Meclizine Has Limited Use for Dizziness

meclizineAntivert (meclizine) is one of the most popular and commonly prescribed medications for dizziness. However, there is no scientific evidence supporting it’s benefit and in fact, we now have evidence against it’s use, especially long-term use.

Meclizine is an antihistamine with anticholinergic, central nervous system and labyrinth (inner ear) depressant effects, so meclizine may cause drowsiness, confusion, memory impairment, and slow reaction time.

While migraine is the most common (and most under recognized) cause of dizziness, making up approximately 60% of all dizzy patients, Benign Paroxysmal Positional Vertigo (BPPV – aka the “crystal” problem) is second, making up about 15%. In neither condition is meclizine indicated. Meclizine would have minimal, if any benefit for migraine and may help blunt the vertigo associated with BPPV, but we are now able to instantly cure those suffering from BPPV, so why use meclizine at all?

Meclizine may be helpful short term in acute vestibular disfunction (sudden onset of vertigo), such as in vestibular neuritis (without hearing loss) or labyrinthitis (with hearing loss), an attack of Meniere’s, or to reduce motion sickness during travel. When used for these conditions or situations, only a short course, perhaps 3-7 days, should be prescribed.

Chronic use of meclizine is never indicated. Use of meclizine in the elderly, especially in the setting of peripheral neuropathy and/or vision loss from cataract, glaucoma or macular degeneration, may cause more imbalance and lead to painful falls. Chronic use of meclizine following vestibular nerve damage (such as with vestibular neuritis or labyrinthitis, trauma, or Meniere’s) will actually prevent the brain from adjusting and will reduce the effectiveness of vestibular rehabilitation therapy (a specialized form of physical therapy).

If you know of anyone who takes meclizine on a regular basis, please let them know there likely is a better treatment option available. As we are now better able determine the underlying cause of dizziness and vertigo, we have also developed more effective, targeted treatments.

Vertigo is a Symptom, NOT a Diagnosis

vertigo girlWhen many patients arrive at our medical clinic, BalanceMD, they report that they were diagnosed with “vertigo”.  Vertigo is defined as the sensation a person has that they or objects around them are moving when they are not.  There are many medical conditions that might include vertigo as a symptom, most commonly migrainebenign paroxysmal positional vertigo (BPPV)vestibular neuritis or labyrinthitis, and Meniere’s disease.

Vertigo is a symptom, not a diagnosis, much in the same way that chest pain is a symptom, not a diagnosis.  There are many things that might cause chest pain, such as a heart attack, pneumonia, or a broken rib.  As it is important to determine the underlying cause of chest pain, it is also important to determine the underlying cause of vertigo.

While there are many conditions that might cause vertigo, there are only a handful that present most commonly and are listed above.  Differentiating between these conditions is best accomplished with a detailed clinical history, physical exam, and when needed, vestibular function testing and an audiogram (hearing test).  While migraine is the most common cause of recurrent spells of vertigo, BPPV is a vertigo-causing condition which can be quickly identified and cured.  Typical symptoms of BPPV include brief vertigo often lasting 10-15 seconds and triggered by lying back or sitting up in bed, rolling over in bed, and looking up or down.  Benign Paroxysmal Positional Vertigo is easy to evaluate and to treat.  If BPPV is not present, then vestibular function testing is typically necessary to evaluate for other inner ear or brain-related causes of vertigo.

Vestibular function testing is the test of choice in the identification of an underlying cause for vertigo.  This type of testing analyzes both inner ear and brain function associated with vertigo.  Vestibular function testing includes Videonystagmography (VNG)rotational chairVestibular Evoked Myogenic Potential (VEMP) and an audiogram.

Once the underlying cause for dizziness or vertigo is determined, a targeted treatment can be administered.  Because of advancements in our knowledge and technology over the past 20-25 years, we are much better able to arrive at a precise diagnosis.  We now know that while meclizine (Antivert), a commonly prescribed medication for those suffering with vertigo, may reduce vertigo symptoms for some conditions, it does not fix the underly problem causing vertigo.  Those who have been given meclizine (Antivert) for treatment of the symptom of vertigo and continue to suffer with vertigo should seek an evaluation from a specialist who is able to arrive at a diagnosis for the cause of vertigo and administer the most appropriate treatment and/or cure.

Vertigo Cure

There are many causes of dizziness and vertigo that we are now able to recognize and treat. One common type of vertigo, known as BPPV (Benign Paroxysmal Positional Vertigo), aka “the crystal problem”, can be cured with a procedure known as a CRM (Canalith Repositioning Maneuver). Symptoms of BPPVinclude brief vertigo, lasting 10-15 seconds, brought on by lying back or getting up from bed, rolling over in bed, looking up or down. It is important to identify which type of BPPV is present, as we now know multiple types of BPPV exist. With the appropriate CRM, success in treating BPPV is nearly 100%. We should no longer be using medications, such as meclizine, or habituation exercises (Brandt-Daroff or Cawthorne-Cooksey) to treat BPPVClick here to view a video of the most common type of BPPV, posterior semicircular canal BPPV.

Unfortunately, BPPV has become a well known entity over the years and is now over diagnosed.  Treatment with a CRM in someone who does not have BPPV will not work.  So, if you have been told that you have BPPV, but your vertigo symptoms did not resolve after a correctly performed CRM, then BPPV may not be the correct diagnosis.