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Three Part Question

In [adult patients with acute vertigo], is there an [effective medication] to improve [symptoms of veetigo]?

Clinical Scenario

A 40-year-old female is brought into Emergency Department by ambulance complaing of vertigo in acute onset. The history and physical examination suggest that she has a peripheral vertigo. She complains of nausea and cannot tolerate oral agents. You wonder if there is any effective medications to improve her symptoms now.

Search Strategy

Medline 1966-12/2008 using the OVID interface.

(Vertigo) AND (Medication or Antihistamine or Anticholinergic or Benzodiazepine) AND (Acute or Emergency or Urgent) LIMIT to Humans AND English AND Randomized Controlled Trial.

Search Outcome

13 papers were found in total of which 2 were relevant. They are shown in the table below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Irving C, Richman P, Kaiafas C, Eskin B, Allegra J. 2002 USA	40 ED patients with acute peripheral vertigo, of which 20 patients received 2.5 mg droperidol IM, while the other 20 patients received 50 mg dimenhydrinate IM.	Randomized, double-blinded clinical trial	the change in the severity of the vertigo after 30 minutes		Study numbers are small.
Marill KA, Walsh MJ, Nelson BK. 2000 USA	74 patients with the symptom of vertigo recieved intravenous lorazepam, 2 mg or intravenous dimenhydrinate, 50 mg.	randomized, double-blind trial	the patient's sensation of nausea and drowsiness		Small study Numbers

Comment(s)

Few trials heve been performed on the effectiveness of medications used for patients of acute peripheral vertigo. These trials show that droperidol or dimenhydrinate is effective for urgent relief of the symptom of vertigo.

Clinical Bottom Line

For patients suffering from acute peropheral vertigo, droperidol or dimenhydrinate is effective for symptom relief in Emergency Department settings. These medications are administered parenterally, so they can be used for patients that cannot tolerate oral medications.

References

1. Irving C, Richman P, Kaiafas C, Eskin B, Allegra J. Intramuscular droperidol versus intramuscular dimenhydrinate for the treatment of acute peripheral vertigo in the emergency department: a randomized clinical trial. Acad Emerg Med. 2002 Jun;9(6):650-3.
2. Marill KA, Walsh MJ, Nelson BK. Intravenous Lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: a randomized clinical trial. Ann Emerg Med. 2000 Oct;36(4):310-9.