Vertigo is a type of dizziness that can last for a short period of time (minutes) or can last for hours or even days. People who have vertigo may also have a feeling of sickness (nausea) and be sick (vomit). They may also have a loss of balance. Vertigo is usually caused by problems within the inner ear. Medicines to treat vertigo help to ease nausea and vomiting and some can also ease dizziness. These medicines are usually only given for a short period of time (up to 14 days). In many cases your doctor is able to find out what condition has caused the vertigo and will then advise on treatment for this condition.
What is vertigo and what causes it?
Vertigo is a type of dizziness that can last for a short period of time (minutes) or can last for hours or even days. People who have vertigo have a false feeling of their surroundings moving or spinning. This is usually accompanied by a feeling of sickness (nausea) and a loss of balance. Vertigo is a symptom and not a condition in itself. In most cases there is a medical condition that causes vertigo. However, sometimes the cause is unknown.
The most common cause of vertigo is a problem with the inner part of the ear - for example, an infection or inflammation. When we move our head, the inner part of the ear tells us where our head is. It does this by sending signals to the brain and this helps us to keep our balance. If there are problems with the inner part of the ear then this causes us to feel sick and dizzy.
Other conditions that can affect the inner ear and cause vertigo include Ménière's disease, motion sickness and toxicity of the ear caused by medicines. A common cause of vertigo in older people is benign paroxysmal positional vertigo. This causes intense dizziness (short episodes of vertigo) when you move your head in certain directions. It it thought to be caused by tiny fragments of debris in the inner ear.
Less commonly, vertigo may be caused by conditions that make changes to certain parts of the brain - for example:
- A stroke.
- Multiple sclerosis.
- A growth in the brain (acoustic neuroma).
- Double vision (diplopia).
- Drinking too much alcohol.
The treatment of vertigo depends on what has caused it. For example, if you have an ear infection your doctor may prescribe an antibiotic. For other causes of vertigo your doctor may give you special exercises to do. The rest of this leaflet only discusses medicines that help to ease the symptoms of dizziness and nausea caused by vertigo. There are separate leaflets called Benign Paroxysmal Positional Vertigo, Ménière's Disease, Labyrinthitis and Vestibular Neuritis, Dizziness and Migraine.
Note: vertigo is sometimes referred to as a 'fear of heights' - this is not correct. The right term for the fear of heights is acrophobia.
What are medicines for vertigo and how do they work?
A number of medicines can be prescribed to help with the symptoms of vertigo. They include prochlorperazine or antihistamines such as cinnarizine, cyclizine or promethazine. These medicines are the same ones that are used to help treat a feeling of sickness (nausea) and motion sickness. They work by blocking certain chemicals in the brain. Prochlorperazine blocks a chemical called dopamine; this helps with severe sickness. Antihistamines block histamine which helps with mild sickness and being sick (vomiting) as well as vertigo. Betahistine is an antihistamine that may be prescribed for patients with Ménière's disease, to prevent attacks from occurring. It is thought that this medicine improves the blood flow around the ear.
These medicines come in various brand names and are available as tablets, capsules, liquids and injections. Some are available as tablets that dissolve between the upper gum and lip (sublingual tablets).
How well do these medicines work?
There are no good studies that tell us how well these medicines work. However, they have been prescribed to treat vertigo for many years.
Which medicine is usually prescribed?
The choice of medicine depends on what is causing your vertigo and how severe your symptoms are. If you have a severe feeling of sickness (nausea), your doctor may prescribe prochlorperazine. The advantage of this medicine is that it is available as an injection or as a tablet to dissolve between the upper gum and lip (a sublingual tablet). It may be more suitable for people who are very sick and being sick (vomiting).
If you have mild nausea, your doctor may prescribe an antihistamine such as cinnarizine, cyclizine or promethazine. These will also help to treat dizziness.
What is the usual length of treatment?
Medicines to treat vertigo and sickness are usually only taken for a short time - normally from 3 to 14 days. If you have vertigo frequently, your doctor may prescribe a short supply of these medicines to keep at home, to use when you have another attack.
What about side-effects?
It is not possible to list all the possible side-effects of each of these medicines in this leaflet. However, as with all medicines, there are a number of side-effects that have been reported. If you want more information specific to your medicine, see the information leaflet that came with your medicine.
Most side-effects are not serious and each person may react differently to these medicines. Common side-effects include drowsiness, constipation, headaches, tiredness, trouble with sleeping (insomnia) and indigestion. Prochlorperazine can cause muscle twitching of the shoulders, face and neck. This usually goes away once this medicine is stopped.
Who cannot take medicines for vertigo?
There are very few people who cannot take a medicine for vertigo. If for some reason one medicine has caused a side-effect or there is a reason you cannot take one, your doctor can choose a different type of medicine that will suit you.
Can I buy medicines for vertigo?
You can buy cinnarizine from your pharmacy but the pharmacist can only sell it to people who have motion sickness.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.
Dr Colin Tidy
Dr John Cox