Vertigo is a sense of feeling of unnatural motion even if patient is stationary. This leads to sensation of visual spinning, dizziness, imbalance and confusion in space. It is associated with wide ranging conditions from abnormality in auditory canal, vestibular nerve, brain stem and other neurological conditions and hence it is important to rule out any underlying serious medical or surgical pathology.
Symptomatic treatment:
For mild cases:
- Tab. Gemvert (Cinnarizine 20 mg + Dimenhydrinate 40 mg) – one tablet thrice a day for 3 days.
- Tab. Vertistar MD 8 (Betahistine 8 mg) – one tablet thrice a day for 3 months.
In severe cases along with vomiting
- Tab. Avomine 25 (Promethazine 25 mg) one tablet orally four times a day for 3 days.
For Meniere’s disease
- Tab. Aquazide 12.5 (Hydrochlorothiazide 12.5 mg) – one tablet a day with breakfast (monitor blood pressure).
For ear infections – Refer to guidelines for otitis media or labyrinthitis based on underlying condition.
General advice:
- Advice low salt diet
- Decrease caffeine intake
- Stop smoking, limit alcohol intake
- Vestibular rehabilitation (Canalith Repositioning Procedure or Epley manouvre) – for benign paroxysmal positional vertigo
Investigation:
- MRI brain – to rule out central causes.
- Repeat MRI after 7 days in high risk cases – if symptoms do not improve and first MRI is inconclusive after above treatment. Repeat MRI will allow to assess for developing central nervous system pathology.
Referral:
Consider referral to relevant specialist depending on the underlying cause. Urgent referral to neurologist may be needed if there is clinical evidence of stroke.