Antihistamines offered more acute vertigo relief than benzos, but no longer-term benefit
A single dose of antihistamine provided no greater benefit at two hours than ondansetron, droperidol, metoclopramide, or piracetam, and daily antihistamine treatment for a week or month had similar results to placebo.
Antihistamines may be superior to benzodiazepines for treatment of acute vertigo, and use of the latter should be discouraged, a systematic review and meta-analysis concluded.
Researchers analyzed trials comparing antihistamines or benzodiazepines with another drug, placebo, or no intervention for patients with acute vertigo for two weeks or less. They included 17 trials with 1,586 participants. Seven studies with 802 patients evaluated the primary outcome of change in 100-point vertigo visual analog scale (VAS) scores at about two hours after treatment. Secondary outcomes included change in nausea scores and use of rescue medication at two hours and improvement or resolution of vertigo at a week or a month. Studies of healthy volunteers, prophylactic treatment and induced vertigo and those that compared two medications from the same class were excluded. Results were published July 18 by JAMA Neurology.
Overall, single-dose antihistamines resulted in significantly more improvement on 100-point VAS scores compared with benzodiazepines (difference, 16.1 [95% CI, 7.2 to 25.0]) but not other active comparators, including ondansetron, droperidol, metoclopramide, and piracetam (difference, 2.7 [95% CI, –6.1 to 11.5]). At one week and one month, neither daily benzodiazepines nor antihistamines were reported to be superior to placebo. Trials comparing the immediate effects of medications (at two hours) after a single dose generally had a low risk of bias, but those evaluating longer-term outcomes had a high risk of bias.
An editorial argued that making the correct diagnosis of vertigo is more important than simply providing symptom relief. “… [C]orrect, etiologically determined therapy to treat the underlying disease process is even more patient-centric than effective symptomatic management. In the end, antihistamines may be better than benzodiazepines in patients with acute vertigo—but accurate diagnosis is better than both,” the editorialists wrote.