Concepts in Managing Vertigo Symptomatic treatment Is desirable in patient. with this symptom

Vertigo is a disturbance in the orientation-detecting system 01 a subject. It is always a symptom and never a disease, and can be caused by a lesion in any part of the vestibular system.

The management of vertigo involves both causal and symptomatic treatment, including support of the patient in daily life and work environments. When the undertying causes of vertigo are known, causal treatment must be given but often the causes are not known or the cause cannot be treated (e.g. in multiple sclerosis or post-traumatic vertigo), Symptomatic treatment consists 01 immediate treatment of acute aHacks. adaptation methods, surgical treatment and drug therapy.

Adaptation methods, such as the Cawthorne-Cooksey vestibular training programme, involve repetition of movements which induce vertigo, so eye, neck and body musculature are gradually retrained to use visual and proprioceptive input to compensate for the lost vestibular information. Smoking and alcohol consumption should be restricted in patients with vertigo because of the potentially detrimental vasoconstrictor action of nicotine and effects ot carbon monoxide. Drug treatment of vertigo may employ vestibular suppressants. Antihistamines such as cinnarizine (25mg 4- to 6-hourly) or its derivative ftunarizine (1Omg daily) suppress vestibular end-organ receptors and inhibit activation of central cholinergic pathways. Phenothiazines such as prochlorperazine (10mg 4·hourly) suppress central vestibular nuclei and pathways, withoot the sedation associated with antihistamine use. Vestibular action may also be suppressed by other antiemetics such as the anlicholinergics atropine or hyoscine. Diuretics which reduce intralabyrinthine fluid pressure may effectively treat vertigo for a limited period in cases caused by endolymphatic hydrops. Vasodilators such as betahistine (32-72 mgjday) and co-dergocrine mesy1ate are used in vertigo [ergolOO mesylate; dihydroergotoxine1 with a peripheral labyrinthine origin to improve blood flow 10 labyrinth and brain stem. Psychotherapeutic agents can modify the sensation of vertigo. Piracetam (400-BOOmg a·hourly) has been found effective, particularly in the elderly; amitriptyline and nortriptyline may benefit patients in whom depression is the major response to vertigo; and chlordiazepoxide, diazepam or lorazepam may be useful when anxiety is involved. Surgical treatment of vertigo should not be considered when the nature 01 the disease is unclear. and should only be considered in other cases when medical treatment has failed. Oosl~. W.J.: Oot.qs 30: 275-283 (Sep 1985,

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