Patient handout

Vertigo (acute / recurrent)

PRODUCTION

1. Your condition

This handout is for vertigo (acute / recurrent). Your care team identified this based on: acute continuous vertigo + nausea + nystagmus + gait unsteadiness ≥24 h (newman-toker stroke 2009 pmid 19762709 — hints+ indication).

Other reasons your team may use this plan: brief vertigo provoked by head position change (aao-hns bppv 2017 pmid 28248609 — dix-hallpike indication); recurrent spontaneous vertigo episodes — meniere (aao-hns 2020 pmid 32267799) / vestibular migraine (bárány 2015 pmid 23532572); vertigo with hearing loss / tinnitus / aural fullness (aao-hns 2020 meniere criteria).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
meclizine	25 mg	PO	q6-8h PRN ≤72 h	Short-course only — chronic use delays vestibular compensation (AAO-HNS 2017 PMID 28248609); AGS Beers 2023 in elderly
lorazepam	0.5-1 mg	PO/IV	q6-8h PRN ≤48 h	Limit to 48 h; falls and dependence risk; AGS Beers 2023 in elderly; delays vestibular compensation
prochlorperazine	5-10 mg	PO/IM/IV	q6h PRN	Effective antiemetic; watch dystonia + QTc (AAN 2024)
ondansetron	4-8 mg	PO/IV	q8h PRN	QTc precaution; preferred over droperidol (AAN 2024)
prednisolone	60 mg	PO	daily × 5 d then taper over 2 wk	Strupp NEJM 2004 PMID 15269315 — improves caloric recovery; antivirals not routinely added

Plan: Acute vertigo symptomatic management (≤72 h, peripheral) (AAO-HNS 2017 + AAN 2024)

3. When to call your provider

Contact your care team if any of the following happen:

Progressive hearing loss → ENT urgently (AAO-HNS 2020)
New focal neurology → stroke workup (AHA/ASA 2021)
Refractory Meniere → ENT for intratympanic / surgical options
NEW central feature (diplopia, dysarthria, hemiparesis) → ED

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

HINTS+ central pattern: normal head impulse + direction-changing nystagmus + skew deviation (Newman-Toker Stroke 2009 PMID 19762709) — sens 100% / spec 96% for posterior circulation stroke; LR+ ~6.0 for central(life-threatening)
Sudden SNHL >30 dB at ≥3 contiguous frequencies within 72 h + vertigo — AICA territory infarct vs labyrinthitis vs Meniere onset (AAO-HNS 2019 SSNHL CPG PMID 31369359)
Vertigo + new neck pain + posterior circulation deficit, often after trauma / chiropractic manipulation / strenuous neck motion (AHA/ASA 2021 PMID 34024117)(life-threatening)
Truncal ataxia disproportionate to vertigo, severe headache, declining LOC, brainstem signs → cerebellar hemorrhage or infarct with mass effect on STAT non-contrast CT (AHA/ASA 2021)(life-threatening)

5. Follow-up

Vestibular rehab referral (AAO-HNS 2017 strong recommendation; Cochrane 2014); audiology q6-12 mo for Meniere; neurology if vestibular migraine (Bárány 2015 — route to neuro.migraine.core.v1); ENT for refractory Meniere

6. Sources

Guideline: AAO-HNS BPPV CPG (2017) + AAO-HNS Meniere CPG (2020) + AAO-HNS SSNHL CPG (2019) + Bárány Society 2015 vestibular migraine + Newman-Toker HINTS+ (Stroke 2009 / Neurology 2013) + AHA/ASA Stroke Prevention 2021 (posterior circulation) + Strupp NEJM 2004 (vestibular neuritis) + Cochrane Vestibular Rehab 2014