The efficacy of betahistine in treating benign paroxosymal vertigo
Date First Published:
February 14, 2021
Last Updated:
April 8, 2021
Report by:
Jana Balakumaran, Resident (McMaster University)
Search checked by:
Jana Balakumaran and Ali Rizvi, McMaster University
Three-Part Question:
In [patients with benign paroxysmal peripheral vertigo], does [betahistine] [reduce residual dizziness after canalolith repositioning]?
Clinical Scenario:
A 44 year old woman with recurrent episodes of benign paroxysmal peripheral vertigo (BPPV) presents to the ED. You perform a successful Epley manoeuvre but are unsure if there is anything you can prescribe her for residual dizziness as an outpatient.
Search Strategy:
MEDLINE and Embase using the OVID interface.
(exp Vertigo/ or exp Benign Paroxysmal Positional or vertigo.mp) AND (exp Betahistine/ or Serc.mp. or Betaserc.mp. or Vergo.mp. or antihistamine.mp. or exp Histamine Antagonists/).
(exp Vertigo/ or exp Benign Paroxysmal Positional or vertigo.mp) AND (exp Betahistine/ or Serc.mp. or Betaserc.mp. or Vergo.mp. or antihistamine.mp. or exp Histamine Antagonists/).
Outcome:
422 papers found, of which 417 were considered irrelevant and 1 was considered relevant with results not yet accessible. The remaining 4 papers are discussed below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The Impact of Betahistine versus Dimenhydrinate in the Resolution of Residual Dizziness in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial. Jalali MM, Gerami H, Saberi A, Razaghi S. 2020 Iran | 78 patients with BPPV & successful Epley manoeuvre Betahistine 16 mg TID (39) vs Placebo (39) |
RCT | No analysis of heterogeneity of comorbidities between groups Small sample size |
||
| Management of benign paroxysmal positional vertigo: a comparative study between Epleys manouvre and Betahistine. Kaur J, Shamanna K. 2017 India | 60 patients with BPPV & successful Epley manoeuvre Betahistine 16 mg TID (30) vs control (30) |
RCT | Dizziness Handicap Inventory score score (Day 1 and 7 of treatment) | (No statistically significant change in dizziness scores between groups p>0.05) (Data presented graphically without raw numerical data) | Did not present raw values for DHI scores No analysis of heterogeneity of comorbidities between groups Small sample size |
| Efficacy of medical therapy in the prevention of residual dizziness after successful repositioning maneuvers for benign paroxysmal positional vertigo (BPPV). Acar B, Karasen RM, Buran Y. 2015 Turkey | 50 patients with BPPV & successful Epley manoeuvre Betahistine 24 mg BID (25) vs control (25) |
RCT | Dizziness Handicap Inventory score (Day 1, 3, and 5 of treatment) | Betahistine Day 1: 61.44 (± 22.09) Day 5: 23.68 (± 18.24) No medication Day 1: 69.04 (± 17.28) Day 5: 13.52 (±11.06) (No statistically significant change in dizziness scores between groups p>0.05) | No analysis of heterogeneity of comorbidities between groups Small sample size |
| The effects of betahistine in addition to epley maneuver in posterior canal benign paroxysmal positional vertigo. Guneri EA, Kustutan O. 2012 Turkey | 72 patients with BPPV & successful Epley manoeuvre Betahistine 24 mg BID (24) vs Placebo (26) vs Control (22) |
RCT | Heterogeneity of comorbidities between groups exists (more hypertension in betahistine group) Small sample size |
Author Commentary:
There are many studies that investigate the effectiveness of betahistine in peripheral vertigo in general but fewer that examine BPPV specifically. Of the few studies that do exist, all have small sample sizes and many lack assessment of heterogeneity between groups. Three of four included studies show no difference between use of the Epley manoeuvre alone and additionally prescribing betahistine. The one study that showed higher reduction of dizziness scores had a disproportionate prevalence of hypertension in the treatment group which was shown to be associated with a higher rate of improvement, potentially skewing results.
The abstract of the RCT for which the full text and results are not yet available in English further suggest that betahistine does not significantly improve residual dizziness compared to no medications.
The abstract of the RCT for which the full text and results are not yet available in English further suggest that betahistine does not significantly improve residual dizziness compared to no medications.
Bottom Line:
There is insufficient robust evidence to recommend advise against the use of betahistine in patients with BPPV with a successful Epley manoeuvre. The evidence from the small RCTs captured in this search largely suggests that there is no benefit from betahistine use but also do not assess the associated adverse effects of this medication. Further research on the topic is required before recommendations can be made.
References:
- Jalali MM, Gerami H, Saberi A, Razaghi S.. The Impact of Betahistine versus Dimenhydrinate in the Resolution of Residual Dizziness in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial.
- Kaur J, Shamanna K.. Management of benign paroxysmal positional vertigo: a comparative study between Epleys manouvre and Betahistine.
- Acar B, Karasen RM, Buran Y.. Efficacy of medical therapy in the prevention of residual dizziness after successful repositioning maneuvers for benign paroxysmal positional vertigo (BPPV).
- Guneri EA, Kustutan O.. The effects of betahistine in addition to epley maneuver in posterior canal benign paroxysmal positional vertigo.