How do you approach the symptomatic management of central vertigo in a patient with minimal improvement on (or contraindication to) meclizine?

1 Answer

Mednet Member

Neurology · University of Pennsylvania

Answered on

Central vertigo is a difficult symptom to manage and can be frustrating for the patient (and their doctor). Depending on the etiology, treating the underlying cause would be the best first step (e.g. migraine prophylaxis). However, some causes of vertigo may be intractable or take a long time to recover from. If the cause is unknown, then a diagnostic work-up is imperative.

For pharmacologic treatment, benzodiazepines, diuretics, and corticosteroids have all been mentioned in the literature as treatments. Of course, the cause of the vertigo and any potential contraindications should be considered.

One non-pharmacological option would be Vestibular Rehabilitation Therapy, which may help patients cope with the symptoms.

Sources:

Choi et al., PMID 29084063
Swartz and Longwell, PMID 15791890
Han et al., PMID 22259614