Treatment for vertigo will depend on the cause and severity of your symptoms.
During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea that you have and reduce the sensation of spinning. You should also avoid stressful situations as anxiety can make the symptoms of vertigo worse.
Labyrinthitis
Labyrinthitis is an inner ear infection that causes the labyrinth (a delicate structure deep inside your ear) to become inflamed. It's usually caused by a viral infection and clears up on its own without treatment. In rare cases, where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed.
If you have lost your hearing in one ear, your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular physician. This is a doctor who specialises in hearing and balance disorders. You may need emergency treatment to restore your hearing.
Labyrinthitis may also be treated with vestibular rehabilitation, also called vestibular rehabilitation training or VRT (see box, left).
See Labyrinthitis - treatment for more information about treating this condition.
Vestibular neuronitis
Vestibular neuronitis, also known as vestibular neuritis, is inflammation of the vestibular nerve (one of the nerves in your ear that's used for balance). It's usually caused by a viral infection. The symptoms of vestibular neuronitis usually get better without treatment over several weeks. However, you may need to rest in bed if your symptoms are severe.
You may find that your balance is particularly affected if you:
- drink alcohol
- are tired
- have another illness as well
Vestibular neuronitis may also be treated with vestibular rehabilitation (see box, left) and medication (see below).
Benign paroxysmal positional vertigo (BPPV)
Like vestibular neuronitis, benign paroxysmal positional vertigo (BPPV) often clears up without treatment after several weeks or months. It's thought that the small fragments of debris in the ear canal that cause vertigo either dissolve or become lodged in a place where they don't cause symptoms. However, BPPV sometimes reoccurs.
To avoid triggering BPPV, you should:
- get out of bed slowly
- avoid activities that involve looking upwards, such as painting and decorating or looking for something on a high shelf
BPPV can be treated using a procedure called the Epley manoeuvre (see below).
The Epley manoeuvre
The Epley manoeuvre is often very effective in resolving the symptoms of vertigo. It's been shown to cure up to 89% of BPPV cases.
The Epley manoeuvre involves performing four separate head movements to move the fragments to a place where they can't cause symptoms. Each head position is held for at least 30 seconds. You may experience some vertigo during the movements.
In the past, after performing the Epley manoeuvre, patients were given instructions to follow, such as not lying flat for 48 hours. However, this is now considered to be unnecessary.
Your symptoms should improve shortly after the Epley manoeuvre is performed, although it may take up to two weeks for a complete recovery. Return to your GP if your symptoms haven't improved after four weeks. The Epley manoeuvre can be repeated.
Brandt-Daroff exercises
If the Epley manoeuvre doesn't work or if it's not suitable – for example, because you have neck or back problems, you can try the Brandt-Daroff exercises. These are a series of movements that you can do unsupervised at home to treat BPPV.
Your GP will need to teach you how to do the exercises. You repeat them three or four times a day for two days in a row. Following the exercises, your symptoms may improve for up to two weeks.
Referral for BPPV
Your GP may refer you to a specialist, such as an ear, nose and throat (ENT) specialist if:
- the Epley manoeuvre doesn't work or can't be performed
- you still have symptoms after four weeks
- you have unusual signs or symptoms
In very rare cases, where the symptoms of vertigo last for many months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist will be able to advise you further about this.
Ménière’s disease
If your vertigo is caused by Ménière’s disease (a rare condition that affects the inner ear), there are a number of treatment options for both the vertigo and the other symptoms caused by the condition.
Possible treatments for Ménière’s disease include:
- dietary advice, particularly a low salt diet
- medication to treat attacks of Ménière's disease
- medication to prevent attacks of Ménière's disease
- treatment for tinnitus (ringing in your ears), such as sound therapy (therapy that works by reducing the difference between tinnitus sounds and background sounds to make the tinnitus sounds less intrusive)
- treatment for hearing loss, such as using hearing aids
- physiotherapy to deal with balance problems
- surgery
- treatment for the secondary symptoms of Ménière's disease (stress, anxiety and depression)
See Ménière’s disease - treatment for more information about treating the condition.
The medications that are used to treat vertigo that's caused by Ménière’s disease are described below.
Central vertigo
Central vertigo is caused by problems in part of your brain, such as the cerebellum (which is located at the bottom of the brain) or the brainstem (the lower part of the brain that's connected to the spinal cord). Causes of central vertigo include migraine headaches and, less commonly, brain tumours (see Vertigo - causes for more information).
If your GP suspects that you have central vertigo they may:
- admit you to hospital if your symptoms are severe – particularly if you have severe nausea and vomiting and can't keep fluids down
- refer you to a specialist for further tests to confirm the diagnosis – this may be a neurologist (a specialist in treating conditions that affect the nervous system) or an audiovestibular physician (a specialist in hearing and balance disorders)
While you're waiting to be admitted to hospital or seen by a specialist, you may be given medication to treat your vertigo (see medicines below).
Migraines
If you've already been diagnosed with vertigo that's caused by migraines, you may already have a treatment plan in place, such as medication that you can take at home. See Migraines - treatment for more information. You may also be referred to a specialist for further tests.
Vertigo with an unknown cause
If the cause of your vertigo is unknown, you may be admitted to hospital if:
- you have severe nausea and vomiting and can't keep fluids down
- your vertigo comes on very suddenly and was not caused by you changing position
- you possibly have central vertigo
- you have sudden hearing loss but it's not thought to be Ménière’s disease
Alternatively, you may be referred to a specialist such as:
- a neurologist – a specialist in treating conditions that affect the nervous system
- an ENT specialist – a specialist in conditions that affect the ear, nose or throat
- an audiovestibular physician – a specialist in hearing and balance disorders
While waiting to see a specialist, you may be treated with medication (see below).
Medicines
Medicines can be used to treat:
- vertigo that's caused by vestibular neuronitis
- vertigo that's caused by Ménière’s disease
- central vertigo
- vertigo with an unknown cause
The medicines are usually prescribed for 3 to 14 days, depending on which condition they're for. The two medicines that are usually prescribed are:
- prochlorperazine, or
- an antihistamine
If these medicines are successful in treating your symptoms, you may be given a supply to keep at home so that you can take them the next time you have an episode of vertigo.
Prochlorperazine
Prochlorperazine can help to relieve the severe nausea and vomiting that's associated with vertigo. It works by blocking the effect of a chemical in the brain called dopamine.
Prochlorperazine can cause side effects, including:
- tremors (shaking)
- abnormal or involuntary body and facial movements
It can also make some people feel sleepy. For the full list of possible side effects, check the patient information leaflet that comes with your medicine or see prochlorperazine medicines information.
If you're vomiting, there's a type of prochlorperazine called Buccastem that dissolves on your tongue and is absorbed by your body so that you don't have to keep down tablets that you swallow.
Antihistamines
Antihistamines can be used to help relieve less severe nausea, vomiting and vertigo symptoms. They work by blocking the effects of a protein called histamine.
Possible antihistamines that may be prescribed include:
Like prochlorperazine, antihistamines can also make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.
