Chronic vertigo: treat with exercise, not drugs

Vugt, Vincent A Van; Horst, Henriëtte E. van der; Payne, Rupert; Maarsingh, Otto R

doi:10.1136/bmj.j3727

Cited by 21 publications

(19 citation statements)

References 27 publications

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“…Examples are the Epley maneuver for benign paroxysmal positional vertigo, 17,18 and vestibular rehabilitation for vertigo persisting after the Epley maneuver. 19 Dizziness in older people is, however, often a diagnostic challenge for physicians because it can refer to a variety of sensations, as there are many potential underlying causes, and there is often a multifactorial origin. 9,13 As a result, primary care physicians often manage dizziness in this age-group with a wait-andsee strategy, 2 although they could also focus on targeting potential contributing factors such as multiple drug use or depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

Predicting an Unfavorable Course of Dizziness in Older Patients

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Predicting an Unfavorable Course of Dizziness in Older Patients

et al. 2018

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“…Recently, it has been published and suggested that chronic and acute peripheral vestibular vertigo should be treated with vestibular rehabilitation rather than any type of drug therapy. 7 AS medication does not only have an overall effect on functioning, it is moreover known to extend cognitive decline. 42,43 Interestingly, chronic VoD have also been posited as risk factors for cognitive decline, 44 e.g., by a direct action on hippocampal structures and functions.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 While there are distinct vestibular and non-vestibular etiologies of vertigo that can be addressed by specific therapy, a large part of vertiginous symptoms remain underdiagnosed or misdiagnosed, and are inaccurately accommodated in primary care. 3,5,6 A challenging task in primary care is to recommend effective therapy to vertigo or dizziness (VoD) patients, 7 because this is dependent on an accurate diagnosis. 8 Identifying an adjustable risk factor, like medication 9 for VoD, warrants attention for the operative prevention and management of this disorder in primary care.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic and sedative medications and the risk of vertigo or dizziness in the German primary care setting—A matched case‐control study from the CONTENT registry

Phillips

Strobl

Grill

et al. 2018

Pharmacoepidemiology and Drug

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“…Anti-vertigo medications in particular, are commonly prescribed for non-vestibular causes of dizziness [ 16 ]. Therefore, there is a need to develop and validate non-pharmacological treatment strategies for dizziness in this population, which in turn may reduce the need for prescription of pharmacological agents with their attendant potential side-effects [ 15 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Chiropractic treatment including instrument-assisted manipulation for non-specific dizziness and neck pain in community-dwelling older people: a feasibility randomised sham-controlled trial

et al. 2018

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BackgroundDizziness in older people is a risk factor for falls. Neck pain is associated with dizziness and responds favourably to neck manipulation. However, it is unknown if chiropractic intervention including instrument-assisted manipulation of the neck in older people with neck pain can also improve dizziness.MethodsThis parallel two-arm pilot trial was conducted in Melbourne, Australia over nine months (October 2015 to June 2016). Participants aged 65–85 years, with self-reported chronic neck pain and dizziness, were recruited from the general public through advertisements in local community newspapers and via Facebook. Participants were randomised using a permuted block method to one of two groups: 1) Activator II™-instrument-assisted cervical and thoracic spine manipulation plus a combination of: light massage; mobilisation; range of motion exercises; and home advice about the application of heat, or 2) Sham-Activator II™-instrument-assisted manipulation (set to zero impulse) plus gentle touch of cervical and thoracic spinal regions. Participants were blinded to group allocation. The interventions were delivered weekly for four weeks. Assessments were conducted one week pre- and post-intervention. Clinical outcomes were assessed blindly and included: dizziness (dizziness handicap inventory [DHI]); neck pain (neck disability index [NDI]); self-reported concerns of falling; mood; physical function; and treatment satisfaction. Feasibility outcomes included recruitment rates, compliance with intervention and outcome assessment, study location, success of blinding, costs and harms.ResultsOut of 162 enquiries, 24 participants were screened as eligible and randomised to either the chiropractic (n = 13) or sham (n = 11) intervention group. Compliance was satisfactory with only two participants lost to follow up; thus, post-intervention data for 12 chiropractic intervention and 10 sham intervention participants were analysed. Blinding was similar between groups. Mild harms of increased spinal pain or headaches were reported by 6 participants. Costs amounted to AUD$2635 per participant. The data showed a trend favouring the chiropractic group in terms of clinically-significant improvements in both NDI and DHI scores. Sample sizes of n = 150 or n = 222 for dizziness or neck pain disability as the primary outcome measure, respectively, would be needed for a fully powered trial.ConclusionsRecruitment of participants in this setting was difficult and expensive. However, a larger trial may be feasible at a specialised dizziness clinic within a rehabilitation setting. Compliance was acceptable and the outcome measures used were well accepted and responsive.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000653763. Registered 13 June 2013.Trial funding: Foundation for Chiropractic Research and Postgraduate Education (Denmark).

show abstract

Chronic vertigo: treat with exercise, not drugs

Cited by 21 publications

References 27 publications

Predicting an Unfavorable Course of Dizziness in Older Patients

Predicting an Unfavorable Course of Dizziness in Older Patients

Anticholinergic and sedative medications and the risk of vertigo or dizziness in the German primary care setting—A matched case‐control study from the CONTENT registry

Chiropractic treatment including instrument-assisted manipulation for non-specific dizziness and neck pain in community-dwelling older people: a feasibility randomised sham-controlled trial

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