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Single-dose antihistamines more effective at decreasing acute vertigo severity within 2 hours than single-dose benzodiazepines
Clinical Question
Which works better for acute vertigo: antihistamines or benzodiazepines?
Bottom line
This systematic review finds that patients with acute vertigo who receive a single dose of an antihistamine have greater short-term improvement in severity than those treated with a single dose of a benzodiazepine. However, medications were no better than placebo in improving longer-term outcomes. Finally, the reporting of individual trials was such that 37% of potentially eligible trials did not contribute data to this analysis. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
These authors searched several databases, the bibliographies of included studies and review papers, and ClinicalTrials.gov to identify randomized or quasi-randomized trials that evaluated drugs for the management of patients with acute vertigo (duration of 2 weeks or less). They were interested in symptom improvement at 2 hours, 1 week, and 1 month after treatment. Although they found 27 trials, only 17 (with 1586 participants) reported data on the outcomes of interest. Most of the studies enrolled patients with generalized or nonspecific “peripheral” vertigo; 4 enrolled patients with benign paroxysmal positional vertigo (BPPV). The studies evaluated 2 benzodiazepines (lorazepam and diazepam) and a variety of antihistamines, each variably compared with placebo, no treatment, another active agent, or, in the case of BPPV, Epley maneuvers. Of the 8 trials reporting 2-hour outcomes, 5 were low risk of bias. Of the 9 trials reporting 1-week and 1-month outcomes, all had a high risk of bias. All the studies assessing 2-hour outcomes compared antihistamines with other medications. Three trials with low risk of bias reported that antihistamines were more effective at decreasing vertigo severity than benzodiazepines (16.1/100 on a visual analog scale), but with moderate heterogeneity (I2 = 47%). After pooling all the data, antihistamines were no better than other therapies, but the authors found high heterogeneity (I2 = 84%). The authors found no significant differences for treatments at 1 week or at 1 month. In the studies evaluating patients with BPPV, 1 week later and again 1 month later, antihistamines were no better than Epley maneuvers in decreasing vertigo severity nor in resolution. Overall, none of the medications were effective in decreasing nausea severity or the need for rescue therapy. Finally, the authors note that the studies inconsistently reported adverse events and that, other than 2 patients needing bag-valve-mask treatment for benzodiazepine-induced hypoventilation (I hate when that happens), the adverse events were mild.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Antihistamines for vertigo
Makes perfect sense. Antihistamines are active in the Vestibule-Cochlear system
Benzodiazepines
I wonder when doctors will stop ladling out highly addictive benzos for just about everything. Highly irresponsible.
Antihistamines vs Benzos for vertigo
Yikes, what a dog's breakfast of literature. Seems to me that probably nothing works other than "time" during which vertigo will resolve for most people. This is probably because vertigo is a symptom the end result of many causes yet we seem to treat it as a specific diagnosis. That's sort of like treating all patients experiencing dypsnea with albertol and wondering why it doesn't work. More research on vertigo needed, in volume and in quality!