Treatment for vertigo, or dizziness, depends on identifying and eliminating the underlying cause. If a particular medication is responsible for the condition, lowering the dosage or discontinuing the drug may eliminate vertigo.
Endolymphatic sac procedures: Endolymphatic sac procedures are surgical procedures that reduce the swelling caused by endolymph (an inner ear fluid) buildup. In endolymphatic sac decompression, some of the bone surrounding the inner ear is removed. In some cases, endolymphatic sac decompression is coupled with the placement of an endolymphatic shunt, a tube that drains excess fluid from the inner ear. Another surgical approach called a sacculotomy involves implanting a permanent, tack-like device that allows endolymph to drain out of the inner ear whenever pressure builds up.
If vertigo appears without warning, the individual should not drive. Failure to control the vehicle may be hazardous to the individual and others. It is also best to avoid activities that require balance such as climbing ladders, scaffolds, and swimming (due to the possibility of drowning).
Labyrinthectomy: A labyrinthectomy removes the entire inner ear sense organ (vestibular labyrinth). The operation may be an option if antibiotic injections do not help and the individual has near-total or total hearing loss in the affected ear.
Lifestyle changes: Healthcare professionals recommend that individuals with conditions causing vertigo to: avoid caffeine, smoking, and alcohol; get regular sleep; eat a healthy diet, including fresh fruits and vegetables and limiting meats and fatty foods; and avoid foods that contain MSG or monosodium glutamate. Prepackaged food products and Chinese foods include MSG, which contains sodium. MSG can contribute to fluid retention and worsen symptoms. Stress may aggravate vertigo. Stress avoidance or counseling may be advised.
Medications: A low salt diet and a prescription diuretic, or water pill (such as hydrochlorothiazide), may reduce the frequency of attacks of dizziness in some individuals. Because diuretic medications cause the individual to urinate more frequently, their body may become depleted of certain minerals, such as potassium. Healthcare providers may recommend taking a potassium supplement or eating three or four extra servings of potassium-rich foods a week, such as bananas.
A middle ear injection consists of a healthcare professional injecting gentamicin (Garamycin®, a toxic antibiotic) in the inner ear, through the eardrum and into the inner ear. The gentamycin can now be absorbed. This reduces the balancing function of the individual's ear, and their other ear assumes responsibility for balance. The procedure, which can be performed with local anesthesia in a doctor's office, often reduces the frequency and severity of vertigo attacks.
Middle ear injections with a steroid, such as dexamethasone (Decadron®), may also help control vertigo attacks in some individuals. Although dexamethasone injections may be slightly less effective than gentamicin, dexamethasone is less likely than gentamicin to cause further hearing loss.
Anti-vertigo medications, such as meclizine (Antivert®), may provide temporary relief from vertigo. Anti-nausea medication is sometimes prescribed, such as prochlorperazine (Compazine®). Anti-anxiety drugs, such as alprazolam (Xanax®), may also be used if the individual has vertigo due to anxiety. Anti-vertigo, anti-nausea, and anti-anxiety medications may cause drowsiness. Alprazolam is in a class of drugs called benzodiazepines. These medications may cause physical and psychological addiction.
Anticholinergic medications may also be used to decrease dizziness. These drugs include scopolamine patches (Transderm Scop®).
Surgery: If the vertigo attacks are severe and debilitating and medical treatments do not help, surgery may be an option. A myringotomy is a surgical procedure that may be used to treat chronic ear infections. In this procedure, which is performed under anesthesia, an incision is made in the eardrum and a small tube is placed in the opening to prevent fluid and bacteria from building up inside the ear.
Vestibular neurectomy: A vestibular neurectomy involves cutting the nerve that controls balance (vestibular nerve). When intense vertigo is experienced, a vestibular neurectomy may be done to surgically destroy the entire inner ear. The individual's other ear then takes over the balance function.
Vestibular rehabilitation therapy: Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to treat vertigo. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system. In VRT, the individual performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo. The success of this treatment depends on several factors including the following: age of the patient (the younger the individual, the more responsive to treatment); cognitive function (such as memory and the ability to follow directions in order); coordination and motor skills; overall health of the individual (including the central nervous system); and physical strength.
Unclear or conflicting scientific evidence
Acupuncture: The practice of acupuncture originated in China 5,000 years ago. Today, it is widely used throughout the world and is one of the main pillars of Chinese medicine. Early evidence suggests that deep needling may be more effective in treating sudden deafness than shallow needling. Better-designed trials are needed to reach a firm conclusion. Both jinger moxibustion and acupuncture have been studied for cervical vertigo, although few conclusions can be made at this time.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Limited research suggests that functional reach performance may be improved through Alexander technique instruction, particularly in people older than 65 years. Better quality evidence is needed before a conclusion can be made.
Serious side effects of the Alexander technique have not been reported. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
Chiropractic: Chiropractic therapy is a type of healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system). It focuses on how this relationship affects the preservation and restoration of health. The broad term "spinal manipulative therapy" incorporates all types of manual techniques, including chiropractic. There is currently insufficient evidence to recommend chiropractic manipulative therapy for the treatment of cervical vertigo.
Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders or migraines. Use cautiously with a risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
Feldenkrais method®: It has been suggested that the Feldenkrais Method® may help improve balance problems or function, but there is little available research. There is currently a lack of available scientific studies or reports of safety of the Feldenkrais Method®.
Ginkgo: Ginkgo, or Ginkgo biloba, has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States. Preliminary study has been conducted on the effects of ginkgo in chronic cochleovestibular disorders and vertigo. Additional study is needed before a conclusion can be made.
Ginkgo may cause bleeding in sensitive individuals, such as those with bleeding disorders or those taking medications such as aspirin or warfarin (Coumadin®). Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily.
If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.
Hellerwork: Hellerwork is a form of deep tissue bodywork and movement therapy that was developed in the 1970s by aerospace engineer Joseph Heller. It uses multiple techniques, including deep-tissue bodywork, movement education and verbal interaction to improve posture and movement patterns. High-quality scientific evidence on the effects of this technique for balance and posture is currently unavailable.
Hellerwork should not be used as the sole therapeutic approach to disease, and it should not delay the time to speak with a health care provider about a potentially severe condition. In theory, Hellerwork may make some existing symptoms worse. Deep-tissue massage is not advisable in some conditions. Speak with a qualified healthcare professional before starting treatment. Use cautiously with psychosis or bipolar disorder, bleeding disorders, bone or joint disorders using blood thinners (rheumatoid arthritis, ankylosing spondylitis or aortic aneurisms), history of blood clots, recent abdominal surgery, or major diseases of internal organs. Use cautiously in women who are menstruating and in people with severe diseases of the kidneys, liver or intestines. Avoid with recent musculoskeletal injury, trauma, or major surgery. Avoid with broken bones, severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, or blood clots in areas being manipulated. Avoid if pregnant or breastfeeding.
Meditation: Meditation (in the form of Tai Chi or Qi gong) may help to improve balance in healthy elderly people. More research is needed.
Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
Physical therapy: Physical therapy has been used to treat vertigo (specifically, benign paroxysmal positional vertigo). Physical therapy protocols are not well outlined, and there is limited study comparing physical therapy to other modalities. Nevertheless, physical therapy may be helpful for vertigo, but more study is needed.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Tai chi: Tai chi is a system of movements and positions believed to have been developed in 12th Century China. Early research suggests that tai chi practice may improve balance and strength maintenance. These benefits may be similar to other forms of exercise. Additional research is necessary before a conclusion can be reached.
Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
Healthcare professionals recommend that if an individual is susceptible to vertigo (dizziness), they should: be aware of the possibility of losing balance, which can lead to falling and serious injury. Patients are directed to sit or lie down immediately when feeling dizzy; avoid driving a car or operating heavy machinery if experiencing frequent dizziness; use good lighting when getting out of bed at night; walk with a cane for stability; and avoid using caffeine, alcohol, and tobacco. Excessive use of these substances can constrict blood vessels and worsen signs and symptoms. Always work closely with a doctor to manage symptoms effectively. A doctor or pharmacist can also advise the individual about certain medications that may cause dizziness.