Treatment of vertigo and dizziness

Treatment strategies for the various forms of vertigo include drugs, physical-rehabilitative therapy, psychotherapeutic measures and rarely surgery. Since most vertigo syndromes require a specific therapy, a correct diagnosis is the prerequisite for every treatment. The first part of this overview describes the general principles of therapy; the second part deals with the specific treatment of the most frequent forms of peripheral vestibular, central vestibular, and psychogenic vertigo.

Drug treatment

Antiepileptics
(carbamazepine)

Vestibular paroxysmia
Paroxysmal brainstem attacks
Superior oblique myokymia
Vestibular epilepsy

Antivertiginous drugs
(antihistamines: dimenhydrinate,
anticholinergics: scopolamine)

Beta-receptor blockers
(metoprolol, valproic acid, topiramate)

Treatment of the symptoms of acute
central or peripheral vestibular disorders
Motion sickness

Vestibular migraine

Corticosteroids

Acute vestibular neuritis

Betahistine

Menière's disease

Ototoxic antibiotics

Menière's disease

4-Aminopyridine

Downbeat / upbeat nystagmus syndrome, episodic ataxia type 2

Acetazolamide

Familial episodic ataxia type 2

Physical-rehabilitative treatment

Balance training and positioning maneuvers

Liberatory maneuver
for benign paroxysmal positioning vertigo

Schematic depiction of the Semont positioning maneuver in a patient with a left-sided benign paroxysmal positioning vertigo (BPPV).

Above: while in the initial sitting position, the patient turns his/her head by 45 degrees to the unaffected ear ("healthy").

Middle: positioning of the patient to the left, i.e., in the direction of the affected ear, while preserving the position of the head (ca. 1min in a lying position).

Below: next the patient is quickly tipped over to the unaffected ear, while preserving the head turn and now with the nose pointing downward (ca. 1 min in a lying position). Finally the patient sits upright.

Frequency of maneuvers:

3 times in the morning, at noon and at night

These positioning exercises or liberatory maneuvers in BBPV almost always lead to freedom from symptoms within a few days.

Film on the BPPV liberatory maneuver

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Film on balance training

Balance training

Specific balance training is carried out to improve the central vestibular compensation in peripheral and central vestibular disorders. Special exercises are performed for the vestibular, somatosensory, and visual/oculomotor systems, in order to promote, for example, the substitution of the missing vestibular information by that of another system.

The efficacy of this therapy was proven in animal experiments as well as clinically for both acute lesions as well as chronic conditions.

Central compensation of a peripheral vestibular tone difference (acute unilateral vestibular failure).

Habituation to prevent motion sickness.

Surgical treatment

If, for example, an acoustic neurinoma or a cavernoma of the brainstem causes vertigo, surgical treatment is the main option. Otherwise surgery is required only in rare cases of Menière's disease or vestibular paroxysmia when drug treatment fails. A perilymph fistula is also treated surgically. In most of the other forms of vertigo, however, surgical treatment is only resorted to if the other treatment approaches fail.