Diagnosis and Treatment

If you experience significant vertigo that lasts longer than a few minutes, you should be evaluated urgently by a physician. If the symptom is associated with any other neurologic deficit, like difficulty speaking or swallowing, double or blurry vision, numbness or weakness, or incoordination, you should be seen immediately, as this could be a sign of a stroke.

During the evaluation, the doctor will do a complete physical and neurologic exam, and do some specific tests of your balance and movements of your eyes. A physical test called the Dix-Hallpike and/or head impulse tests (see video below) are generally done. If there is any concern that a stroke or some other more serious problem is present, an imaging test can be performed, usually an MRI or CT of the head. However, these tests are often not necessary and should only be performed when indicated.

In the initial period, vertigo is frequently treated with a few different classes of medications:

• Antihistamines, especially meclizine, which appears to suppress the nerve signals from the inner ear.
• Antiemetics, including prochlorperazine and metoclopramide, which generally treat the severe nausea associated with the vertigo.
• In refractory cases, benzodiazepines, such as lorazepam and diazepam, which can both relieve the vertigo and the frequent anxiety associated with it by decreasing the excitability of neurons in the brain.

The Epley maneuvers (video below) often successfully relieve the symptoms immediately in patients with BPPV. Chronic symptoms can be managed with the medications above–although benzodiazepines should be avoided, if possible, due to dependence that can develop with chronic use. Sometimes treatment with steroids is appropriate when an inflammatory cause is suspected. Physical therapy, specifically vestibular therapy, is the most important treatment to make chronic symptoms manageable.

Dora, do see a specialist in vertigo at the university medical center. After a thorough evaluation you may find ways to cope with these symptoms of vertigo and be able to improve your quality of life.

References

Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L. and Reed, M. (2001), Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II. Headache: The Journal of Head and Face Pain, 41: 646–657. doi: 10.1046/j.1526-4610.2001.041007646.x
Vuković, V., Plavec, D., Galinović, I., Lovrenčić-Huzjan, A., Budišić, M. and Demarin, V. (2007), Prevalence of Vertigo, Dizziness, and Migrainous Vertigo in Patients With Migraine. Headache: The Journal of Head and Face Pain, 47: 1427–1435. doi: 10.1111/j.1526-4610.2007.