribe migraine medication to prevent and treat the condition. 

Over-the-counter vertigo medicine

Some antihistamines used to treat vertigo symptoms are available over the counter. These include:

• Benadryl (diphenhydramine)

• Bonine, Dramamine Less Drowsy (meclizine) 

• Dramamine Original (dimenhydrinate)

These medications are OTC, but can still have side effects such as drowsiness. Check with a healthcare provider or pharmacist before using.

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