Vertigo - Treating vertigo

Treatment for vertigo will depend on the cause and severity of your symptoms.

During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea that you have and reduce the sensation of spinning. You may be advised to take medication during this time.

You should also try to avoid stressful situations, as anxiety can make the symptoms of vertigo worse.

Labyrinthitis

Labyrinthitis is an inner ear infection that causes the labyrinth (a delicate structure deep inside your ear) to become inflamed. It's usually caused by a viral infection and clears up on its own without treatment. In rare cases where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed.

If you have experienced any hearing loss, your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular physician. This is a doctor who specialises in hearing and balance disorders. You may need emergency treatment to restore your hearing.

Labyrinthitis may also be treated with vestibular rehabilitation, also called vestibular rehabilitation training or VRT.

See treating labyrinthitis for more information.

Vestibular neuronitis

Vestibular neuronitis, also known as vestibular neuritis, is inflammation of the vestibular nerve (one of the nerves in your ear that's used for balance). It's usually caused by a viral infection.

The symptoms of vestibular neuronitis often get better without treatment over several weeks. However, you may need to rest in bed if your symptoms are severe. See your GP if your symptoms get worse or don't start to improve after a week.

You may find that your balance is particularly affected if you:

drink alcohol
are tired
have another illness as well

Avoiding these can help improve your condition.

Vestibular neuronitis can also be treated with vestibular rehabilitation and medication.

Benign paroxysmal positional vertigo (BPPV)

Like vestibular neuronitis, benign paroxysmal positional vertigo (BPPV) often clears up without treatment after several weeks or months. It's thought the small fragments of debris in the ear canal that cause vertigo either dissolve or become lodged in a place where they no longer cause symptoms. BPPV can sometimes recur.

Until the symptoms disappear or the condition is treated, you should:

get out of bed slowly
avoid activities that involve looking upwards, such as painting and decorating or looking for something on a high shelf

BPPV can be treated using a procedure called the Epley manoeuvre.

The Epley manoeuvre

The Epley manoeuvre is a type of procedure called a canalith repositioning procedure. It is often effective in resolving the symptoms of vertigo.

The Epley manoeuvre involves performing four separate head movements to move the fragments that cause vertigo to a place where they will no longer cause symptoms. Each head position is held for at least 30 seconds. You may experience some vertigo during the movements.

In the past, patients were given instructions to follow after performing the Epley manoeuvre, such as not lying flat for 48 hours. However, this is now considered unnecessary.

Your symptoms should improve shortly after the Epley manoeuvre is performed, although it may take up to two weeks for a complete recovery. Return to your GP if your symptoms haven't improved after four weeks. The Epley manoeuvre isn't usually a long-term cure and may need to be repeated.

Brandt-Daroff exercises

If the Epley manoeuvre doesn't work or if it's not suitable – for example, because you have neck or back problems – you can also try Brandt-Daroff exercises. These are a series of movements you can do unsupervised at home to treat BPPV.

Your GP will need to teach you how to do the exercises. You repeat them three or four times a day for two days in a row. Your symptoms may improve for up to two weeks.

Referral for BPPV

Your GP may refer you to a specialist, such as an ear, nose and throat (ENT) specialist if:

the Epley manoeuvre doesn't work or can't be performed
you still have symptoms after four weeks
you have unusual signs or symptoms

In rare cases, where the symptoms of vertigo last for months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist will be able to advise you further about this.

Ménière's disease

If your vertigo is caused by Ménière's disease (a rare condition that affects the inner ear), there are a number of treatment options for both the vertigo and other symptoms caused by the condition.

Possible treatments for Ménière's disease include:

dietary advice, particularly a low salt diet
medication to treat attacks of Ménière's disease
medication to prevent attacks of Ménière's disease
treatment for tinnitus (ringing in your ears), such as sound therapy, a therapy that works by reducing the difference between tinnitus sounds and background sounds to make the tinnitus sounds less intrusive
treatment for hearing loss, such as using hearing aids
physiotherapy to deal with balance problems
treatment for the secondary symptoms of Ménière's disease, such as stress, anxiety and depression

See treating Ménière's disease for more information.

Central vertigo

Central vertigo is caused by problems in part of your brain, such as the cerebellum (which is located at the bottom of the brain) or the brainstem (the lower part of the brain that's connected to the spinal cord).

Causes of central vertigo include migraine headaches and, less commonly, brain tumours.

If your GP suspects you have central vertigo, they may organise a scan or refer you to a hospital specialist, such as a neurologist or an ENT (ear, nose and throat specialist) or audiovestibular physician.

Migraines

You can be treated at home if you've already been diagnosed with vertigo caused by migraines. The condition may be treatable with the same medications used to control migraines, such as triptans.

See treating migraines for more information.

Vertigo with an unknown cause

If the cause of your vertigo is unknown, you may be admitted to hospital if:

you have severe nausea and vomiting and can't keep fluids down
your vertigo comes on suddenly and was not caused by you changing position
you possibly have central vertigo
you have sudden hearing loss but it's not thought to be Ménière's disease

Alternatively, you may be referred to a specialist such as:

a neurologist – a specialist in treating conditions that affect the nervous system
an ENT specialist – a specialist in conditions that affect the ear, nose or throat
an audiovestibular physician – a specialist in hearing and balance disorders

While waiting to see a specialist, you may be treated with medication.

Vestibular rehabilitation

Vestibular rehabilitation, also called vestibular rehabilitation training or VRT, is a form of "brain retraining". It involves carrying out a special programme of exercises that encourage your brain to adapt to the abnormal messages sent from your ears.

During VRT you keep moving despite feelings of dizziness and vertigo. Your brain should eventually learn to rely on the signals coming from the rest of your body, such as your eyes and legs, rather than the confusing signals coming from your inner ear. By relying on other signals, your brain minimises any dizziness and helps you maintain your balance.

An audiologist (hearing specialist) or a physiotherapist may provide VRT. Your GP may be able to refer you for VRT, although it will depend on availability in your area.

In some cases, it may be possible to use VRT without specialist help. Research has shown people with some types of vertigo can improve their symptoms using a self-help VRT booklet. However, you should discuss this with your doctor first. If it is likely to be useful, you can download a copy of this booklet from the Ménière's society.

Medicines

Medication can be used to treat episodes of vertigo caused by vestibular neuronitis or Ménière's disease. It may also be used for central vertigo or vertigo with an unknown cause.

The medicines are usually prescribed for 3 to 14 days, depending on which condition they're for. The two medicines that are usually prescribed are:

prochlorperazine
antihistamines

If these medicines are successful in treating your symptoms, you may be given a supply to keep at home so you can take them the next time you have an episode of vertigo.

In some cases you may be advised to take long-term medication, such as betahistine, for conditions like Ménière's disease.

Prochlorperazine

Prochlorperazine can help relieve severe nausea and vomiting associated with vertigo. It works by blocking the effect of a chemical in the brain called dopamine.

Prochlorperazine can cause side effects, including tremors (shaking) and abnormal or involuntary body and facial movements.

It can also make some people feel sleepy. For the full list of possible side effects, check the patient information leaflet that comes with your medicine or see prochlorperazine medicines information.

If you're vomiting, there are some types of prochlorperazine that dissolve on your tongue so you don't have to swallow any tablets. It can also be administered as a suppository (a medication inserted into the rectum).

Antihistamines

Antihistamines can be used to help relieve less severe nausea, vomiting and vertigo symptoms. They work by blocking the effects of a chemical called histamine.

Possible antihistamines that may be prescribed include:

cinnarizine
cyclizine
promethazine teoclate

Like prochlorperazine, antihistamines can also make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.

A medication called betahistine works in a similar way to antihistamines. It has been used to treat Ménière's disease and may also be used for other balance problems. It may have to be taken for a long period of time. The beneficial effects vary from person to person.