Medications are often the first line treatment for patients experiencing severe dizziness and vertigo. These medications are essentially “rescue” drugs that can greatly alleviate the symptom of debilitating vertigo. However, these “rescue” drugs are neither always effective nor appropriate for many types of dizziness, and they may have potentially serious side effects and drug interactions. We find that many patients come to us taking the wrong kind or wrong dosage of “anti-dizziness” medications. To make matters worse, many elderly patients who receive rescue drugs for dizziness don’t have symptoms of vertigo or dizziness; they actually have imbalance, which is a different symptom. Alarmingly, the side effects of rescue medications can actually make their balance worse!
When are medications appropriate? There are certain conditions that require medication:
Labyrinthitis is a bacterial or viral infection of the inner ear. The patient experiences severe, spinning vertigo that can last weeks. Medications such as Meclizine or Antivert are usually prescribed to help reduce the severity of dizziness. These medications are very helpful in the acute stage, but are not recommended for long-term use, as they actually slow the recovery process.
Meniere’s disease is due to an excess of fluid inside the inner ear. A patient experiences attacks of debilitating vertigo, hearing loss, and tinnitus, that last for hours or days. Prescribing a diuretic to remove the extra fluid from the inner ear, is essential in reducing the frequency and severity of attacks.
On the other hand, Benign Paroxysmal Positional Vertigo (BPPV) is a common type of vertigo affecting millions; however, medications are completely ineffective and inappropriate treatment. BPPV is a mechanical disorder of the ear that requires a series of simple head-body maneuvers to return the offending loose crystals of the inner ear back to their original place. Treatment for most patients is usually a one-time clinic visit.
The Physicians’ Role: In order to correct dizziness, we must first understand the symptoms and make the correct diagnosis. Stroke, heart problems, and hypoglycemia are all very different conditions, yet they share seemingly similar symptoms of “dizziness”. Inner ear problems causing dizziness require completely different treatment. Finally, many medications themselves cause “dizziness”.
To establish the correct diagnosis, we must pay attention to the patient’s description of their symptoms, as this often establishes the cause. A thorough review of the medical history and medication list is performed. Patients are taken off rescue medications as soon as possible, because they are not appropriate for long-term management of most dizzy conditions. Medications serve as a panacea, but slow the recovery process in the brain, ultimately making the patient’s balance worse. The good news is that there are highly effective treatment options. One is called Vestibular Rehabilitation Therapy (VRT). VRT is rendered by a licensed Physical Therapist who specializes in the treatment of vestibular dysfunction. Therapy is highly successful in eliminating dizziness without medication, and is necessary for restoring balance and mobility in chronic inner ear conditions.
Dr. Kato is the founder of The Ear Institute in Palm Desert. Her top priority is improving the quality of life of her patients. Dr. Kato can be reached at: 760-565-3900.
Resources: 1) Overreliance on Symptom Quality in Diagnosing Dizziness: Results of a Multicenter Survey of Emergency Physicians Mayo Clinic Proc. November 2007 82(11):1319-1328; doi:10.4065/82.11.1319; 2) Physicians’ Desk Reference. Copyright © 2004- 2008 Thomson Healthcare. Montvale, NJ. 3) Excellent review of medications for dizzy professionals: http://www.dizziness-and-balance.com/practice/drugrx.html; 4) Cohen JS. Dose Discrepancies Between the Physicians’ Desk Reference and the Medical Literature, and Their Possible Role in the High Incidence of Dose-Related Adverse Drug Events. Arch Intern Med. 2001;161:957-964. 5) Mindel JS, Teich SA, Teich CM, Beam P. Editorial: Limitations of the Physicians’ Desk Reference 2007 Surv of Ophth 2008;53:82-84 ; 6) Williams M, Gentili A, Assessment of the Geriatric Patient: Gait and Balance CME/CE: Medscape.com. Oct 28, 2005; 7) Staab J, Ruckenstein M. Expanding the Differential Diagnosis of Chronic Dizziness. Arch Otolaryngol Head Neck Surg. 2007;133(2):170-176.