Therapeutic target
Improvement of symptoms
Therapy recommendations
Note: There is no confirmed causal therapy.
The following is drug therapy depending on the indication:
- Benign paroxysmal positional vertigo (BPLS): dimenhydrinate (antivertiginosa).
- Bilateral vestibulopathy (BV): prednisolone (glucocorticoids); for about 4 weeks; descending doses; possibly for recovery of vestibular function.
- Meniere’s disease: therapy is carried out in four stages (see below Meniere’s disease / drug therapy).
- Neuritis vestibularis: dimenhydrinate (antivertiginosa) or methylprednisolone (glucocorticoids); most important is prophylaxis, which is based primarily on the strict indication of aminoglycosides.
- Vestibular migraine: treatment analogous to migraine with or without aura; note: to date, prospective controlled therapeutic studies are lackingTreatment of the attack: zolmitriptan, rizatripanProphylaxis: beta-blockers (propranolol 80-240 mg, metoprolol 50-200 mg, bisoprolol 5-10 mg), antiepileptic drugs (topiramate 50-100 mg, valproic acid 1. 000-1,500 mg), antidepressants (amitriptyline or venlafaxine), calcium channel blockers (flunarizine 5-10 mg); magnesium 400 mg.
- Vestibular paroxysmia:
- Therapy: carbamazepine, oxcarbamazepine (antiepileptic drugs).
- Prophylaxis: eg, carbamazepine (antiepileptic drugs); if the above agents are unsuccessful, gabapentin or phenytoin (no evaluated data on dosage) may be tried.
- See also under “Other therapy.”
Further notes.
The use of antivertiginosa (drugs for the treatment of vertigo) may be considered in cases of unclear vertigo with pronounced symptomatology (e.g., nausea/nausea). For use:
- Cinnarizine (antihistamine and calcium channel blocker of the diphenylmethylpiperazine group) with dimenhydrinate (antihistamine) and monotherapy with betahistine (antivertiginosa, antiemetic/medication that suppresses nausea and emesis; betahistine is approved for Meniere’s disease)Duration of use: only a few daysNote: The dizziness stimulated by exercise (s. Below “Further therapy”) stimulable compensatory mechanisms that lead to adaptation of vertigo are better achieved without antivertiginosa.
