Therapeutic interventions in vertigo management

Authors

  • Mohan Kameshwaran Madras ENT Research Foundation (MERF), Chennai
  • Kushal Sarda Abbott India Ltd, Mumbai

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20174311

Keywords:

Betahistine, Benign paroxysmal positioning vertigo, Peripheral Vertigo, Vestibular dysfunctions, Vestibular compensation, Meniere's disease

Abstract

Vertigo is a condition associated with a spectrum of symptoms and ~30% of general population experience vertigo in their life time. In spite of being of high clinical importance, the management of vertigo is quite challenging. Though the literature supports the availability of various therapeutic interventions used in vertigo treatment, their effectiveness depends on accurate diagnosis, appropriate use of intervention, and physician’s awareness of the overlap between vestibular, autonomic, and psychological aspects of vestibular pathology. Unfortunately, several drugs act as tranquilizers and impede the process of vestibular compensation. Betahistine, a histamine analogue, is one of the most commonly used anti-vertigo drugs worldwide and has been supported by many clinical trials. There have been several oral communications in international conferences on the efficacy of using betahistine in several clinical vertiginous syndromes. The current review assesses the use of betahistine 48 mg twice daily for three months as an efficient and well-tolerated treatment for vertigo. Additionally, it highlights the low incidence of side effects even at high doses of betahistine and suggests that it may be considered as the first-line of treatment for vestibular dysfunction.

Author Biographies

Mohan Kameshwaran, Madras ENT Research Foundation (MERF), Chennai

Director, Madras ENT Research Foundation (MERF)

Kushal Sarda, Abbott India Ltd, Mumbai

Medical Advisor, Medical Sciences Division,

Abbott India Limited,

 

References

Alcocer RR, Rodríguez JGL, Romero AN, Nuñez JLC, Montoya VR, Deschamps JJ, et al. Use of betahistine in the treatment of peripheral vertigo. Acta Oto-Laryngol. 2015;35:1205-11.

Strupp M, Dieterich M, Brandt T. The Treatment and Natural Course of Peripheral and Central Vertigo. Dtsch Arztebl Int. 2013;110:505−16.

Strupp M, Brandt T. Current Treatment of Vestibular, Ocular Motor Disorders and Nystagmus. Ther Adv Neurol Disord. 2009;2:223–39.

Lempert T, Neuhauser H. Epidemiology of vertigo, migraine and vestibular migraine J Neurol. 2009;256:333-8.

Abrol R, Nehru VI, Venkatramana Y. Prevalence and etiology of vertigo in adult rural population. Indian J Otolaryngol Head Neck Surg. 2001;53:32-6.

Cha Y-H. Acute Vestibulopathy. Neurohospitalist. 2011;1(1):32-40.

Neuhauser HK, Radtke A, Brevern M, Feldmann M, Lezius F, Ziese T, et al. Migrainous vertigo: prevalence and impact on quality of life. Neurol. 2006;67:1028.

Neuhauser, H. Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology. 2001;56:436–41.

Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases):vestibular migraine? J Neurol. 1999;246(10):883-92.

Furman JM, Balaban CD. Vestibular migraine. Ann NY Acad Sci. 2015;1343:90-6.

Lacour M, van de Heyning P H, Novotny M, Tighilet B. Betahistine in the treatment of Meniere’s disease. Neuropsychiatr Dis Treat. 2007;3:429-40.

Luxon LM. Evaluation and Management of the Dizzy Patient. J Neurol Neurosurg Psychiatr. 2004;75 (Suppl IV):iv45–iv52.

D'Silva LJ, Staecker H, Lin J, Sykes KJ, Phadnis MA, McMahon TM, et al. Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. J Vestib Res 2016;25:233-9.

Tsukamoto HF, de’Souza V, Rubens CP, da’Silva A Jr, Pelosi GG, de’Moraes Marchiori LL, et al. Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo. Int Arch Otorhinolaryngol. 2015;19:238–47.

Walker MF. Treatment of Vestibular Neuritis. Curr Treat Options Neurol. 2009;11:41–5.

Obermann M, Strupp M. Current treatment options in vestibular migraine. Front Neurol. 2014;5:1-5.

Bronstein AM, Lempert T. Management of the patient with chronic dizziness. Restor Neurol Neurosci. 2010;28:79-86.

Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93:457-62.

Baloh RW, Kerber KA. Clinical Neurophysiology of vestibular system. Fourth ed. New York: Oxford University Press, 2011.

Djelilovic-Vranic J, Alajbegovic A, Tiric-Campara M, Volic A, Sarajlic Z, Osmanagic E, et al. Betahistine or Cinnarizine for treatment of Meniere's disease. Med Arch. 2012;66:396-8.

Masmoudi K, Masson H, Gras V, Andréjak M. Extrapyramidal adverse drug reactions associated with trimetazidine:a series of 21 cases. Fundam Clin Pharmacol. 2012;26:198-203.

Lacour M. Betahistine treatment in managing vertigo and improving vestibular compensation: Clarification. J Vestibular Res. 2013;23:139–51.

Bodla R, Thota P, Sarabu A, Mohantha GP, Shanmugam R. Comparison of efficacy and tolerability of cinnarizine with betahistine in the treatment of otogenic vertigo. Int J Pharma Res. 2011;3:36-40.

Scholtz AW, Steindl R, Burchardi N, Bognar-Steinberg I, Baumann W. Comparison of the therapeutic efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate with betahistine in vestibular neuritis:a randomized, double-blind, non-inferiority study. Clin Drug Investig. 2012;32:387-99.

Hahn A, Novotný M, Shotekov PM, Cirek Z, Bognar-Steinberg I, Baumann W. Comparison of cinnarizine/dimenhydrinate fixed combination with the respective monotherapies for vertigo of various origins:a randomized, double-blind, active-controlled, multicentre study. Clin Drug Investig. 2011;31:371-83.

Weerts A, Pattyn N, Van de Heyning P, Wuyts F. Evaluation of the effects of anti-motion sickness drugs on subjective sleepiness and cognitive performance of healthy males. J Psychopharmacol. 2013;28:655-64.

Otto V, Fischer B, Schwarz M, Baumann W, Preibisch-Effenberger R. Treatment of Vertebrobasilar Insufficiency–Associated Vertigo with a Fixed Combination of Cinnarizine and Dimenhydrinate. Int Tinnitus J. 2008;14:57–67.

Strupp M, Hupert D, Frenzel C, Wagner J, Hahn A, Jahn K, et al. Long-term prophylactic treatment of attacks of vertigo in Menie`re’s disease - comparison of a high with a low dosage of betahistine in an open trial. Acta Otolaryngol. 2008;128:520-4.

Yomiya K, Takei D, Kurosawa H, Kono B. A study on the antiemetic effect and extrapyramidal symptoms of prochlorperazine versus perospirone for the control of nausea and vomiting due to opioid introduction. Gan to Kagaku Ryoho. 2013;40:1037-41.

Prochlorperazine: MedlinePlus Drug Information; Updated on: 2016. Available at: https://www.nlm. nih.gov/medlineplus/druginfo/meds/a682116.html. Accessed on 4 February 2017.

Takeno K, Shimogori H, Takemoto T, Tanaka K, Mikuriya T, Orita H, Yamashita H. The systemic application of diazepam facilitates the reacquisition of a well-balanced vestibular function in a unilateral vestibular re-input model with intracochlear tetrodotoxin infusion using an osmotic pump. Brain Res. 2006;22;1096:113-9.

Nguyen-Huynh AT. Evidence-Based Practice: Management of Vertigo. Otolaryngol Clin North Am. 2012;45:925–40.

Wanamaker HH. Surgical treatment of benign paroxysmal positional vertigo. Oper Tech Otolaryngol. Head Neck Surg. 2001;12(3):124-8.

MERISLON® Summary of Product Characteristics. Eisai Co., Japan. 2009. Available at: http://www.eisai.jp/medical/products/di/EPI/MRS_T_EPI.pdf. Accessed on 4 February 2017.

SERC®-16. Summary of Product Characteristics uploaded to UK electronic Medicines Compendium (eMC). BGP Products Limited, UK. 2015 April 14. Available at: https://www.medicines.org.uk/emc/ medicine/2086. Accessed on 7 February 2017.

Guneri EA, Kustutan O. The Effects of Betahistine in Addition to Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg 2012;146:104-8.

Lacour M, Sterkers O. Histamine and Betahistine in the Treatment of Vertigo. Elucidation of Mechanisms of Action Betahistine: Dosage and Efficacy. CNS Drugs. 2001;15:853-70.

Padgaonkar KA, Rohira PG, Bhave AC, Nair BS. Betahistine in the treatment of vertigo. Indian Medical Gazette. 1999:239-46.

Albera R. Betahistine in the treatment of Meniere’s disease and other balance disturbances. Review of its efficacy and safety. Otorinolaringol. 2005;55:115-21.

Adrion C, Fischer CS, Wagner J, Gürkov R, Mansmann U. Efficacy and safety of betahistine treatment in patients with Meniere's disease:primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ. 2016;352:6816.

Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F. Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine. Am J Otolaryngol. 2016;37:225-30.

Morozova SY, Alekseeva NS, Lilenko SV, Matsnev EI, Melnikov OA. Effects and safety profile of betahistine in patients in the Russian contingent of OSVaLD, an open-label observational study in vestibular vertigo. Int J Gen Med. 2015;8:47–53.

Sundararajan I, Rangachari V, Sumathi V, Kumar K. Epley’s manoeuvre versus Epley’s manoeuvre plus labyrinthine sedative as management of benign paroxysmal positional vertigo: prospective, randomised study. J Laryngol Otol. 2011;125:572-5.

Lezius F, Adrion C, Mansmann U, Jahn K, Strupp M. High-dosage betahistine dihydrochloride between 288 and 480 mg/day in patients with severe Meniere’s disease: a case series. Eur Arch Otorhinolaryngol. 2011;268:1237-40.

Ganaca MM, Caovilla HH, Ganaca FF. Comparable efficacy and tolerability between twice daily and three times daily betahistine for Meniere’s disease. Acta Oto-Laryngologica. 2009;129:487-92.

Benecke H, Pérez-Garrigues H, bin Sidek D, Uloziene I, Sondag KE, Theeuwes A. Effects of betahistine on Patient-Reported Outcomes in Routine Practice in Patients with Vestibular Vertigo and Appraisal of Tolerability: Experience in the OSVaLD Study. Int Tinnitus J. 2010;16:14-24.

Bradoo RA, Nerurkar NK, Mhapankar JB, Patil SF, Kute DG. Management of Acute Vertigo with betahistine. Indian J Otolaryngol Head Neck Surg. 2000;52:151:8.

Băjenaru O, Roceanu AM, Albu S, Zainea V, Pascu A, Georgescu MG, et al. Effects and tolerability of betahistine in patients with vestibular from vertigo: results the Romanian contingent of the OSVaLD study. Inter J Gen Med. 2014;7:531-8.

Oosterveld WJ, Blijleven W, Van Elferen LWM. Betahistine versus placebo in paroxysmal vertigo;a double-blind trial. J Drug Therapy Res. 1989;14:122-6.

Ganança MM, Caovilla HH, Gazzola JM, Ganança CF, Ganança FF. Betahistine in the treatment of tinnitus in patients with vestibular disorders. Braz J Otorhinolaryngol. 2011;77:499-503.

Tootoonchi SJS, Ghiasi S, Shadara P, Samani SM, Fouladi DF. xHearing function after betahistine therapy in patients with Ménière's disease. Braz J Otorhinolaryngol. 2016;82:500-6.

Downloads

Published

2017-09-22

Issue

Section

Review Articles