Treatment for Acute Vertigo

Diagnosis-Based Treatment Approach

The American Academy of Otolaryngology-Head and Neck Surgery recommends canalith repositioning procedures as first-line treatment for Benign Paroxysmal Positional Vertigo (BPPV) with 80% success rates after 1-3 treatments 1
For Ménière's disease, a limited course of vestibular suppressants is recommended only during acute attacks, according to the American Academy of Otolaryngology-Head and Neck Surgery 3, 4
Vestibular rehabilitation/physical therapy should not be recommended for managing acute vertigo attacks in patients with Ménière's disease, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 3

Benzodiazepines, such as diazepam, may be used for short-term management of severe vertigo and can help with psychological anxiety secondary to vertigo, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4, 1
Centrally acting anticholinergic drugs, such as scopolamine and atropine, and glycopyrrolate can suppress acute vertigo attacks but have significant side effects, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
Antiemetics, such as prochlorperazine, may be used for short-term management of severe nausea/vomiting associated with vertigo, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 2, 5

Vestibular suppressants have significant side effects, including drowsiness, cognitive deficits, and increased fall risk, especially in elderly patients, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
All benzodiazepines carry a significant risk for drug dependence, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
Anticholinergics can cause blurring of vision, dry mouth, dilated pupils, urinary retention, and sedation, as reported by the American Academy of Otolaryngology-Head and Neck Surgery 4
Prolonged use of vestibular suppressants can interfere with central compensation in peripheral vestibular conditions and delay recovery, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2

Patients should be educated on dietary and lifestyle modifications that may reduce or prevent symptoms, including limiting salt/sodium intake, avoiding high-sugar beverages, managing stress, getting regular exercise and adequate sleep, and identifying and managing any allergies, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4, 1, 2
Allergies have been shown to contribute to symptoms of Ménière's disease in up to 30% of patients, according to the American Academy of Otolaryngology-Head and Neck Surgery 4

Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 5
Vestibular rehabilitation is recommended for chronic imbalance but not for acute vertigo attacks in Ménière's disease, according to the American Academy of Otolaryngology-Head and Neck Surgery 3, 1
Transition from medication to vestibular rehabilitation when appropriate to promote long-term recovery, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 5
For patients with increased bouts of vertigo, assessment for sleep apnea should be considered, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4