Is it really vertigo (ENT cause) rather than light-headedness (anxiety, syncope, postural hypotension)
- consider duration: minutes for Benign Paroxysmal Positional Vertigo (BPPV), hours for Meniere’s and Migraine Associated Vertigo, days for Labyrinthitis or vascular cause
- treat acute labyrinthitis with 2-3 days of prochlorperazine, but avoid long courses which delay central compensation. Do not use betahistine for acute labyrinthitis. Encourage early mobilisation.
- for Menieres disease, consider betahistine. Also avoid excess salt and caffeine.
- for Migraine, consider life-style measures such as elimination of caffeine. Migraine prophylaxis can also be considered. Note that head and neck pain may not occur at the same time as vertigo/dizziness.
- BPPV will not be helped by prochlorperazine. GP may consider Hallpike test for diagnosis, and Epley manoeuvre for treatment, or refer to ENT for these and for vestibular rehabilitation.
- See DVLA guidelines on ‘liability to sudden attacks of unprovoked or unprecipitated disabling giddiness’
Refer ENT Vertigo Clinic if suspected BPPV, Meniere’s or uncertain diagnosis.