Vertigo: Its Causes and Treatment

The most reliable treatment for BPPV is a fairly simple, non-surgical procedure called canalith repositioning.(12) This is done by changing the patient's head and body position in a series of steps that are thought to dislodge the calcium crystals within the vestibular labyrinth that caused the problem.

Canalith repositioning is usually done under expert supervision, but it is easy enough that doctors often teach it to BPPV sufferers and their families.

Many doctors also prescribe drugs called vestibular suppressants. Because of unwanted side effects, such as lethargy and impaired balance, they are given sparingly and only for more severe and long-lasting attacks. The elderly are particularly sensitive to these side effects.

Another concern about these drugs is that they may slow or prevent the central nervous system from adjusting to a problem in the vestibular system. While vetibular suppressants often help lessen symptoms, especially in the short term, surgery is the ultimate answer for the unlucky few with severe BPPV-related vertigo that does not respond to the canalith repositioning procedure.(13)

The treatments for Meniere's disease are generally not as effective as those for BPPV. Severe attacks are treated with vestibular suppressant drugs; in between, Meniere's symptoms are often controlled by reducing salt intake and by taking diuretic drugs, which reduce the amount of fluids in the body.

For similar reasons, people with Meniere's should avoid alcohol, coffee, chocolate and other foods that are high in sugar or salt. As with BPPV, surgery is a last resort.

Vertigo is not a disease but a symptom that can have many causes. The most common are benign paroxysmal positional vertigo (BPPV) and Meniere's disease, which for most people can be treated and controlled without surgery. The best treatment for BPPV, a simple, non-surgical procedure called canalith repositioning, is easy to perform; both sufferers and their families can be trained to do it. Another option, vestibular suppressants drugs, has serious side effects and should be used very cautiously.

When should you seek medical help?

The answer is that anyone with recurring or severe dizziness or vertigo should see a doctor. Most of the time, the most serious cause will be BPPV or Meniere's, both of which can be treated and controlled with drugs and other non-surgical therapy. It is particularly urgent, however, to seek medical treatment if the dizziness or vertigo occurs together with one or more of the following symptoms, which can be a sign of a more serious underlying heath problem:

• Severe or "different" headache
• Blurred vision
• Hearing loss
• Speech problems
• Weakness in a leg or arm
• Fainting
• Problems walking
• Numbness or tingling
• Chest pain or changes in heart rate