Vertigo: Treatment

VERTIGO

• There are two types of vertigo
• Peripheral vertigo
• Central vertigo

A)Peripheral vertigo

• It is caused by the inbalance mechanisms of the inner ear.
• The most common causes are :
• Benign paroxysmal positional vertigo (BPPV)
• Head injury
• Labyrinthis
• Vestibular neuronitis
• Meniere’s disease
• Taking certain types of medication

Treatment

• The vestibular rehabilitation exercises such as Cawthorne head exercises or modified Epley maneuver  need to be done on regular basis because it can lead to marked improvements in vertigo. These exercises can help to loose the crystals (canaliths) within the inner ear.
• Symptomatic treatments are the mainstay treatment in this type of disease. The medications to treat symptoms of peripheral vertigo are listed as below.
• Symptomatic treatment is only used for a short duration of time. Vestibular rehabilitation exercises will be the mainstay of the treatment for the peripheral vertigo.

B) Central Vertigo

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• Occur in part of brain as the cerebellum (which is located at the bottom of the brain) or the brainstem (the lower part of the brain that’s connected to the spinal cord 
• The causes are
• Migraines
• Multiple sclerosis
• Acoustic neuroma (benign brain tumor grows on acoustic nerve;rare)
• Brain tumor (rare)
• Transient ischaemic attack (TIA)
• Stroke

Treatment

• Most of central vertigo is treated by symptomatically. The drugs used in the symptomatic treatments are listed in the table below.
• Thrombolytic therapy can be given if radiologic evaluation suggest an acute ischemic stroke (need to be starts after consult with neurologist)
• Recombinant activated factor VII maybe useful for acute hemorrhagic stroke when administered within 4 hours of symptom onset.
• Intracranial pressure usually will increase in depressed mental status, thus by administering diuretics or corticosteroids can decrease the pressure before planning for more definitive treatment.
• Most of the treatment used only in acute or in a short duration of treatment. Definitive treatment such as surgery might be one of the option if patient’s condition is not improving (decided by neurologist consultant).

Algorithm in diagnosing vertigo

Reference

1. http://www.aafp.org/afp/2005/0315/p1115.html
2. Medscape.com
3. Uptodate.com
4. http://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-medication
5. http://www.dizziness-and-balance.com/treatment/drug/vestibular%20compensation.html
6. http://www.nhs.uk/Conditions/Vertigo/Pages/Treatment.aspx
7. http://www.aafp.org/afp/2006/0115/p244.html