Spinning out-You too have Vertigo?

Dim asks: “I have vertigo, what medications are available apart from Serc (betahistine)?”

*Couple of scrap notes from my research on Vertigo..

Almost 25% of the elderly have dizziness lasting more than one month.

Targets for therapy:

  1. hallucination alleviated through vestibular suppressants eg anticholingerics, benzodiazepines, or antihistamines
  2. Nausea and vomiting plus anxiety alleviated through antidepressants
  3. Enhance vestibular compensation through physical head exercises

Armamentarium:

  • benzodiazepines
  • histamingerics
  • Sympathomimetics
  • Calcium channel blockers
  • Steroids methylprednisolone
  • repositioning maneuvers

Differential diagnoses:

  • psychiatric
  • motion sickness
  • otitis media
  • cerumen impaction
  • herpes zoster (shingles)
  • seizures

Risk factors (elderly syndrome? like falling, delirium, incontin)

  • anxiety
  • depression
  • hearing impairment
  • taking more than 5 medications
  • postural hypotension
  • balance impairment
  • past heart attack

Dizziness shouldn’t be taken lightly (even though the majority of cases resolve on its own) as there is greater morbidity associated such as: increased chance of falls, having a stroke, ending up in nursing home care.

Types of dizziness:

  • paroxymsal positional
  • acute vestibular neuronitis/labyrinthitis
  • Menieres+tinitus
  • migraine
  • anxiety disorders
  • vertigo
  • presyncope
  • disequilibrium
  • peripheral vs central vertigo
  • and the list goes on!….

A simple screening test to separate dizziness requiring medicines and those that require further checkup is if the dizzy spell lasts less than one minute or if it lasts for hours to days. The latter you would consider trial of certain medications and following this further medical treatment should it not improve.

Causes:

  • Ototoxic: some medications can be toxic the little hairs in our ear leading to permanent hearing loss and dizziness.
  • Multi-system impairment: data shows that elderly people suffer more dizzy spells than young people. We’re not sure why but perhaps a combined deterioration in visual acuity, muscle strength, hearing ability, etc is the reason; much like in dementia and falls.
  • Viral infections: of the inner ear leading to inflammation of the vestibular nerve causing mixed signals at the brain.

Tests

American guidelines do not recommend any lab tests except for:

  • Audiometric tests: when suspecting hearing loss
  • Brain imaging: when suspecting tumor or stroke
  • MRI: when suspecting acute vertigo with hear loss

Treatments

Type of dizziness Treatments
Labyrinthitis (inflammation of inner ear) Triggered by cold or flu virus, therefore goes away on it’s own. In resistant cases: vestibular suppressant + vestibular rehabilitation
Ménière’s disease No cure. Just relieve symptoms with: a low-salt diet, and/or diuretics
Vertiginous migraine Dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker.
Vertigo with anxiety Slow introduction of selective serotonin-reuptake inhibitor (SSRI)

 

 

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