Results between 30 minutes and 4 hours were allowed, but the time frame closest to 2 hours was preferentially used. The predefined primary outcome was change in 10- or 100-point vertigo or dizziness visual analog scale (VAS) score at 2 hours after treatment. In this systematic review and meta-analysis, we assessed the relative efficacy of benzodiazepines and antihistamines when compared with each other, other active comparators, placebo, or no intervention in the treatment of acute vertigo from any underlying cause. 1, 3, 8 Symptom control for acute vertigo with vestibular suppressants may be indicated with or without a definitive diagnosis, and the efficacy of these medications remains unclear. 2 - 4Īlthough treatment based on acute vertigo etiology is recommended, a specific cause is not always immediately identified. 7 Antihistamines and benzodiazepines are frequently prescribed as “vestibular suppressants” for vertigo. 3, 5, 6 However, medications are also frequently prescribed, 6 perhaps because many patients experience ongoing symptoms despite treatment with repositioning maneuvers. 2, 5, 6 Repositioning techniques are the preferred treatment for benign positional paroxysmal vertigo (BPPV). 1, 2 Curative treatment can sometimes be tailored to the specific underlying cause, 1 - 5 but medications are frequently used to suppress vertigo symptoms. It effects up to 20% of adults, with a higher incidence in women and older individuals. Vertigo is the sensation of movement (typically rotatory) and is frequently associated with nausea or imbalance. Larger randomized trials comparing both antihistamines and benzodiazepines with placebo could better clarify the relative efficacy of these medications. Other evidence suggested that daily antihistamine use may not benefit patients with acute vertigo. Furthermore, the available evidence did not support an association of benzodiazepine use with improvement in any outcomes for acute vertigo. RCTs comparing the immediate effects of medications (at 2 hours) after a single dose generally had a low risk of bias, but those evaluating 1-week and 1-month outcomes had a high risk of bias.Ĭonclusions and Relevance Moderately strong evidence suggests that single-dose antihistamines provide greater vertigo relief at 2 hours than single-dose benzodiazepines. At 1 week and 1 month, neither daily benzodiazepines nor antihistamines were reported to be superior to placebo. Seven trials with a total of 802 participants evaluated the primary outcome of interest: single-dose antihistamines resulted in significantly more improvement on 100-point VAS scores compared with benzodiazepines (difference, 16.1 ) but not compared with other active comparators (difference, 2.7 ). Results Of the 27 trials identified in the systematic review, 17 contributed to the quantitative meta-analysis and involved a total of 1586 participants. Secondary outcomes included change in nausea VAS scores at 2 hours, use of rescue medication at 2 hours, and improvement or resolution of vertigo at 1 week or 1 month. Main Outcomes and Measures The predefined primary outcome was change in 10- or 100-point vertigo or dizziness visual analog scale (VAS) scores at 2 hours after treatment. Data were pooled using a random-effects model. Studies of healthy volunteers, prophylactic treatment, or induced vertigo were excluded, as were studies that compared 2 medications from the same class.ĭata Extraction and Synthesis Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, data were extracted and risk of bias was assessed by 2 authors independently for each study. Study Selection We included randomized clinical trials (RCTs) comparing antihistamine or benzodiazepine use with another comparator, placebo, or no intervention for patients with a duration of acute vertigo for 2 weeks or less. Bibliographies of the included studies and relevant reviews were also screened. Objective To assess the efficacy of antihistamines and benzodiazepines in the treatment of acute vertigo from any underlying cause.ĭata Sources We searched the PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and databases from inception to January 14, 2019, without language restrictions. Antihistamines and benzodiazepines are frequently prescribed as “vestibular suppressants,” but their efficacy is unclear. Importance Acute vertigo can be disabling. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.
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