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Treatment for lightheadedness depends on the cause or underlying problem. Treatment may include drinking plenty of water or other fluids (unless the lightheadedness is the result of water intoxication in which case drinking water is quite dangerous). If a sufferer is unable to keep fluids down from nausea or vomiting, they may need intravenous fluid. Sufferers should try eating something sugary and lying down or sitting and reducing the elevation of the head relative to the body (for example, by positioning the head between the knees).
Other simple remedies include avoiding sudden changes in posture when sitting or lying and avoiding bright lights.
Several essential electrolytes are excreted when the body perspires. When people are out in unusual or extreme heat for a long time, sweating excessively can cause a lack of some electrolytes, which in turn can cause lightheadedness.
Definitive treatment depends on the underlying cause of vertigo. Ménière's disease patients have a variety of treatment options to consider when receiving treatment for vertigo and tinnitus including: a low-salt diet and intratympanic injections of the antibiotic gentamicin or surgical measures such as a shunt or ablation of the labyrinth in refractory cases.
Common drug treatment options for vertigo may include the following:
- Anticholinergics such as hyoscine hydrobromide (scopolamine)
- Anticonvulsants such as topiramate or valproic acid for vestibular migraines
- Antihistamines such as betahistine, dimenhydrinate, or meclizine, which may have antiemetic properties
- Beta blockers such as metoprolol for vestibular migraine
- Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis or dexamethasone as a second-line agent for Ménière's disease
All cases of decompression sickness should be treated initially with 100% oxygen until hyperbaric oxygen therapy (100% oxygen delivered in a high-pressure chamber) can be provided. Several treatments may be necessary, and treatment will generally be repeated until either all symptoms resolve, or no further improvement is apparent.
Physical activity in extremely hot weather should be avoided. If a person starts to experience over heating, and symptoms of heat syncope, they should move or be moved to a shaded or cool area. It is also recommended to avoid alcoholic beverages in hot weather, because they cause dehydration which may worsen symptoms. Finally, drinking plenty of water is imperative when engaging in physical activity in hot weather.
The basic treatment for heat syncope is like that for other types of fainting: the patient is positioned in a seating or supine position with legs raised. Water containing salt, or another drink containing electrolytes, is administered slowly, and the patient is moved to a cooler area, such as the shade.
The affected person should rest and recover, because heat syncope can lead to heat stroke or heat exhaustion.
Many conditions cause dizziness because multiple parts of the body are required for maintaining balance including the inner ear, eyes, muscles, skeleton, and the nervous system.
Common physiological causes of dizziness include:
- inadequate blood supply to the brain due to:
- a sudden fall in blood pressure
- heart problems or artery blockages
- loss or distortion of vision or visual cues
- disorders of the inner ear
- distortion of brain/nervous function by medications such as anticonvulsants and sedatives
- result of side effect from prescription drugs, including proton-pump inhibitor drugs (PPIs) and Coumadin (warfarin) causing dizziness/fainting
Dizziness is broken down into 4 main subtypes: vertigo (~50%), disequilibrium (less than ~15%), presyncope (less than ~15%) and lightheadedness (~10%).
Lightheadedness can be simply (and most commonly) an indication of a temporary shortage of blood or oxygen to the brain due to a drop in blood pressure, rapid dehydration from vomiting, diarrhea, or fever. Other causes are: low blood sugar, hyperventilation, Postural Orthostatic Tachycardia Syndrome, panic attacks, and anemia. It can also be a symptom of many other conditions, some of them serious, such as heart problems (including abnormal heart rhythm or heart attack), respiratory problems such as pulmonary embolism, and also stroke, bleeding, and shock. If any of these serious disorders is present, the individual will usually have additional symptoms such as chest pain, a feeling of a racing heart, loss of speech or change in vision.
Many people, especially as they age, experience lightheadedness if they arise too quickly from a lying or seated position. Lightheadedness often accompanies the flu, hypoglycaemia, common cold, or allergies.
Dizziness could be provoked by the use of antihistamine drugs, like levocetirizine or by some antibiotics or SSRIs. Nicotine or tobacco products can cause lightheadedness for inexperienced users. Narcotic drugs, such as codeine can also cause lightheadedness.
Because mood disorders can interfere with the vestibular compensation and adaptive plasticity, it suggested to address any co-occurring anxiety disorder and/or depression. Severe anxiety episodes are usually addressed by short-term benzodiazapine therapy. Long-term use of benzodiazapines such as diazepam, however, is not recommended due to the tolerance issues. SSRIs and SSNRIs are among a number of first line treatments for anxiety or depression.
Vestibular neuronitis is generally a self-limiting disease. Treatment with drugs is neither necessary nor possible. The effect of glucocorticoids has been studied, but they have not been found to significantly affect long-term outcome.
Symptomatic treatment with antihistaminics such as cinnarizine, however, can be used to suppress the symptoms of vestibular neuronitis while it spontaneously regresses. Prochlorperazine is another commonly prescribed medication to help alleviate the symptoms of vertigo and nausea.
Studies have shown that older adults with dementia who take antipsychotics (medications for mental illness) such as prochlorperazine have an increased chance of death during treatment.
Treatment of migraine-associated vertigo is the same as the treatment for migraine in general.
Sedative drugs are often prescribed for vertigo and dizziness, but these usually treat the symptoms rather than the underlying cause. Lorazepam (Ativan) is often used and is a sedative which has no effect on the disease process, but rather helps patients cope with the sensation.
Anti-nauseants, like those prescribed for motion sickness, are also often prescribed but do not affect the prognosis of the disorder.
Specifically for Meniere's disease a medication called Serc (Beta-histine) is available. There is some evidence to support its effectiveness in reducing the frequency of attacks. Also Diuretics, like Diazide (HCTZ/triamterene), are effective in many patients. Finally, ototoxic medications delivered either systemically or through the eardrum can eliminate the vertigo associated with Meniere's in many cases, although there is about a 10% risk of further hearing loss when using ototoxic medications.
Treatment is specific for underlying disorder of balance disorder:
- anticholinergics
- antihistamines
- benzodiazepines
- calcium channel antagonists, specifically Verapamil and Nimodipine
- GABA modulators, specifically gabapentin and baclofen
- Neurotransmitter reuptake inhibitors such as SSRIs, SNRIs and Tricyclics
If a person with heat exhaustion gets medical treatment, Emergency Medical Technicians (EMTs) or doctors and/or nurses may also:
- Give them supplemental oxygen
- Give them intravenous fluids and electrolytes if they are too confused to drink and/or are vomiting
There is insufficient evidence for or against breathing exercises.
While traditional intervention for an acute episode has been to have the patient breathe into a paper bag, causing rebreathing and restoration of CO₂ levels, this is not advised. The same benefits can be obtained more safely from deliberately slowing down the breathing rate by counting or looking at the second hand on a watch. This is sometimes referred to as "7-11 breathing", because a gentle inhalation is stretched out to take 7 seconds (or counts), and the exhalation is slowed to take 11 seconds. This in-/exhalation ratio can be safely decreased to 4-12 or even 4-20 and more, as the O₂ content of the blood will easily sustain normal cell function for several minutes at rest when normal blood acidity has been restored.
It has also been suggested that breathing therapies such as the Buteyko Breathing method may be effective in reducing the symptoms and recurrence of the syndrome.
Benzodiazepines can be prescribed to reduce stress that provokes hyperventilation syndrome. Selective serotonin reuptake inhibitors (SSRIs) can reduce the severity and frequency of hyperventilation episodes.
Dysequilibrium arising from bilateral loss of vestibular function – such as can occur from ototoxic drugs such as gentamicin – can also be treated with balance retraining exercises (vestibular rehabilitation) although the improvement is not likely to be full recovery.
Many drugs taken to relieve typical symptoms of motion sickness (including nausea, dizziness, etc.) contain compounds that may exacerbate drowsiness. Antihistamines are commonly used to treat motion sickness; however, side effects include drowsiness and impaired cognitive abilities. Anticholinergics such as scopolamine have also proved effective against motion sickness, but may induce drowsiness. These treatments may be combined with stimulants to counteract typical motion-induced nausea and dizziness while also preventing sedation.
However, many stimulants possess addictive properties, which result in a high potential for substance abuse. Some stimulants also tend to interfere with normal sleep patterns. Modafinil has been studied as a possible treatment for the sopite syndrome that does not appear to have the same side effects of normal stimulants. Modafanil appears to be effective when taken in combination with anticholinergics such as scopolamine, but studies of Modafanil-only treatments for motion sickness remain inconclusive.
During MD episodes, medications to reduce nausea are used, as are drugs to reduce the anxiety caused by vertigo.
For longer term treatment to stop progression, the evidence base is weak for all treatments.
Although a causal relation between allergy and Menière's disease is uncertain, medication to control allergies may be helpful.
Diuretics are widely used to manage Ménière's on the theory that it reduces fluid buildup in the ear. Based on evidence from multiple but small clinical trials, diuretics appear to be useful for reducing the frequency of episodes of dizziness, but do not seem to prevent hearing loss.
In cases where there is significant hearing loss and continuing severe episodes of vertigo, a chemical labyrinthectomy, in which a drug (such as gentamicin) that "kills" parts or most of the vestibular apparatus is injected into the middle ear.
There is no cure for Ménière's disease but medications, diet, physical therapy and counseling, and some surgical approaches can be used to manage it.
Medical treatment with anti-vertigo medications may be considered in acute, severe exacerbation of BPPV, but in most cases are not indicated. These primarily include drugs of the anti-histamine and anti-cholinergic class, such as meclizine and hyoscine butylbromide (scopolamine) respectively. The medical management of vestibular syndromes has become increasingly popular over the last decade, and numerous novel drug therapies (including existing drugs with new indications) have emerged for the treatment of vertigo/dizziness syndromes. These drugs vary considerably in their mechanisms of action, with many of them being receptor- or ion channel-specific. Among them are betahistine or dexamethasone/gentamicin for the treatment of Ménière's disease, carbamazepine/oxcarbazepine for the treatment of paroxysmal dysarthria and ataxia in multiple sclerosis, metoprolol/topiramate or valproic acid/tricyclic antidepressant for the treatment of vestibular migraine, and 4-aminopyridine for the treatment of episodic ataxia type 2 and both downbeat and upbeat nystagmus. These drug therapies offer symptomatic treatment, and do not affect the disease process or resolution rate. Medications may be used to suppress symptoms during the positioning maneuvers if the patient's symptoms are severe and intolerable. More dose-specific studies are required, however, in order to determine the most effective drug(s) for both acute symptom relief and long-term remission of the condition.
First aid for heat exhaustion includes:
- Moving the person to a cool place
- Having the patient take off extra layers of clothes
- Cooling the patient down by fanning them and putting wet towels on their body
- Having them lie down and put their feet up if they are feeling dizzy
- Having them drink water or sports drinks – but only if they are awake, not confused nor vomiting
- Turning the person on their side if they are vomiting
Mild disease can be treated with fluids by mouth. In more significant disease spraying with mist and using a fan is useful. For those with severe disease putting them in lukewarm water is recommended if possible with transport to a hospital.
Prevention includes avoiding medications that can increase the risk of heat illness (e.g. antihypertensives, diuretics, and anticholinergics), gradual adjustment to heat, and sufficient fluids and electrolytes.
Surgical treatments, such as a semi-circular canal occlusion, do exist for BPPV, but carry the same risk as any neurosurgical procedure. Surgery is reserved as a last resort option for severe and persistent cases which fail vestibular rehabilitation (including particle repositioning and habituation therapy).
Common pharmacological treatments include:
- Mast cell stabilizers, including cromolyn sodium and natural stabilizers such as quercetin
- H1-antihistamines, such as cetirizine or ketotifen
- H2-antihistamines, such as ranitidine or famotidine
- Antileukotrienes, such as montelukast or zileuton as well as natural products (e.g., curcumin or St. John's wort extracts)
- Nonsteroidal anti-inflammatory drugs, including aspirin can be very helpful in reducing inflammation in some patients, while others can have dangerous reactions
Fillers, binders and dyes in many medications are often the culprit in causing reactions, not necessarily the active agent, so alternative formulations and compounding pharmacies should be considered.
Lifestyle changes may also be needed. Avoidance of triggers is important. It should be emphasized that MCAS patients can potentially react to any new exposure, including food, drink, medication, microbes and smoke via inhalation, ingestion or touch.
A low histamine diet and other elimination diets can be useful in identifying foods that trigger or worsen symptoms. Many MCAS patients already have high histamine levels, so ingesting foods with high histamine or histamine liberators can worsen many symptoms such as vasodilation that causes faintness and palpitations.
Treatment may involve investigation, reassurance and explanation, and possibly specialist treatment such as antidepressants or cognitive behavioral therapy.
Pharmacological methods of treatment include fludrocortisone, midodrine, somatostatin, erythropoietin, and other vasopressor agents. However, often a patient with pure autonomic failure can mitigate his or her symptoms with far less costly means. Compressing the legs and lower body, through crossing the legs, squatting, or the use of compression stockings can help. Also, ingesting more water than usual can increase blood pressure and relieve some symptoms.