Guidelines
Management
Conservative Management / Self-Care Advice
Counsel the patient that:
- Ménière’s disease is a long-term condition, and vertigo usually significantly improves with treatment
- Acute attacks of vertigo usually settle within 24 hours
Advise the patient to:
- Keep their medication readily accessible
- Consider risks before undertaking activities such as driving, swimming, operating dangerous machinery, using ladders or scaffolding
The DVLA states that people with ‘liability to sudden and unprovoked or unprecipitated episodes of disabling dizziness‘ should stop driving and inform the DVLA.
Symptomatic Management – Acute Attacks
1st line: short course (up to 7 days) of oral
- Prochlorperazine, or
- Antihistamine (e.g. cyclizine, promethazine, cinnarizine)
For rapid relief of severe symptoms:
- Buccal prochlorperazine, or
- IM prochlorperazine / cyclizine
Prevention of Recurrent Attacks
1st line: Consider betahistine
- A histamine analogue (H3 antagonist + partial H1 agonist)
- MoA: increases inner ear microcirculation and reduces endolymphatic pressure
2nd line (not responding well to betahistine): refer to ENT for alternative secondary care interventions
Note that vestibular rehabilitation has NO role in Meniere’s disease, it is not helpful to prevent attacks.
However, vestibular rehabilitation is useful in the other 3 most common peripheral vestibular disorders (BPPV, vestibular neuritis, labyrinthitis).
However, betahistine only has a role in Meniere’s disease, not the other 3.