Definitive treatment depends on the underlying cause of vertigo. Some of the treatment options for vertigo may include the following:
· Anticholinergics such as scopolamine.
· Anticonvulsants such as valproic acid for vestibular migraines.
· Antihistamines such as meclizine, which have antiemetic properties.
· Beta blockers such as metoprolol for vestibular migraine.
· Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis.
Canalith repositioning procedure (Epley maneuver) – employs gravity to move calcium build-up that causes benign positional paroxysmal vertigo. It can also be performed by trained otolaryngologists, neurologists, chiropractors or audiologists. It is performed as:
1) Patient starts in long sitting, head rotated 45 degrees to affected side.
2) Patient rapidly reclined to supine position with neck slightly extended. Hold position for 30 seconds, or until nystagmus and dizziness subside.
3) Rotate head 90 degree to opposite side. Hold position for 20 seconds, or until nystagmus and dizziness subside.
4) Patient rotated 90 degrees from supine to side-lying. Hold position for 20 seconds, or until nystagmus and dizziness subside.
5) Bring patient up into short-sitting. May need to complete this maneuveer 1to 3 visits for resolution of symptoms.
o Liberatory oe Semont maneuver:
a) Patient sits in short sitting, head rotated 45 degrees towards unaffected ear.
b) Examiner places one hand under the bottommost shoulder while the other hand supports the neck
c) Patient rapidly moves into side-lying to the affected side (face should be oriented towards ceiling). Hold this position for 30 seconds.
d) Without any head movement, patient is to move to side- lying on opposite side of the body (face oriented towards bed). Hold this position for 30 seconds.
o Gufoni Maneuver: Treatment for horizontal/lateral canal BPPV.
a) Patient taken from sitting to side-lying on affected or unaffected side
b) Geotropic nystagmus: unaffected
c) Apogeotropic: affected
d) Turn patient head quickly towards ground (45-60 degrees), hold in this position for 2 minutes.
Patient returns to sitting with head maintained in that position