Evaluation and Treatment of Dizziness/Vertigo
Diagnosis
If your doctor suspects you are having or may have had a stroke, are older or suffered a blow to the head, he or she may immediately order an MRI or CT scan.
Most people visiting their doctor because of dizziness will first be asked about their symptoms and medications and then be given a physical examination. During this exam, your doctor will check how you walk and maintain your balance and how the major nerves of your central nervous system are working.
You may also need a hearing test and balance tests, including:
- Eye movement testing. Your doctor may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which water or air are placed in your ear canal.
- Head movement testing. If your doctor suspects your vertigo is caused by benign paroxysmal positional vertigo, he or she may do a simple head movement test called the Dix-Hallpike maneuver to verify the diagnosis.
- Posturography. This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a platform and try to keep your balance under various conditions.
- Rotary chair testing. During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.
In addition, you may be given blood tests to check for infection and other tests to check heart and blood vessel health.
Treatment
Dizziness often gets better without treatment. Within a couple of weeks, the body usually adapts to whatever is causing it.
If you seek treatment, your doctor will base it on the cause of your condition and your symptoms. It may include medications and balance exercises. Even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.
Medications
- Water pills. If you have Meniere’s disease, your doctor may prescribe a water pill (diuretic). This along with a low-salt diet may help reduce how often you have dizziness episodes.
- Medications that relieve dizziness and nausea. Your doctor may prescribe drugs to provide immediate relief from vertigo, dizziness and nausea, including prescription antihistamines and anticholergenics. Many of these drugs cause drowsiness.
- Anti-anxiety medications. Diazepam (Valium) and alprazolam (Xanax) are in a class of drugs called benzodiazepines, which may cause addiction. They may also cause drowsiness.
- Preventive medicine for migraine. Certain medicines may help prevent migraine attacks.
Therapy
- Head position maneuvers. A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist or a physical therapist and involves maneuvering the position of your head. It’s usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina, or blood vessel problems.
- Balance therapy. You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
- Psychotherapy. This type of therapy may help people whose dizziness is caused by anxiety disorders.
Surgical or other procedures
- Injections. Your doctor may inject your inner ear with the antibiotic gentamicin to disable the balance function. The unaffected ear takes over that function.
