Dizziness medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2] Norina Usman, M.B.B.S [3]

Overview

The mainstay of treatment for dizziness is supportive, medical, and physical therapy^[1]^[2]^[3].

Medical Therapy

Supportive therapy:

Treatment for lightheadedness can include drinking plenty of water or other fluids (unless the lightheadedness is the result of water intoxicationin which case the drinking water is quite dangerous)
Eating something sugary
Lying down or sitting and reducing the elevation of the head relative to the body (for example by positioning the head between the knees).
Intravenous fluids in case of nausea and vomiting from drinking too much liquid.
During attacks of vertigo from any cause, rest and lie still. Avoiding sudden changes in position as well as bright lights.
Cautious about driving or using machinery.
Salt restriction (less than 1 to 2 g of sodium per day)

Medication:

Diuretics (such as hydrochlorothiazide/triamterene)
Antihistamines
Sedatives
Intratympanic gentamicin or dexamethasone
Methylprednisolone
Pills for nausea
Migraine prophylaxis serotonin 5-HT1 receptor agonists (triptans)
Midodrine
Pseudoephedrine
Beta blockers
Antianxiety agents

Approach to the Patient with Dizziness:

Patient with dizzinesss^[4]

Presentation episodic or countinuous?

Episodic

Countinuous

Triggered

Spontaneous

Is it associated with trauma or toxins or spontaneous?

Dix-Hallpike maneuver

Hearing loss

Migraine

Psychiatric Symptoms

Trauma or toxin

Spontaneous

Positive

Negative

Vestibular Migraine

Panic attack

Barotrauma,Medication

HINTS Examination

Benign Paroxysml Vertigo

Access for orthostatic hypotension

Saccade present
Undirectional horizontal nystagmus
Normal test of skew

No saccade,Nystagmus dominantly vertical
torsional or gaze-evoked bidirectional,Abnormal test of skew

Peripheral etiology

Central etiology

Vestibular neuritis

Stroke or transient ischemic attack

Physical therapy:

Therapies for dizziness include^[5]:

Epley maneuver (canalith repositioning)
Vestibular rehabilitation
Breathing control exercises
Balance therapy
Psychotherapy

References

↑ Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D; et al. (2002). “Water drinking as a treatment for orthostatic syndromes”. Am J Med. 112 (5): 355–60. doi:10.1016/s0002-9343(02)01025-2. PMID 11904109.
↑ Hain TC, Uddin M (2003). “Pharmacological treatment of vertigo”. CNS Drugs. 17 (2): 85–100. doi:10.2165/00023210-200317020-00002. PMID 12521357.
↑ Kuo CH, Pang L, Chang R (2008). “Vertigo – part 2 – management in general practice”. Aust Fam Physician. 37 (6): 409–13. PMID 18523693.
↑ Post RE, Dickerson LM (2010). “Dizziness: a diagnostic approach”. Am Fam Physician. 82 (4): 361–8, 369. PMID 20704166.
↑ Holmberg J, Karlberg M, Harlacher U, Magnusson M (2007). “One-year follow-up of cognitive behavioral therapy for phobic postural vertigo”. J Neurol. 254 (9): 1189–92. doi:10.1007/s00415-007-0499-6. PMID 17676355.

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[pmid11904109-1] Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D; et al. (2002). “Water drinking as a treatment for orthostatic syndromes”. Am J Med. 112 (5): 355–60. doi:10.1016/s0002-9343(02)01025-2. PMID 11904109.

[pmid12521357-2] Hain TC, Uddin M (2003). “Pharmacological treatment of vertigo”. CNS Drugs. 17 (2): 85–100. doi:10.2165/00023210-200317020-00002. PMID 12521357.

[pmid18523693-3] Kuo CH, Pang L, Chang R (2008). “Vertigo – part 2 – management in general practice”. Aust Fam Physician. 37 (6): 409–13. PMID 18523693.

[pmid20704166-4] Post RE, Dickerson LM (2010). “Dizziness: a diagnostic approach”. Am Fam Physician. 82 (4): 361–8, 369. PMID 20704166.

[pmid17676355-5] Holmberg J, Karlberg M, Harlacher U, Magnusson M (2007). “One-year follow-up of cognitive behavioral therapy for phobic postural vertigo”. J Neurol. 254 (9): 1189–92. doi:10.1007/s00415-007-0499-6. PMID 17676355.

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