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. Let’s take a more in-depth look at vertigo to find the best options to help your symptoms.

What is vertigo?

Vertigo is the dizziness characterized by a feeling of movement: either spinning or swaying. During a vertigo attack, you may also feel light-headed or off-balance. The most common symptoms of vertigo include:

• Dysequilibrium, or difficulty keeping your balance

• Feelings of spinning/swaying or being pulled in one direction

• Feelings of pressure or fullness in the inner ear

• Difficulty walking

• Headache

• Tinnitus or ringing in the ear

• Nausea

• Vomiting

• Hearing loss

• Nystagmus or abnormal eye movements

Treatment for vertigo depends on the underlying cause. Some causes of vertigo will clear up on their own, such as those from standing up too quickly or a head injury. The most common cause of vertigo is an inner ear infection, which may require antibiotics to treat the infection. Benzodiazepine drugs, or drugs that calm the central nervous system, are used for people with vertigo caused by vestibular disorders, or problems in the inner ear and brain. One vestibular disorder is Meniere’s disease, which is an inner ear disorder characterized by vertigo and hearing loss. In some cases, such as with benign paroxysmal positional vertigo (BPPV), a simple head movement treats the disorder. This helps clear the calcium buildup in the inner ear, which causes BPPV and can help relieve vertigo. In some more serious cases, inner ear surgery may be required for BPPV. Physical therapy may also benefit those who suffer from long term vertigo symptoms.

How is vertigo diagnosed?

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

• What medications are you currently taking? The doctor 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 experience? 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 vertigo attacks (that last 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 (migraines 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 laying down, this is more common in BPPV.

• What other symptoms are you experiencing? Other symptoms caused by inner ear problems include tinnitus, difficulty hearing, or pressure in the ears. 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 doctor will likely send you to an otolaryngologist, or if a brain disorder is suspected, they may send you to a neurologist or neurosurgeon for more medical advice. When seeing the specialty doctors, there are a few tests they may run depending on your symptoms, these include:

• Routine tests: Blood pressure, blood sugar levels, and oxygen level tests 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 your doctor may perform. Your doctor also may have you try to walk in a straight line.

• Hearing test: If you or your doctor notice a change in hearing abilities, your doctor 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.

• Brain imaging: An MRI (magnetic resonance imaging) may be used in patients with neurological causes of vertigo. A CT (computed tomography) scan might be ordered, but it’s typically less preferred than an MRI.

• Specialized tests: In some cases, more specialized tests such as electronystagmography (ENG) and videonystagmography (VNG) may be ordered by a physician.

During these tests, it is important to ask your doctor any questions you may have about your vertigo. These questions may include:

• What condition is causing my vertigo?

• Is there anything triggering my vertigo? What triggers should I avoid?

• Is my condition temporary or permanent?

• What treatment options do I have?

• How long will my treatment last?

• What should I expect during treatment? What are the risk factors?

• What outcomes can I expect from treatment? Will there be side effects?

• Do I need to take any precautions while experiencing vertigo? (i.e., is it still safe to drive?)

How is vertigo treated?

Vertigo varies depending on the underlying cause of vertigo. Some cases of vertigo will resolve on their own since the brain is able to adapt to changes in the inner ear. However, for moderate to severe vertigo there are three common treatments:

• Physical therapy/repositioning maneuvers: Some physical therapists are trained in vestibular rehabilitation, which helps strengthen the vestibular system to improve vertigo. They can also teach you ways to move around safely despite vertigo. There are also head movements helpful to those with BPPV, which helps clear calcium in the ear canal.

• Medication: A doctor may switch your current medications if they are the cause of vertigo. Medications to help vertigo, will either treat the underlying cause of the vertigo or help suppress the symptoms of vertigo caused by a recurring condition. For causes like Meniere’s disease, vestibular suppressants are used. These medications may include

  benzodiazepines, which work by suppressing the nervous system. Vertigo associated with migraines is often treated with benzodiazepines, antiemetics, and antihistamines. It can be prevented with either antidepressants or calcium channel antagonists, which prevent constriction in the arteries.

• Surgery: Rare causes of vertigo, such as those caused by a tumor or brainstem injury, may require surgery.

What medications treat vertigo?

There are a variety of drugs that may be prescribed to treat vertigo. These medications include:

• Antihistamines, such as Antivert (meclizine) or Phenergan (promethazine), may be prescribed to treat nausea and vomiting associated with vertigo. These decrease the feelings of motion sickness associated with vertigo. Antihistamines can sometimes cause drowsiness.

• Benzodiazepines, such as Valium (diazepam) or Ativan (lorazepam), often relieve vertigo caused by inner ear disorders such as Meniere’s disease, labyrinthitis, migraine-associated vertigo, or vestibular neuronitis. These drugs relieve vertigo by suppressing the vestibular system. These drugs are typically given in small doses to avoid addiction to the medication. These drugs also have a side effect of drowsiness.

• Diuretics, or water pills—such as Dyazide (triamterene/HCTZ), Lasix (furosemide), or acetazolamide—are often prescribed to those with Meniere’s disease. Diuretics help remove inner ear fluid that can cause vertigo. Side effects of diuretics can include dehydration and frequent urination.

• Corticosteroids, such as Decadron (dexamethasone) or oral prednisone, have been found to decrease the length and frequency of vertigo in those with Meniere’s disease. These drugs should be used for a short time, otherwise, you can become steroid-dependent and develop adrenal insufficiency.

What is the best medication for vertigo?

Discuss with your doctor the best medication for your vertigo. The best medication will depend on your medical condition, medical history, and medications you are currently taking that may interact with vertigo medication as well as your response to the treatment. Here is a list of the most commonly prescribed medications.

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Best medications for vertigo