By definition, vertigo is a feeling of movement in a stationary
positioning of the patient. These symptoms are noticed by the patient when
there is a malfunctioning in the inner ear which is otherwise known as the
vestibular system of the human being. The patient may notice a balancing
problem which is combined with the adverse effects of nausea and vomiting.
When vertigo treatment is
taken into consideration, the most important point is to rule out the cause of
vertigo. The factors leading to vertigo can be divided into peripheral and
central. The peripheral causes are those that are related to the inner ear and
some of these conditions are Benign Paroxysmal Positional Vertigo (BPPV – the
most common), Meniere’s disease and labyrinthitis. Drugs such as Aminoglycoside
antibiotics are also amongst the causative agents. The central causes of
vertigo are related to any disease that causes injury/insult to the Central
Nervous System. Common examples are infarctions, cerebral tumor, epilepsy,
migraine, hemorrhage or degenerative diseases such as Parkinsonism and Multiple
Sclerosis.
Once the cause is determined, treating the cause may treat the vertigo
itself. However, there are some patients who are solely suffering from vertigo
and for them, separate attention to treat vertigo is thought of.
A detailed history from the patient regarding vertigo is important
because not only it rules the cause of vertigo but also enlightens the
triggering factor behind it. For example, the patient may notice vertigo while
in situations such as ascending on a mountainous area or in a rocking boat. In
this situation, it is best to close the eyes or fixate the eyes to a distant
object which is stationary.
Additionally, some triggers should always be avoided in patients who
have been diagnosed with vertigo. These are: tilting the head suddenly and/or
producing sudden head motions, rolling over in bed and looking up or under for
more than 3 seconds. Avoiding these triggers themselves may alleviate most of
the vertigo attacks. Lack of sleep and stress may also sometimes trigger
vertigo attacks so the patient must be properly counseled for it.
Anti-cholinergics can be considered as good choices in the treatment of vertigo. In anti-cholinergics, the common drug that we use is Scopolamine. It is also effectively used in motion sickness. Nowadays, Scopolamine is available in dermal patches so it has really helped those who do not prefer the oral doses. Alternatively, we have other choices available such as anti-histamines. Both these groups of medicines work on the inner ear canal and suppress the balancing disorders. The common anti-histamines that are efficacious for vertigo treatment are cyclizine, diphenhyramine, dimenhydrinate, promethazine, hydroxyzine and meclizine.
Vertigo itself can sometimes be so severe that it can affect the daily
lifestyle of the patient and this is also accompanied with profound anxiety. In
this case, it is advised to take a benzodiazepine such as alprazolam or
lorazepam because they have effects that are very short acting and can rapidly
provide relief to the patient.
Apart from medical management, there are some maneuvers that are
effective in vertigo treatment. For
example, the Epley and Sermont maneuvers have very high cure rates if they are
performed properly by an experienced clinician. Some rotational chairs are also
available in markets which are also proving effective results. Exercises such
as the Brandt-Daroff exercises have also given promising results.
Finally, surgery is recommended for those who have not got any relief of
symptoms from the above mentioned therapies. However, surgical prognosis is
just like any other neurosurgery and the patient may adequately be counseled
before he/she decides to opt for it.
