Dizziness medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2] Norina Usman, M.B.B.S[3]
Overview
The mainstay of treatment for dizziness is supportive, medical, and physical therapy[1][2][3].
Medical Therapy
Supportive therapy:
- Treatment for lightheadedness can include drinking plenty of water or other fluids (unless the lightheadedness is the result of water intoxicationin which case the drinking water is quite dangerous)
- Eating something sugary
- Lying down or sitting and reducing the elevation of the head relative to the body (for example by positioning the head between the knees).
- Intravenous fluids in case of nausea and vomiting from drinking too much liquid.
- During attacks of vertigo from any cause, rest and lie still. Avoiding sudden changes in position as well as bright lights.
- Cautious about driving or using machinery.
- Salt restriction (less than 1 to 2 g of sodium per day)
Medication:
- Diuretics (such as hydrochlorothiazide/triamterene)
- Antihistamines
- Sedatives
- Intratympanic gentamicin or dexamethasone
- Methylprednisolone
- Pills for nausea
- Migraine prophylaxis serotonin 5-HT1 receptor agonists (triptans)
- Midodrine
- Pseudoephedrine
- Beta blockers
- Antianxiety agents
Approach to the Patient with Dizziness:
| Patient with dizzinesss[4] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Presentation episodic or countinuous? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Episodic | Countinuous | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Triggered | Spontaneous | Is it associated with trauma or toxins or spontaneous? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dix-Hallpike maneuver | Hearing loss | Migraine | Psychiatric Symptoms | Trauma or toxin | Spontaneous | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive | Negative | Vestibular Migraine | Panic attack | Barotrauma,Medication | HINTS Examination | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Benign Paroxysml Vertigo | Access for orthostatic hypotension | Saccade present Undirectional horizontal nystagmus Normal test of skew | No saccade,Nystagmus dominantly vertical torsional or gaze-evoked bidirectional,Abnormal test of skew | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Peripheral etiology | Central etiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vestibular neuritis | Stroke or transient ischemic attack | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical therapy:
Therapies for dizziness include[5]:
- Epley maneuver (canalith repositioning)
- Vestibular rehabilitation
- Breathing control exercises
- Balance therapy
- Psychotherapy
References
- ↑ Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D; et al. (2002). "Water drinking as a treatment for orthostatic syndromes". Am J Med. 112 (5): 355–60. doi:10.1016/s0002-9343(02)01025-2. PMID 11904109.
- ↑ Hain TC, Uddin M (2003). "Pharmacological treatment of vertigo". CNS Drugs. 17 (2): 85–100. doi:10.2165/00023210-200317020-00002. PMID 12521357.
- ↑ Kuo CH, Pang L, Chang R (2008). "Vertigo - part 2 - management in general practice". Aust Fam Physician. 37 (6): 409–13. PMID 18523693.
- ↑ Post RE, Dickerson LM (2010). "Dizziness: a diagnostic approach". Am Fam Physician. 82 (4): 361–8, 369. PMID 20704166.
- ↑ Holmberg J, Karlberg M, Harlacher U, Magnusson M (2007). "One-year follow-up of cognitive behavioral therapy for phobic postural vertigo". J Neurol. 254 (9): 1189–92. doi:10.1007/s00415-007-0499-6. PMID 17676355.