If you suffer with vertigo or dizziness you may feel desperate for immediate relief, but be careful before you reach for that bottle of Meclazine! Medication isn’t a long-term solution and can often delay rehabilitation and/or cause other negative side effects. It is important to understand what is causing your symptoms and how to most effectively treat the underlying problem.
The two most common causes of dizziness/vertigo are from Benign Paroxysmal Positional Vertigo (BPPV) and vestibular neuritis. In BPPV, calcium carbonate crystals (otoconia) that detect body and head movement and help with balance become dislodged and move into one of the three canals in the inner ear. The movement of the free-floating crystals within the inner ear canal as you change positions causes vertigo. Vestibular neuritis is an inflammation of the nerve that connects the inner ear to the brain, often caused by a viral infection. This leads to imbalance, dizziness, and vertigo.
The most appropriate treatment for BPPV is a repositioning maneuver where a patient is taken through a series of movements to move the dislodged calcium carbonate crystals out of the inner ear canal. Such maneuvers are performed by a medical professional (often a vestibular therapist) and can eliminate vertigo in as little as 1-3 visits. Repositioning maneuvers are the only way to medically treat BPPV. Medications do not have any effect on the crystals and vestibular suppressant meds such as antihistamines and/or benzodiazepines should only be considered for short-term management of nausea/vomiting accompanying BPPV in a severely symptomatic patient.
Short-term medication management for dizziness, vertigo, and nausea in the acute stages of vestibular neuritis may be appropriate for symptom modification and allow participation in vestibular rehabilitation (which is more effective when patients are seen early on). However, evidence does not support medication management of individuals with chronic vestibular hypofunction. The use of a corticosteroid (Medrol dose pack) has been found to improve recovery if administered acutely in the disease process (within 72 hours). Long-term use of vestibular suppressant medications (such as Antivert and Meclazine) can negatively impact an individual’s recovery and can also cause adverse side effects such as increased risk of falling, drowsiness, sedation, dry mouth, and blurred vision. Treatment with vestibular suppressors should be discontinued once the acute symptoms are controlled; chronic treatment with these drugs is discouraged as it may hinder the brain from compensating/recovering.
Medication use for the treatment of vestibular neuritis and BPPV is only a temporary fix to alleviate symptoms. Vestibular rehabilitation has shown to be most effective strategy in reaching complete clinical recovery. If you are suffering from dizziness, vertigo, or imbalance, you should be assessed and treated (if indicated) by a Physical Therapist that is specialized in vestibular rehabilitation therapy. Let us help you stop spinning and start living your best life, medication-free! Contact Lifeline Therapy today
Our Vestibular Physical Therapist, Dr. Rachel Long, PT, DPT has over 14 years of experience in vestibular rehabilitation therapy. She obtained her APTA recognized vestibular competency in 2011 and continues to expand her skills and knowledge through continuing education and clinical experience.