Epley Maneuver or Meclizine to Treat Vertigo

March 2, 2023

Benign paroxysmal positional vertigo (BPPV) causes feelings of dizziness and the impression that surroundings or the inside of one’s head are spinning. It can be caused by a blow to the head, lying down for extended periods of time, migraine attacks, or dislodging of tiny crystals called otoliths inside the inner ears. Otoliths normally function to orient us to gravity. When they become dislodged, they can irritate the canals of the inner ears and cause vertigo when the head is in certain positions or moves suddenly. The Epley maneuver is performed to guide the little crystals out of the inner ear canals and back into the correct position.

To have an Epley maneuver performed, the patient first sits, while the doctor turns his or her head slightly, toward the problem ear. This should cause vertigo, which will end in about a minute. The doctor tilts the patient backward until he or she is lying down. Next, the physician turns the patient’s head toward the healthy ear, and rolls the patient onto that side. The patient remains in that position until the vertigo stops.

Another solution is an antihistamine called meclizine. Among other uses (to treat nausea, vomiting, and dizziness of motion sickness), it is useful for treating the dizziness and vertigo of displaced inner ear crystals. For vertigo, adults take 25 to 100 mg per day by mouth, in divided doses. Common side effects are drowsiness, fatigue, headache, blurred vision, and dry mouth. The cost of meclizine ranges from $5 to $15 for a bottle of 30 tablets, strength 25 mg. Some studies suggest that the Epley maneuver may be at least as effective as meclizine—without the side effects.

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