Treatment and the Epley maneuver

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Home remedies for vertigo include a set of exercises known as the Epley maneuver, staying hydrated, gingko biloba supplements, and ginger tea. If these do not help, medication is available.

Vertigo is a feeling of dizziness and spinning, occurring with or without any movement. It is caused when the brain feels the body is off-balance even though it is not. It can limit a person’s activities and make them feel sick.

When feeling dizzy, a person should sit down immediately to reduce the chances of getting hurt if they fall.

Usually, vertigo is a symptom of an underlying medical condition or several different conditions. Sometimes, vertigo will only occur once, but for other people, it will reoccur until the underlying cause is determined.

Fast facts on vertigo:

• Symptoms can last anywhere from a few minutes to a few hours and may come and go.
• Treatment for vertigo will depend on the cause.
• Medication can relieve symptoms of dizziness, nausea, and motion sickness.

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Vertigo can be managed naturally with a variety of home remedies.

Epley maneuver

The Epley maneuver is often recommended by chiropractors or physical therapists as a way of treating vertigo at home.

One of the most common ways to manage vertigo is a technique called the Epley maneuver. This involves a set of steps done before bed each night until the symptoms of vertigo resolve for at least 24 hours.

A report from the Institute for Quality and Efficiency in Health Care says 52 out of every 100 people who use the Epley maneuver gain relief from vertigo symptoms.

If symptoms of vertigo occur from the left side and left ear, the Epley maneuver can be done by:

• sitting on the edge of a bed and turning the head 45 degrees to the left
• lying down quickly and facing head up on the bed at a 45-degree angle
• maintaining the position for 30 seconds
• turning the head halfway — 90 degrees — to the right without raising it for 30 seconds
• turning the head and entire body to the right side, looking downward for 30 seconds
• slowly sitting up but remaining sitting for at least a few minutes

If vertigo starts on the right side in the right ear, these directions should be done in reverse.

Ginkgo biloba

Ginkgo biloba is a Chinese herb known for resolving the symptoms of vertigo. It works by managing blood flow to the brain to relieve dizziness and balance issues.

A study reported in the International Journal of Otolaryngology finds Ginkgo biloba is just as effective as the medication betahistine in managing vertigo.

Ginger tea

Research published in the Journal of Acupuncture and Tuina Science finds ginger root can reduce the effects of vertigo better than manual repositioning, such as the Epley maneuver, alone.

Ginger root can be steeped in a cup of boiling water for 5 minutes. Honey can help with the bitter taste. Drinking ginger tea twice a day may help dizziness, nausea, and other vertigo symptoms.

Almonds

Almonds are rich sources of vitamins A, B, and E. Eating a daily handful of almonds can help with vertigo symptoms.

How almonds help is unknown, but it is possible the vitamin content can combat the causes of vertigo.

Staying hydrated

Dehydration can cause symptoms of vertigo. Even mild dehydration can trigger the condition.

Staying hydrated can help minimize dizziness and balance issues.

The body needs 8 to 12 cups of liquid per day. While this includes all liquids, water is the best option because it is calorie- and caffeine-free and not a diuretic. Diuretics increase the amount of water and salt the body expels as urine.

Essential oils

Various essential oils, when applied topically or inhaled, may help to ease the symptoms of vertigo.

Essential oils are natural and affordable options for managing the symptoms of vertigo, including nausea, headaches, and dizziness.

Some of the options available for managing vertigo include peppermint, ginger, lavender, and lemon essential oils.

Essential oils are inhaled through an infuser or diluted in a carrier oil before being applied topically. A person may have to experiment with a variety of oils to find the best one to treat their vertigo symptoms.

Apple cider vinegar and honey

Both apple cider vinegar and honey are believed to have curative properties to relieve blood flow to the brain. Two parts honey and one part apple cider vinegar can prevent and treat vertigo symptoms.

Acupressure

Acupressure applies the same concepts as acupuncture, but it is without the needles. The goal of acupressure is to promote wellness and relaxation. It can help manage vertigo by stimulating pressure points throughout the body.

One common method, called the P6 acupressure method, involves an effective pressure point located in the two tendons between the inner forearm and the wrist.

Vertigo may cause headaches, nausea, double vision, or changes in hearing.

In addition to causing a person feelings of being unbalanced or spinning, vertigo can lead to the following symptoms:

• nausea or vomiting
• abnormal eye movements
• headaches
• sweating
• ear ringing
• hearing loss
• double vision
• lack of coordination
• arm or leg weakness

Benign positional paroxysmal vertigo or BPPV is the most common type of vertigo. A buildup of deposits in the inner ear causes BPPV.

The inner ear is responsible for the body’s sense of balance. With BPPV, certain movements may cause dizziness and a spinning sensation for a short time.

BPPV is a common condition. Most people have a lifetime prevalence of 2.4 percent, according to researchers from the University of British Columbia. Also, BPPV recurs 50 percent of the time, according to a 2014 report published in the journal Advances in Otolaryngology.

Other conditions that may cause vertigo include:

• Cold viruses: The common cold can cause ear inflammation. This type of vertigo usually resolves within a few days but can reoccur.
• A head or neck injury: Vertigo is a common symptom that can follow a head or neck injury. Vertigo related to a neck or head injury tends to resolve but can be debilitating and ongoing.
• Stroke: According to the American Stroke Association, someone experiencing a stroke may have vertigo, including symptoms of dizziness and severe imbalance. A stroke will cause dizziness and imbalance rather than just one.
• Vestibular neuritis or VN: VN is a condition affecting the vestibulocochlear nerve in the inner ear. This nerve is responsible for balance and head-positioning signals received in the brain. When the nerve is inflamed, the brain misinterprets balance and head positioning.
• Meniere’s disease: Meniere’s is a condition that affects hearing in one ear. It causes symptoms of vertigo, tinnitus or ringing in the ears, hearing loss, and a feeling of “fullness” in the ear. Some people with Meniere’s disease have severe vertigo, causing balance loss and falls.

Most of the time, vertigo resolves without treatment, as the brain can compensate for changes to the inner ear to restore someone’s balance.

Medications, such as steroids, can reduce inner ear inflammation, and water pills can reduce fluid buildup.

For people who have recurrent episodes of vertigo, a physical therapy called vestibular rehabilitation can help. Vestibular rehabilitation encourages the central nervous system to compensate for inner ear problems.

Anyone who has reoccurrences of vertigo should see their doctor. For most people, vertigo is usually not harmful, but the underlying cause needs to be identified. A doctor can also prescribe medications and other treatments to lessen symptoms, especially if home remedies do not help.

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The home remedies listed in this article are available for purchase online.

• Shop for Ginkgo biloba.
• Shop for ginger tea.
• Shop for almonds.
• Shop for apple cider vinegar.
• Shop for peppermint essential oil.
• Shop for ginger essential oil.
• Shop for lavender essential oil.
• Shop for lemon essential oil.
• Shop for carrier oils.

What to Do and When to See a Doctor

Written by WebMD Editorial Contributors

• Remedies and Treatments for Vertigo
• When to See a Doctor

Vertigo is the sudden sensation of losing balance, associated particularly with the feeling of looking down from a great height. It can also feel like you are spinning or the room around you is spinning. Vertigo attacks can last for a few seconds or persist for a couple of hours and even days.

Vertigo is considered a symptom, not a condition, and has been associated with ear infections like Benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and vestibular neuritis. While these diseases are different, they affect the ear in a similar way by throwing off the brain’s sense of balance.

Around 30% of people will suffer vertigo at least once in their lives, and it’s a very frequent symptom in emergency patients. Thankfully, most vertigo symptoms can be treated successfully.

If you’re experiencing a vertigo attack, the best thing to do is lie down in a quiet, dark room, close your eyes, and take deep breaths. This may help ease any nausea symptoms and reduce the sensation of spinning. It is also important to avoid stressful situations because anxiety and anger can make vertigo symptoms worse.  

Vertigo is most commonly treated with simple exercises or procedures. It is recommended that you perform these exercises with a trained physician or after consulting with a doctor. Exercises for vertigo include:

Epley Maneuver

This maneuver, also known as the Canalith Repositioning Maneuver, is the most common exercise to address vertigo, specifically BPPV. This easy procedure can be done by yourself at home.

1. Lie on a flat surface like the floor or a bed with a pillow behind your head, and your legs outstretched.
2. Sit up with your back straight.
3. Turn your head 45 degrees to the right.
4. With your head still tilted, quickly recline back down to the pillow and stay in this position for 30 seconds.
5. Turn your head 90 degrees to the left without lifting your neck.
6. Turn your entire body so you end up completely on your left side.
7. Return to the starting position and slowly sit back up.

Gufoni Maneuver 

This maneuver provides a quick and effective counter to the effects of vertigo.

If the vertigo is more intense when your head is turned toward the unaffected ear:

1. Start in a sitting position.
2. Rapidly lie down toward the affected side and hold for one to two minutes.
3. Turn your head quickly 45 degrees toward the ceiling and hold for two minutes.
4. Sit back upright.

If the vertigo is more intense when your head is turned toward the affected ear:

1. Start in a sitting position.
2. Rapidly lie down toward the unaffected side and hold for one to two minutes.
3. Turn your head quickly 45 degrees toward the floor and hold for two minutes.
4. Sit back upright.

Semont Maneuver
The Semont-Toupet maneuver is similar to the Epley maneuver, but it requires less neck flexibility.

1. Sit upright on a flat surface like the floor or a bed, with a pillow behind you, and your legs outstretched.
2. Lie down and turn to your right side.
3. Tilt your head 90 degrees to look upward.
4. Quickly sit up and turn to your left side, keeping your head facing to your left. You should now be looking down to the ground.
5. Slowly return to the original sitting position and look forward.

Zuma Maneuver 

The Zuma maneuver is a recently developed exercise that has also been shown to be effective against vertigo.

1. Start in a sitting position.
2. Quickly lie down on the affected side and hold for three minutes.
3. Rotate your head 90 degrees toward the ceiling and hold for another three minutes.
4. Move your body to lie facing the ceiling. Rotate your head 90 degrees, now looking over the shoulder of the affected side, and hold for three minutes.
5. Rotate your head back up to face the ceiling and slowly rise to a sitting position.

While the above maneuvers address vertigo and related symptoms while they are happening, the following activities and considerations may help you prevent vertigo attacks:

Yoga

Yoga can help you regain balance, focus, coordination, and movement—and can help train the brain to counteract the effects of vertigo. Simple positions like Child’s Pose or Corpse Pose combined with deep, regular breaths can calm the body and mind. By reducing anxiety, yoga and deep breathing could prevent vertigo attacks in some people.

Hydration

Dehydration is detrimental to the body, and it can cause vertigo symptoms to flare. Make sure that you drink plenty of water throughout the day. Be aware of situations where you are losing more water than normal, like at the gym or outside on a hot summer day.

Vitamin D Deficiency

One study suggested that people who suffer from vertigo could have a deficiency of vitamin D. While more research needs to be done to confirm the correlation, this study did show that patients who were given vitamin D supplements stopped having vertigo attacks. 

You should seek medical advice if vertigo symptoms persist for a couple of hours or keep reoccurring for more than a couple of days. A doctor may prescribe medication, such as prochlorperazine and antihistamines, or recommend vestibular rehabilitation training (VRT).

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Seven principles for the treatment of vertigo and results of the study

Vestibular vertigo (VV) is one of the most common syndromes, with about 5% of people experiencing it annually [1]. The prevalence of V.G. increases with age. Women suffer from vestibular disorders 2-3 times more often than men. The most common causes of VH are benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular migraine, vestibular neuronitis, stroke, and transient ischemic attacks (TIA). VH is usually accompanied by severe instability, as well as nausea and vomiting. Seizures V.G. are difficult to tolerate by patients, and anxiety and expectation of new attacks often lead to the formation of emotional disorders that make vestibular compensation difficult. All this makes the use and search for the most effective methods of stopping VH particularly relevant.

The choice of modern methods of treatment of VH is quite wide. In this case, effective treatment is based on establishing the cause of vestibular disorders. In our country, the contribution of cerebrovascular pathology, arterial hypertension, or diseases of the cervical spine is often overestimated. Meanwhile, large studies conducted in recent years show that other diseases can be the most common causes of dizziness: disorders of the peripheral vestibular analyzer (BPPV, Meniere’s disease, vestibular neuronitis) and migraine.

Seven principles for improving the effectiveness of treatment of CH

1. In the most acute period of SH, vestibular suppressants are indicated . Classical vestibular suppressants include antihistamines and benzodiazepines. In addition to them, some other drugs can be used: calcium channel blockers and acetyleucine.

Antihistamines. Only those h2-blockers that penetrate the blood-brain barrier are effective in CHB. These drugs include dimenhydrinate (50-100 mg 2-3 times a day), promethazine (25 mg 2-3 times a day orally or intramuscularly), diphenhydramine (25-50 mg orally 3-4 times a day or 10-50 mg intramuscularly) and meclozine (25–100 mg/day orally) [2, 3]. Side effects of vestibular suppressants include drowsiness, dry mouth, and confusion.

Benzodiazepines. The inhibitory mediator of the vestibular system is GABA, and benzodiazepines enhance the inhibitory effects of GABA, which explains the effect of these drugs in V.G. Benzodiazepines, even in small doses, significantly reduce dizziness and associated nausea and vomiting. The risk of drug dependence, side effects (drowsiness, increased risk of falls, memory loss), and slowing of vestibular compensation limit their use in vestibular disorders. The most commonly prescribed lorazepam, which at low doses (eg, 0.5 mg 2 times a day) rarely causes drug dependence and can be used sublingually (at a dose of 1 mg). Diazepam at a dose of 2 mg 2 times a day can also effectively reduce G.G. Clonazepam has been less studied as a vestibular suppressant but appears to be as effective as lorazepam and diazepam. Usually it is prescribed at a dose of 0.5 mg 2 times a day. Long-acting benzodiazepines, such as phenazepam, are not effective in SH [4]. A recent comparative study of the efficacy of lorazepam and promethazine demonstrated greater efficacy of the latter as a drug for the relief of CH [5].

Other vestibular suppressants . Less common vestibular suppressants include acetyleucine and calcium channel blockers. The effectiveness of acetyleucine (currently not registered in the Russian Federation) is due to its interaction with phospholipids of cell membranes and the ability to regulate the membrane potential of neurons in the vestibular nuclei and Purkinje cells [6]. Calcium channel blockers – nimodipine, verapamil, flunarizine (not registered in the Russian Federation) and cinnarizine – block voltage-gated calcium channels of inner ear labyrinth neurons. These drugs are inferior in effectiveness to antihistamines and benzodiazepines [7]. Sometimes anticholinergics (scopolamine, platyfillin) are used as vestibular suppressants. These drugs inhibit the activity of the central vestibular structures, thereby reducing dizziness [3]. However, some side effects of these drugs, in particular drowsiness and visual impairment due to accommodation disorders, superimposed on vestibular symptoms, in some cases only worsen the condition of patients, which significantly limits their use in recent times. As a result, these drugs are more often used to prevent motion sickness than to treat CH.

2. Antiemetics enhance and complement the effect of vestibular suppressants in the acute period of CH. They do not affect the severity of SH, but reduce the autonomic symptoms that often accompany it: nausea and vomiting. The most common antiemetics include phenothiazines, in particular prochlorperazine (5-10 mg 3-4 times a day). Metoclopramide (10 mg intramuscularly) and domperidone (10–20 mg 3–4 times a day, orally), peripheral D2 receptor blockers, normalize gastrointestinal motility and thus also have an antiemetic effect [8]. Ondansetron, a serotonin 5-HT3 receptor blocker, also reduces vomiting in vestibular disorders [9]. Side effects of antiemetics are dry mouth, drowsiness, extrapyramidal disorders.

3. The duration of administration of vestibular suppressants and antiemetics should not exceed 2-3 days. Vestibular suppressants and antiemetics depress the CNS and thus slow down vestibular compensation [10, 11]. Animal studies have shown that drugs such as phenobarbital, chlorpromazine, diazepam, and ACTH antagonists slow vestibular compensation and delay recovery [12]. These data served as a reason to recommend limiting the use of vestibular suppressants in acute VH (2–3 days). Moreover, this period is reduced as much as possible. In practice, the reason for the abolition of vestibular suppressants is the cessation of vomiting. Instead of vestibular suppressants, vestibular exercises and drugs that stimulate central vestibular compensation are prescribed.

4. Vestibular gymnastics stimulates vestibular compensation and speeds up recovery. Among the methods of treatment of diseases of the vestibular system, rehabilitation occupies a special place. There are several reasons for this, first of all, its high efficiency and sometimes the absence of a serious alternative from drug therapy. As a result, today, in accordance with international recommendations, vestibular gymnastics occupies almost the main place in the complex treatment of almost any disease of the vestibular system, whether it be central or peripheral vestibulopathy.

Gymnastics for vestibular disorders consists of four groups of exercises: for gaze stabilization, for training postural stability and gait, for sensory substitution and for habituation. Vestibular gymnastics should start as early as possible (no later than the 1st week of the disease) [13]. Postponing the start of rehabilitation to a later time is likely to slow down vestibular compensation and prolong the period of disability. In addition to an early start, there are several other rules of vestibular rehabilitation that can increase its effectiveness: do not use monotonous exercises and select them according to the needs of the patients’ daily activity, take into account the patient’s cognitive functions and comorbidities that affect balance, take measures to reduce anxiety and depression, since these conditions impede vestibular compensation [14].

5. The effectiveness of vestibular gymnastics can be increased with the help of drugs that stimulate vestibular compensation. Some substances have the property of stimulating central vestibular compensation. Animal studies have shown that amphetamine, caffeine, and ACTH accelerate vestibular adaptation [12]. Among drugs, the ability to stimulate vestibular compensation was found in betahistine dihydrochloride (betaserc), piracetam, and ginkgo biloba extract [15–17]. The effectiveness of these drugs is due to their effect on CNS neuroplasticity and, in some cases, has been confirmed not only by experimental studies, but also by clinical studies. Thus, the results of a placebo-controlled study [17] showed that betahistine dihydrochloride accelerates the onset of vestibular rehabilitation effects by 3 times in patients with unilateral non-progressive peripheral vestibulopathy resulting from labyrinthectomy in Meniere’s disease.

The duration of the use of these drugs is not completely clear, apparently determined by the nature of the vestibular damage and, therefore, the expected timing of vestibular compensation. If with unilateral peripheral vestibulopathy compensation occurs approximately after 2 months, then with bilateral, as well as with central vestibular disorders, it is much slower: within several months or years [18].

6. Pathogenetically substantiated treatment is based on finding out the cause of VH. The high frequency of diagnostic errors in VH, resulting from an overestimation of the role of vascular and cervicogenic mechanisms in the development of vestibular dysfunction, significantly reduces the effectiveness of vertigo treatment in general. The consequence of inadequate diagnosis is the widespread use of vasoactive and nootropic drugs, the value of which in the treatment of the most common causes of VH (peripheral vestibular disorders and vestibular migraine) is small. At the same time, the possibilities of pathogenetically substantiated drug and non-drug treatment of vestibular diseases have recently expanded due to the emergence of new drugs and the improvement of vestibular gymnastics.

Treatment of BPPV mainly consists of the use of therapeutic repositioning maneuvers. Maneuvers are designed to treat canalolithiasis of the various semicircular canals; their efficiency is high and approaches 100%. Medical or surgical treatment of BPPV is not required in most cases [19].

Treatment of Meniere’s disease consists of several stages. At the first stage, conservative approaches are applied, which are reduced to a salt-free diet, the use of diuretics and betahistine dihydrochloride. If no results are achieved within six months and attacks of VH continue, transtympanic injections of corticosteroids or gentamicin are performed. Finally, if these measures are ineffective, they resort to surgical treatment — labyrinthectomy, or selective neurectomy of the vestibular part of the vestibulocochlear nerve [20–23].

Treatment of vestibular neuronitis is reduced to the use of symptomatic agents (vestibular suppressants and antiemetics) in the acute period of the disease, followed by the selection of vestibular rehabilitation exercises in combination with drugs that stimulate vestibular compensation [24].

For vestibular migraine, the same drugs are used to prevent vertigo attacks as for normal migraine: β-blockers (propranolol or metoprolol), antidepressants (tricyclics or SSRIs), antiepileptics (eg, topiramate, lamotrigine, or valproic acid drugs), blockers calcium channels (eg flunarizine). To stop attacks of vestibular migraine, in addition to vestibular suppressants and antiemetics, triptans and NSAIDs are used [25, 26].

Symptomatic agents aimed at reducing oscillopsia and unsteadiness are used for the treatment of central vestibular disorders, which have arisen, for example, due to stroke, trauma or MS [27]. These drugs include baclofen, memantine, gabapentin, aminopyridine, and acetyleucine [28].

7. According to the study VIRTUOSO , betahistine dihydrochloride can reduce the frequency of attacks of CH, regardless of the cause of their occurrence. Betahistine was first registered in Canada in 1968 and has since been widely used worldwide for the treatment of VG disease. Betahistine is a strong h4 receptor antagonist and a weak h2 agonist [29]. By acting on the h2 receptors of the inner ear, betahistine has a pronounced vasodilating effect [30]. The decrease in the number of vertigo attacks in the treatment with betahistine is apparently due to an increase in blood flow in the inner ear, which reduces the increased endolymphatic pressure in it, restoring the balance between production and reabsorption of endolymph [31]. In addition, various animal studies have shown that betahistine is able to improve vestibular compensation, showing a direct histaminergic effect; the drug accelerates the release and metabolism of histamine by blocking presynaptic h4 histamine receptors (in the vestibular and tuberomamillary nuclei) [30].

The clinical efficacy of betahistine has been evaluated in several studies. At the same time, in a number of studies, the effectiveness of betahistine was confirmed [17, 32, 33], while the results of others did not differ from the effectiveness of placebo [34].

The aim of the recently completed international observational program VIRTUOSO was to evaluate the effects of betahistine dihydrochloride (betaserc) at a dose of 48 mg/day in the form of tablets in routine clinical practice in outpatients with VG. At the same time, not only the overall clinical response was assessed during the period of therapy, but also the delayed effects of treatment, determined by the frequency of attacks of CH within 2 months after the completion of betahistine [35].

Study design. The study was a prospective, multicentre, non-comparative, post-marketing observational program that included 23 medical centers and 309 patients; 305 patients completed the observational program. The program included patients who were prescribed betahistine in accordance with the instructions for use of the drug and clinical recommendations for the treatment of a disease manifested by paroxysmal V.G. Betahistine was administered at a dose of 48 mg/day. The treatment lasted 1-2 months; the follow-up period after discontinuation of treatment was 2 months.

The study included men and women aged 18 years and older suffering from attacks of CH of known or unknown etiology, who were treated with betaserc (betahistine dihydrochloride) at a daily dose of 48 mg. All patients consented to the use and processing of personal data. Enrolled patients could not take betahistine for 5 or more days prior to obtaining written consent and enrollment in the study.

The number and proportion of patients with a clinical response at the end of therapy during program follow-up, assessed by the CHS severity and clinical response scale (SVVSLCRE), were assessed as treatment outcome measures. In addition, a change in the incidence of CH episodes at the end of therapy during program follow-up compared with inclusion visit was observed among patients treated with betahistine dihydrochloride. The overall clinical response was also assessed separately by the doctor and the patient, determined on a 4-point scale, where 4 is a marked improvement, 3 is a significant improvement, 2 is a slight improvement, and 1 is worsening. We analyzed the change in the frequency of CH episodes within 2 months after the end of therapy compared with the end of the therapy period. Finally, regression of vertigo-related symptoms (ringing in the ears, hearing loss, nausea, vomiting, weakness, and headache) was determined during treatment as judged by the clinician and patient.

Research results. Clinical efficacy of treatment on the SVVSLCRE scale was assessed as significant improvement, marked improvement or very marked improvement in 74.1% of cases ( p <0.001). The number of vertigo attacks per month while taking betahistine decreased from an average of 8.0 to 3.0 ( p <0.001). During the 2-month follow-up period after discontinuation of the drug, the number of seizures continued to decrease until complete disappearance by the end of the 1st month of follow-up ( p <0.001). This effect persisted by the end of the 2nd month of observation.

The overall clinical response to treatment with betahistine (by the end of the 2nd month of taking the drug) according to the doctor was assessed as a marked improvement or significant improvement in 94.4% of cases, and according to the patient – in 95.4% of cases.

Betahistine also had an effect on the symptoms associated with dizziness. The effectiveness of the treatment of concomitant symptoms was assessed as a marked improvement or a significant improvement in 71. 4% of cases by the end of the 1st month of taking the drug and in 90.5% of cases by the end of the 2nd month according to both the doctor and the patient.

An observational program has demonstrated the high safety of betahistine dihydrochloride and the low incidence of side effects. Only one patient dropped out of the study early due to the lack of efficacy of treatment and an increase in the frequency of dizziness attacks. Serious N.Ya. was not registered.

Thus, the observational program VIRTUOSO confirms the results of previous studies that indicated the effectiveness of betahistine at a dose of 48 mg / day in VG. The study demonstrated a significant reduction in the frequency of CH attacks, regardless of the etiology of the disease. An important result of the study was the discovery of a delayed effect of treatment with betahistine: the number of seizures continued to decrease within 2 months after discontinuation of the drug. This result may indirectly testify in favor of stimulation under the influence of betahistine of central vestibular compensation. The low frequency of side effects confirms the good tolerability and high safety of betahistine. All these data make it possible to recommend the inclusion of betahistine dihydrochloride (betaserc) in the complex therapy of various diseases manifested by VH, including not only Meniere’s disease, but also other disorders of the peripheral or central parts of the vestibular analyzer.

In general, if the principles listed above are observed, the treatment of diseases manifested by CH can be quite effective. It seems promising to search for vestibular suppressants that do not suppress vestibular compensation, improve the methods of pathogenetically substantiated therapy and conduct clinical studies aimed at confirming the effectiveness of existing treatment options, as well as finding ways to stimulate vestibular compensation in various peripheral and central vestibular disorders.

Conflict of interest: The authors declare participation in the Abbott-sponsored observational study VIRTUOSO.

*e-mail: [email protected]

Causes and treatment of periodic dizziness

Why does periodic dizziness occur? What diseases can cause this symptom and what to do if it occurs? Find out the answers to these questions in the site article.

Dizziness is a fairly common phenomenon faced by many people. They can be caused by various reasons, both physiological and psychological. Usually, dizziness is a short-term condition and usually does not pose a health risk.

However, when vertigo occurs intermittently, it can greatly affect a person’s quality of life. It is especially difficult for those who work at high loads, drive a car or engage in other dangerous activities. Periodic dizziness can indicate the presence of serious diseases, therefore, if they occur regularly, it is necessary to undergo a qualified medical examination.

In this article we will consider the main causes of periodic dizziness and effective methods of their treatment. You will learn how to approach vertigo prevention the right way, what treatments can be done at home, and what cases need to be identified and treated with the help of medical professionals.

Dizziness: Causes and Symptoms

Dizziness is a sensation of loss of balance or spatial orientation, which may be accompanied by a sharp undulating headache, nausea and vomiting.

Dizziness may be caused by insufficient blood flow to the brain, vestibular neuritis, Meniere’s disease, migraine, acute hypotension, stroke, cerebral hemorrhage, post-head trauma, neck problems, age-related changes and other factors.

It is important to note that dizziness can also be caused by certain medications, low blood glucose levels, alcohol intoxication, and other causes.

Symptoms of dizziness may include feeling like everything is spinning, loss of balance, problems with coordination, weakness, difficulty breathing, increased heart rate, nausea, vomiting, etc.

If you experience dizziness, you should seek medical attention assistance to the doctor to determine its causes and take measures for treatment. Treatment may include medication, lifestyle changes, and special exercises.

What types of dizziness are there?

Dizziness is a sensation of rotation, instability or loss of balance. It can be of a different nature and can be caused by various reasons.

Depending on the cause, dizziness can be:

• Vestibular is dizziness that is associated with a malfunction of the balance organs, such as the inner ear.
• Orthostatic – Occurs when there is a sudden change in body position, such as getting out of bed or sitting.
• Vascular – Circulatory disturbances may cause dizziness.
• Neurogenic – may be caused by various disorders of the nervous system.
• Psychogenic – often associated with emotional stress or anxiety.

As a rule, an accurate diagnosis requires a visit to a doctor and the necessary examinations.

The main causes of dizziness

Vertigo is a condition in which everything around seems to be moving, swaying or spinning. This feeling can occur at any age and for various reasons. Some of the main causes of dizziness are listed below:

• Vestibular disorders: disorders in the balance between the brain and the organs of hearing, which can occur, for example, due to viral infections or problems with the balance of the inner ear.

• High blood pressure: Dizziness may be caused by pressure changes within the blood vessels.

• Emotional or physical stress: such situations can cause dizziness, especially if the person works in an inappropriate position.

• Anemia: lack of oxygen in the blood can cause dizziness.

• Certain medicines: Some medicines may cause dizziness in patients.

This is not a complete list of causes of dizziness that we should consider. If dizziness occurs too frequently or is accompanied by other symptoms, it is important to see a doctor for a professional examination and treatment.

Diseases that can cause dizziness

Dizziness can be the result of diseases that affect various body systems. The following are the most common conditions that can cause occasional dizziness:

• Hypertension – High blood pressure can cause dizziness due to narrowing of the blood vessels in the brain.
• Migraine is a chronic neurological disorder that can cause recurrent headaches and dizziness.
• Meniere’s disease is a disease of the inner ear that causes problems with balance and coordination. Dizziness and nausea are the most common symptoms of Meniere’s disease.
• Hypoglycemia – Low blood sugar can cause weakness and dizziness.
• Stress and depression – Many people may experience dizziness during periods of stress or angst. Dizziness may be associated with panic attacks or other psychological disorders.

If you experience occasional dizziness, it is important to see a doctor for diagnosis and treatment. Self-medication can lead to worsening of symptoms and complicate diagnosis.

Disorders of balance and coordination of movements

Disorders of balance and coordination of movements can cause occasional dizziness. These disorders can be caused by various factors, including diseases of the inner ear, impaired brain function, and changes in the blood supply to the brain.

The inner ear plays an important role in maintaining balance, so any dysfunction of the inner ear can lead to dizziness and coordination problems. Some of the diseases that can cause inner ear disorders include Meniere’s disease, vestibular neuritis, and labyrinthitis.

Impaired brain function can also cause problems with balance and coordination. Head trauma, stroke, Parkinson’s disease, multiple sclerosis, and epilepsy are examples of illnesses that can affect balance and coordination.

Changes in the blood supply to the brain can cause the brain not to get enough oxygen, which can also cause dizziness and balance problems. One of the most common causes is low blood pressure, which can occur when you change your position, such as getting up suddenly after sitting or lying down.

Treatment of occasional vertigo caused by balance and coordination disorders depends on the cause. Inner ear disease may require medication, diet, and exercise. If the cause is a violation of brain function, then it may be necessary to contact a neurologist and prescribe appropriate therapy. With changes in the blood supply to the brain, an increase in the amount of fluid and salt consumed, as well as leukotritherapy and exercise, are usually prescribed.

Psychogenic causes of dizziness

Dizziness can be caused not only by physical factors, but also by psychological ones. One of the most common sources of dizziness is stress and anxiety.

Under stress, the body begins to release more adrenaline, which can lead to vasoconstriction, changes in blood pressure and reduced blood supply to the brain. This can cause feelings of dizziness and disorientation.

Dizziness can also be a symptom of anxiety disorders such as panic disorder, generalized anxiety disorder, or agoraphobia. In these conditions, the body may respond to a possible threat with increased symptoms, including dizziness and confusion.

However, do not forget that psychological factors can become additional to those associated with physical health. With persistent dizziness, it is necessary to consult a specialist to determine their exact cause and choose the necessary treatment.

Diagnosing the causes of dizziness

The first step in diagnosing the causes of dizziness is a medical examination of the patient. The doctor conducts anamnesis – a general and detailed survey, which reveals the frequency, duration and nature of dizziness, as well as other symptoms that may indicate a possible cause of dizziness.

For additional diagnostics, various research methods are used, including neurological and orthostatic tests, audiometry, electronystagmography and MRI of the brain. Measurement of pressure and pulse of the patient is of great importance.

If a serious medical condition such as hypertension, stroke or a brain tumor is suspected, more advanced diagnostic procedures such as angiography or computed tomography may be required.

Careful diagnosis of the causes of dizziness is a key factor in determining effective treatment. Patients need to receive the correct diagnosis and treatment in order to avoid complications and improve their quality of life.

How to treat dizziness: general advice

Dizziness can be managed with some general advice:

• Get some rest if possible: Often, strong emotions, lack of sleep, or prolonged standing can cause dizziness. Therefore, it is recommended to rest and take a break in such conditions.
• Drink more water: Dehydration can be one of the causes of dizziness, especially in hot weather. Therefore, it is recommended to drink more water to reduce the risk of dizziness.
• Avoid alcohol and nicotine: Drinking alcohol and smoking nicotine can cause dizziness. Avoid them, especially in the morning.
• Avoid Hazardous Activities: Do not drive, operate heavy machinery, or engage in other hazardous activities if you experience dizziness.
• Improve your diet: Food can cause dizziness. Choose a diet rich in vitamins and minerals, which can help reduce the risk of dizziness.

We hope these general tips will help you manage your dizziness. If symptoms continue, a specialist should be consulted.

Drug treatment of vertigo

Drug treatment of vertigo may be due to neurological, cardiac or vestibular disorders. Neurological conditions such as migraine, epilepsy, or Parkinson’s disease can cause dizziness. Heart problems such as arrhythmia or high blood pressure can also cause dizziness. Vestibular disorders are associated with balance and sensory systems, such as Meniere’s disease or positional vertigo caused by a change in head position.

Medicines prescribed to treat vertigo vary depending on the cause. For example, drugs from the triptan group are used to treat migraine. For the treatment of vestibular neuritis, the appointment of glucocorticosteroids and antiemetics is used. For the treatment of dizziness caused by a change in the position of the head, positional therapy and manipulations to restore the vestibular apparatus are used.

Before taking any medication to treat dizziness, you should consult your doctor to evaluate the cause and prescribe the appropriate treatment. Self-medication can lead to a deterioration in the condition and complicate the treatment process.

Prevention of repeated dizziness attacks

In order to prevent repeated attacks of dizziness, you should take care of your health and eat right. Nutrition should be complete, rich in vitamins and minerals.

It is also necessary to avoid stressful situations, monitor the daily routine and adequate rest. A good night’s sleep can help improve your health and reduce the risk of recurring dizzy spells.

In the presence of obesity, it is necessary to reduce excess weight through a balanced diet and moderate physical activity. Regular exercise or exercise helps to strengthen the immune system and improve overall health.

It is also recommended to eliminate bad habits such as drinking and smoking from your life. Bad habits negatively affect human health and exacerbate the symptoms of dizziness and other ailments.

If dizziness occurs regularly and there are other symptoms, you should consult a doctor for advice and prescribe the necessary treatment. Self-medication can lead to complications and exacerbate the problem.

What exercises can help with dizziness

Dizziness can occur for many reasons, but there are a number of exercises that can help you cope with this unpleasant symptom. Let’s take a look at some of them:

• Neck Exercises – Slow rotation of the head to the right and left, tilting the head back and forth, light massage movements will help to straighten the neck muscles and avoid dizziness caused by spasms of these muscles.
• Eye Exercises – focusing the eyes on near and far objects, shifting focus, fast blinking and looking in different directions all improve blood circulation and prevent dizziness caused by insufficient supply of oxygen and nutrients to the eyes and brain.
• Balance Exercises Single-legged standing, side-to-side and front-to-back body movements, calf raises and low squats all improve coordination and strengthen leg and trunk muscles to help reduce dizziness.

It is important to remember that before starting any exercise it is necessary to consult a doctor, especially if the occurrence of dizziness is not related to the general state of the body, but is caused by more serious causes, such as disorders of the vestibular apparatus.

Conventional treatments for vertigo

Doctors usually recommend conventional treatments for vertigo as soon as the first symptoms appear to avoid compromising overall well-being.

One of the most common methods is the use of special medicines – to eliminate the imbalance of the inner ear. The drugs can be taken as tablets, drops or injections. But before taking medication, it is necessary to consult a doctor to exclude the possibility of side effects.

One consistent method is the eye exercise. The tissues surrounding the eyes contain numerous receptors associated with balance and coordination. Perform the following exercise: look at an object in front of you and slowly move your eyes to the left, then to the right. Repeat many times.

The use of massage is also one of the effective methods to eliminate dizziness. Massage facilitates blood circulation and helps increase blood circulation in the brain. Treatment must be performed by a qualified professional.

Prevention of dizziness also includes the elimination of possible risk factors. One of these factors is alcohol consumption. Limit your alcohol intake or cut it out completely.

Physiotherapy for dizziness

Physiotherapy is one of the main treatments for dizziness. It is aimed at improving blood circulation in the brain, strengthening the muscles of the neck and head, as well as eliminating nervous disorders.

One effective method is electrotherapy, which uses electrical impulses to stimulate muscles and improve blood circulation. The currents can be low frequency or high frequency and applied directly to the head or neck.

Massage is also a frequently used method of physiotherapy in the treatment of vertigo. It is aimed at reducing tension in the neck muscles, strengthening the muscles of the head, improving blood circulation in the brain and eliminating spasms of blood vessels.

Acupuncture is an effective method, especially in cases where dizziness is associated with disorders of the nervous system. Acupuncture needles stimulate biological points that are associated with the functioning of the brain and the nervous system as a whole.

• Conclusion: Physiotherapy can be effective in the treatment of occasional dizziness, especially if it is caused by circulatory disorders, neck muscle tension or nerve disorders. You need to consult with your doctor to determine which treatment method will be most effective in a particular case.

Massage for dizziness

Massage is one of the effective ways to treat and prevent dizziness. It helps improve circulation, reduce tension, and stimulate muscles that may be associated with dizziness.

Massage techniques:

• Neck massage. This can help relax your neck muscles and increase circulation to your head. With gentle circular motions, massage the neck from the base to the back of the head, then proceed to the massage behind the ears.
• Back massage. Massaging the spine area can help relieve muscle tension and improve blood circulation in the head area.
• Facial massage. Massaging the area around the eyes and forehead will help reduce muscle tension and relieve headaches.

Note:

Acupuncture for dizziness

Acupuncture is a type of alternative medicine that can be used to treat dizziness. It is based on the impact on the points on the body, which are based on Chinese medicine. Acupuncture helps to improve blood circulation and normalize the functioning of nerve endings, which helps to eliminate dizziness.

During an acupuncture session, thin needles are inserted into the patient at various points on the body. The number and location of injections depend on individual cases and the causes of dizziness. The needles are in the body for several minutes, during this period the patient should be in a calm state.

The effectiveness of acupuncture for dizziness depends on the underlying cause of the symptom. Acupuncture can help with dizziness caused by hypertension, impaired blood circulation in the blood vessels in the head, vestibular neuritis, or stress. When doing acupuncture, it is important to understand that it is not a quick cure, and like all alternative medicine methods, acupuncture is not a substitute for conventional medicine.

• Benefits of acupuncture:
• No side effects;
• Results usually appear after two to three sessions;
• Acupuncture can help treat other conditions such as back pain or headaches.
• Disadvantages of acupuncture:
• High level of subjectivity in determining the number and location of injections;
• Risk of infections;
• High price of the procedure.

In general, acupuncture can be an effective treatment for vertigo, but the decision to use it should be made after consultation with a specialist and an examination of all available treatments.

When should I see a doctor?

Dizziness can be the result of many causes, ranging from simple fatigue to serious medical conditions. In most cases, dizziness does not significantly affect the quality of life and does not require special treatment. However, if dizziness occurs regularly and is accompanied by other symptoms, you should consult a doctor.

• If dizziness is accompanied by nausea and vomiting, may be signs of infectious diseases;
• The appearance of dizziness after impact, head trauma may indicate serious brain damage. In this case, medical assistance is needed;
• The lives of people taking heavy drugs can also be accompanied by dizziness. If the appearance of discomfort coincided with the change of the drug, you need to go to the doctor.

In addition, you should consult a doctor in case of imbalance and impaired coordination of movements. The key point in the treatment of dizziness is a timely visit to the doctor and the diagnosis of the possible causes of this unpleasant condition.

How to prevent dizziness

To prevent dizziness, follow a few simple rules:

• Avoid sudden movements and changes in body position . Get out of bed or chair gradually to give your body time to adjust to the new position.
• Turn your head slowly , especially when looking at the tops of trees or buildings.
• Normalize your diet . Prefer light foods and avoid fatty, salty or spicy foods.
• Drink plenty of fluids . Lack of water can cause dizziness.
• Avoid stressful situations and physical fatigue . Give your body time to rest and recharge.
• Spend enough time outdoors . The air must be fresh and clean.

If you suffer from chronic dizziness, you should not treat yourself. Be sure to consult a doctor to identify the cause of your disease and prescribe the best treatment. Follow your doctor’s instructions and take medications only as prescribed.

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Q&A:

What is periodic dizziness and how can it manifest itself?

Periodic vertigo is a condition in which a person experiences a sensation of rotation or rocking. Depending on the cause, dizziness can be accompanied by various symptoms: nausea, vomiting, loss of balance, headache, etc.

What are the causes of occasional dizziness?

Periodic dizziness can be caused by various causes: changes in blood pressure, vestibular disorders, diseases of the inner ear, disorders of glucose oxidation in the brain, etc.

Can periodic dizziness be associated with disorders in the work of the heart?

Yes, occasional dizziness can be related to heart problems.