Specific Management

Specific management options exist for several causes of vertigo.


Canalith repositioning manoeuvres have been used in an attempt to move canaliths out of the semicircular canal to treat BPPV.

The Epley manoeuvre is used to treat BPPV due to posterior canal canaliths (>90% of cases of BPPV) and has been shown to be safe, and effective, at least in the short term. It can be used in the ED. However, recurrence rates may be as high as 50% over 5 years, although the manoeuvre can be repeated or even taught.

Anterior canal BPPV is rare, and can be a complication of canalith repositioning manoeuvres because the canaliths migrate from the posterior canal into the anterior canal. Such cases may respond to other specialist manoeuvres.

The Epley (canalith repositioning) manoeuvre

Vestibular neuritis

There is evidence that corticosteroids (methylprednisolone) given acutely may improve longer-term vestibular function in patients with presumed viral vestibular neuritis.

Meniere’s disease

Betahistine, or diuretics, are often prescribed for dizziness symptoms in Meniere’s disease, and these are generally well tolerated; though evidence of the efficacy of these treatments is lacking.

Specialist treatments such as intratympanic gentamicin may be of benefit in selected cases.