Internal Medicine

Therapy for vertigo

introduction

There are various treatment options available to interrupt the intolerable effects of dizziness.

If known, this depends on the disease causing the vertigo. For this purpose, the family doctor or a neurologist should clarify the cause of the dizziness by talking to the patient and performing further diagnostics. The search for the exact cause can also take place in so-called vertigo clinics, a special consultation hour for the symptom of vertigo.

Therapy options

First of all, drugs can help against nausea (antivertiginous drugs, antiemetics). These include e.g. Metoclopramide (MCP, Paspertin®) and dimenhydrinate (Vomex®). However, these drugs only help symptomatically (against them symptoms of dizziness) and do not eliminate the cause of the disease.

In the most common form, Beningnen paroxysmal positional vertigo (BPLS), so-called liberation maneuvers help. Physiotherapists (physiotherapists) can instruct the patient to regularly perform such maneuvers themselves in the form of positioning exercises.

The family doctor will critically search his patient's list of drugs for those substances that could trigger symptoms of dizziness (e.g. drugs for high blood pressure, antihypertensive drugs, beta blockers) and, if necessary, plan to take the patient again.

For causes in the field of orthopedics, measures for correcting posture, releasing joint blockages, physical methods, massage for tension in the neck muscles and back training courses (back training) are offered.

Inflammatory processes in the area of the equilibrium organ or nerve are treated either symptomatically, with antibiotics, antiviral drugs or, in severe cases, with cortisone.

For acute symptoms of Meniere's disease, medication for nausea such as dimenhydrinate (Vomex®) is currently available. Betahistine (Acqamen retard®) is given in the seizure-free interval.

Medication for dizziness

Before drug therapy for dizziness can be initiated, an exact diagnosis must be made, because dizziness is just a symptom.
In order to be able to treat the patient successfully, the disease causing the vertigo must first be discovered. In any case, there is also the option of treating the vertigo symptomatically first.

So-called antivertiginous drugs are often used, which can be taken for a maximum of three days. They have a calming effect on the vomiting center in the brain and on the balance organ in the ear. In some cases, doctors have tried to control attacks of dizziness with a local anesthetic that was injected into the throat (Stellate blockade) in order to numb the nerve tracts located there, which, however, has proven to be ineffective according to the latest findings.
Appropriate drug therapy for dizziness depends primarily on the type of dizziness. In the case of benign positional vertigo, for example, only a small dose of antivertigo is given in order to keep the nausea that can occur during the various positional maneuvers as low as possible.
The fear-related (phobic) Dizziness, on the other hand, is usually treated with selective serotonin reuptake inhibitors (SSRI), a group of drugs that are also used for depression. The use of St. John's wort is also possible here.

When using St. John's wort, however, the interaction must i.a. with oral contraceptives such as the pill, which can lead to a reduced effectiveness of the pill. If a patient has vestibular migraine attacks, drug treatment in the form of beta-blockers or valproic acid should be initiated to prevent the migraine, as it is likely to trigger the dizziness.
There are several suitable drugs for Menière's disease: On the one hand, therapy with betahistine is possible to prevent attacks of dizziness. It works by reducing pressure in the inner ear.
In addition, gentamicin is often used, an antibiotic that is injected over the eardrum and thus damages some of the hair cells in the inner ear, which trigger dizziness and is supposed to inhibit dizziness.

However, with this procedure there is a relatively high risk of damaging the surrounding structures and should therefore only be carried out by an experienced doctor. In addition, benzodiazepines, antivertiginous drugs for symptomatic therapy and cortisone are used in an acute attack of dizziness. However, the exact mechanism of effectiveness of cortisone in treating dizziness has not yet been established.

Further information on this topic can be found at: Medication for dizziness

Home remedies for treatment

People who are prone to recurring attacks of dizziness can also use home remedies for treatment.

Above all, this includes adequate sleep and regular exercise in the fresh air. In the case of dizziness that can be traced back to a disturbance of the organ of equilibrium (mostly vertigo), special sports exercises that promote the sense of equilibrium and the balance of the body help.

In the case of acute attacks of dizziness, those affected should sit down slowly, because this usually reduces the dizziness quickly and dangerous falls are avoided. A healthy and balanced diet with fresh fruit and vegetables also promotes health and can alleviate symptoms. Older people in particular often drink too little, which dries out (dehydrated) the body and causes dizziness. Drinking enough water regularly can help prevent dizziness.

Since stress is a frequent trigger of dizziness, it can be helpful to avoid excessive nervous tension and to carry out targeted relaxation exercises, especially for the neck muscles.

The herbal medicinal substance Gingko biloba promotes blood circulation in the brain and can therefore be used for dizziness attacks. Gingko also helps with ringing in the ears, which often occurs in combination with dizziness.

Another home remedy is ginger. The small tuber supports the body's immune system and has an invigorating effect due to its pungent effect. It is best to cut ginger into small pieces, pour hot water over it and let the tea steep for about ten minutes. Depending on your taste, the ginger tea can also be seasoned with lemon and honey.

Read more on the subject at: Home remedies for dizziness

Homeopathy for dizziness

Homeopathic remedies can be used especially for recurring attacks of dizziness. A doctor should clarify beforehand whether there are any serious illnesses that are causing the dizziness (for example cardiological problems or structural changes in the brain). A doctor should be consulted, especially in the case of frequently recurring dizziness or accompanying symptoms such as fever, fainting or rapid heartbeat.

However, some forms of dizziness cannot be treated properly by conventional medicine. In such cases, the vertigo attacks can be treated with homeopathic preparations. The active ingredients Anamirta cocculus, Conium maculatum, Ambra grisea, Kalium phosphoricum, Belladonna, Arnica and Petroleum rectificatium are used to treat dizziness. You can get good advice on the appropriate drugs in any pharmacy or from naturopaths.

Exercises against dizziness

Experience has shown that there are no suitable drugs for the treatment of benign, paroxysmal positional vertigo.

Instead, special positioning exercises are supposed to alleviate the symptoms. This type of vertigo is based on the detachment of small particles in the ear, which can migrate back to their place of origin through targeted movements of the head and body.

An important exercise is the Sémont positioning maneuver:
At the beginning, the patient sits upright and has turned his head 45 ° so that the affected side faces forward towards the doctor. Now the patient is suddenly shifted sideways to the affected side, but without moving the head (the view is now directed upwards). You pause in this position for 2-3 minutes. Then the repositioning takes place on the other, unaffected side of the body; also this time without moving the head. Finally, the patient is brought back to the starting position.

Another frequently used positioning maneuver to relieve dizziness is the Epley maneuver. In the beginning, the patient sits upright with his legs straight. The head is also rotated 45 ° here, but to the affected side, i.e. the healthy side points to the attending physician. The patient is now quickly placed on his back with his head hanging over the examination table (also known as head hanging position).
The patient must remain in this position until the dizziness subsides. Mostly this takes place within a period of 1-2 minutes. The patient then turns his head to the other, healthy side and pauses until the dizziness subsides. Next, the patient turns his body completely on the healthy side, but without moving his head. After the vertigo subsides in this position as well, the patient can sit up carefully and the maneuver is over.

In the event that the Epley maneuver does not improve the symptoms, there is also the positioning training according to Brandt and Daroff. The patient alternates between the left and right side positions for 30 seconds each. In between he returns to the upright position. In order to compensate for slight differences in the function of the balance organ in the right and left ear, it is also possible to carry out gait training or balance training. In this way, the “functioning” balance organ learns to work for the “defective” in order to counteract the development of dizziness.

For more information on this topic, also read:

Exercises for positional vertigo
Vertigo training

What is a vertigo clinic?

A vertigo clinic or clinic are specialized centers that treat patients with acute and chronic vertigo. Usually it is an offshoot of the neurology department of a larger hospital. A vertigo clinic has special diagnostic methods and specially trained staff. Dizziness is a common symptom and can have a variety of causes, which is why a dizziness clinic works closely with other departments (e.g. internal medicine, ear, nose and throat department or orthopedics).

At the vertigo clinic, vertigo patients present themselves after they have received a referral from their general practitioner or another resident specialist. First, an attempt is made to fully clarify the causes of the vertigo. A vertigo center has modern diagnostic equipment that is often not available in other clinics. This is followed by targeted treatment of the trigger and the vertigo symptoms.

Therapy for psychosomatic dizziness

In the case of psychosomatic dizziness, there are no organic disorders in the body, rather the complaints are caused by psychological problems such as anxiety disorders or post-traumatic disorders.

During treatment, it is initially important that physical causes, such as diseases of the cervical spine, heart diseases or neurological deficits, are first ruled out. Therapy is then carried out by a psychiatrist or psychologist. As part of psychotherapy, the patient's problems are dealt with together. Behavioral approaches and a so-called psychoeducational education of the patient are in the foreground in the treatment.

If necessary, drugs that relieve anxiety or are antidepressant may also be prescribed.

You might also be interested in these topics:

Antidepressants
Sedatives

Guidelines for vertigo therapy

Since the Symptom dizziness The German Society for Neurosurgery has specially adapted it to be a very stressful symptom that interferes with everyday life Therapy guidelines designed.

These are not rules on how a doctor should treat a patient with dizziness, but rather a recommendation for more optimal, more successful therapy.
Before the therapeutic method proposed in the guidelines can be selected, however, a specific diagnosis of the disease must be made, because dizziness is only the symptom. In many cases there are causal diseases that cause the Balance organ affect the ear, the cerebellum in the head, or one of the twelve cranial nerves.
To treat dizziness there are depending on the causal disease medicinal, physical (Positioning exercises), operational or psychotherapeutic Options.

In order to find out which disease responds best to which therapy, the treating physician can examine the guidelines for treating vertigo. All possible diseases that can cause dizziness are listed here and assigned to the appropriate therapy concept.
There is also a table in which possible Antivertiginosa are listed. Antivertiginous drugs are drugs for the symptomatic treatment of dizziness, which only relieve the symptom of dizziness, but have no relevant influence on the underlying disease. They can be taken for a maximum of 3 days because they are addictive.
The guidelines also contain precise information about which active ingredients are in which medication, as well as the dosage, contraindications, restrictions on use and possible side effects. All in all, the guidelines for treating vertigo represent a kind of "red thread“, Which offers the treating physician recommendations and orientation for the best possible therapy.

Help with therapy failure

When the cause has not been found and medical therapies have not helped.

In many cases, no clear causes of dizziness can be found. Many dizzy diseases are the result of mental overload, emotional stress and emotional conflicts.
Untreated vertigo leads to a loss of joie de vivre, withdrawal from work and private life and even suicide.

In such cases, psychosomatic forms of therapy should be considered. psychotherapy is based either on a change in the patient's behavior in order to be able to deal better with psychologically stressful situations in the future or on analytical methods that make the patient aware of conflicts that cause illness.

Pharmaceuticals can also help in special cases with psychosomatic dizziness. Medication for one depression with simultaneous dizziness (antidepressants) are able to alleviate the symptoms of dizziness. Size fear before falls and their consequences of injury, dizziness alone, especially in older people, can trigger (phobic Vertigo).
If the fear is too stressful, anti-anxiety drugs (anxiolytics) are indicated (indicated).