CNS Causes of Vertigo Treatment & Management

Updated: May 03, 2017
  • Author: Marcelo B Antunes, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Treatment

Medical Care

Medical treatment includes supportive care with fluid replacement and vestibular suppressants for intractable vertigo with nausea and vomiting.

Treatment of migraine-associated vertigo includes analgesics and vestibular suppressants. Drugs useful in the treatment of migraines include sumatriptan, propranolol, imipramine, amitriptyline, and nortriptyline, and the vestibular suppressants diazepam and alprazolam. For further information on the diagnosis and treatment of migraine headaches, please refer to the Medscape Reference topic Migraine Headache.

A retrospective, open-label study by Taghdiri et al indicated that the antihistamine cinnarizine (which currently is not available in the United States) can reduce headache and vertigo in vestibular migraine and migraine with brainstem aura. The investigators found that after 3 months of cinnarizine use, patients with these types of migraine experienced a significant decrease in the mean monthly frequency of vertigo episodes and migraine headaches, as well as a significant reduction in headache duration and intensity. [30]

A retrospective study by Çelebisoy et al indicated that acetazolamide can reduce the frequency and severity of vertigo attacks and, to a lesser extent, headache episodes, in vestibular migraine. The study included 39 patients, who were prescribed 500 mg/day of the drug. [31]

Control of hypertension, diabetes mellitus, and atherosclerosis is indicated for long-term prevention of further complications. Cardiac arrhythmia should also be controlled.

Drugs useful in the treatment of vertebrobasilar insufficiency include aspirin, ticlopidine, pentoxifylline, heparin, and warfarin. Acetazolamide is indicated for the treatment of familial ataxia syndrome.

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Surgical Care

Surgical treatment of central vertigo is limited to urgent posterior fossa decompression of cerebellar and brainstem edema that complicates the infarction.

Cerebellopontine angle (CPA) tumors are surgically removed on an elective basis. If a medical contraindication exists, radiotherapy for tumor control is an option.

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Consultations

Otolaryngologists, neurosurgeons, neurologists, and cardiologists are consulted for further diagnosis and treatment of vertigo of CNS origin.

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Diet

Address dietary management of migraine-associated vertigo with the patient. Avoidance of triggers, such as red wine, chocolate, and cheese, may reduce the frequency of attacks.

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