Management of vertigo is dictated by the underlying cause.

Labyrinthitis usually improves of its own accord, although it can be slow. Recommendations include bed rest and drinking plenty of fluids to avoid dehydration, plus antiemetics if needed to relieve nausea and vomiting. If the patient complains of unilateral sudden-onset deafness, they should be referred as an emergency as it can indicate acute ischaemia (restriction in blood supply) of the labyrinth or brainstem. If a bacterial cause of labyrinthitis is suspected – which is more likely in young children – antibiotics will be given and a hearing test conducted after recovery as there is a risk of permanent hearing loss.

Vestibular neuronitis generally settles down without any intervention. Drinking plenty of fluid will stave off dehydration and many people minimise the impact of symptoms by resting in bed for a few days. If the condition becomes chronic, physiotherapy-led vestibular rehabilitation exercises, which train the body to compensate for the abnormal signals being received by the vestibular system, can help.

BPPV improves over several weeks in most cases although some individuals may find symptoms persist or even recur. The Epley manoeuvre, which repositions otoliths, can make a difference in many cases, but should only be attempted by someone trained to do it.

Ménière’s disease that is acute and causing nausea and vomiting normally responds to prochlorperazine but the course should be limited to seven days because of the risk of sedation and extrapyramidal (involuntary movement) side effects. If attacks are frequent and severe, a course of betahistine, which is thought to work by reducing fluid pressure within the inner ear, may be tried. Some self care measures that can be beneficial include avoiding caffeine, alcohol and smoking, and eating a low-salt diet.