Medication Doesn’t Stop Vertigo’s Spinning

by Keith Roach, M.D.

Dear Dr. Roach:

I have a terrible case of vertigo. I’m not sure what causes it or what I can do to prevent it from happening to me again. I was given two medications, promethazine for nausea and meclizine for vertigo, but still the problem persists. Can you offer some kind of help? — J.G.

Answer: Vertigo is the sensation of movement when not moving. Although it is classically described as a spinning sensation, some people feel as if they or the world is moving in other ways.

There are many causes of vertigo, but we generally break them down into two groups: peripheral causes, from the vestibular nerve, which connects your brain with the organ of balance in the inner ear; and central causes, from the brain itself. Peripheral causes are much more common and generally are labelled “benign,” even though they can be quite severe. Central causes are most commonly attributed to vestibular migraine and poor blood flow to the brainstem.

Only a careful exam and, occasionally, more sophisticated tests can reveal the underlying cause of the vertigo. The most common cause is benign paroxysmal positional vertigo, and I suspect that is what you were being treated for, having received a nonspecific treatment for vertigo. Although it is commonplace, I disagree with this treatment if it is used for more than a day or two, and then only in people whose symptoms are severe.

Most people get relief from an office treatment called the Epley maneuver. They can continue at home with other exercises. I would suggest that you ask your doctor about these procedures, and if he or she isn’t familiar with them, it might be wise to consult with an expert. In any event, vertigo is a symptom that can arise from several distinct medical conditions. You should find out what your diagnosis is.

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