Symptomatic Treatment

Patients may require symptomatic treatment for associated nausea, vomiting and dehydration with antiemetics and intravenous fluids. Admission may be required for patients with particularly severe or persistent symptoms. Some patients with vertigo, especially the elderly or those without social support, may require help from occupational therapy and social services.

Several classes of drugs can be used to treat the symptom of vertigo:

• Centrally-acting antihistamines (e.g. betahistine, cinnarazine)
• Phenothiazines (e.g. prochlorperazine)
• Anticholinergics (e.g. scopolamine)

Betahistine is commonly prescribed for Ménière’s disease, but the mechanism by which it works is incompletely understood. It is believed to be a potent H3 antagonist, acting centrally to increase blood flow to the vestibular apparatus.

Betahistine may be more efficacious for the treatment of Ménière’s disease than cinnarizine¹³ but overall high-quality evidence for the efficacy of betahistine is lacking.¹⁴ Antihistamines are likely to be more effective in the treatment of vertigo than benzodiazepines,¹⁵ and the latter carry significant and well known side effects.

It is suggested that prochlorperazine is effective for management of acute peripheral vertigo,¹⁶ but comparisons with other treatments are lacking.

Anticholinergics may be theoretically efficacious for vertigo, but evidence is lacking, and side effects of dizziness and confusion (particularly in the older patient) are well documented.

For all symptomatic treatments for vertigo, there is a suggestion that long term use may lead to vestibular disequilibrium.