BPPV can occur for no known reason and may be associated with age.  

Meniere's disease: This is an inner ear disorder thought to be caused by a build-up of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss.  

Vestibular neuritis or labyrinthitis: This is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance.  

Less often vertigo may be associated with:  

• Head or neck injury  
• Brain problems such as stroke or tumour  
• Certain medications that cause ear damage  
• Migraine headaches.  

Treatment  

Sanchez-Vanegas et al wanted to establish the clinical effect and safety of betahistine (48mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia.  

An observational prospective cohort study was conducted including patients older than 15 years with a clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks.  

Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. They calculated average weekly improvement, the cumulative incidence of complete improvement, the incidence rate of complete improvement, and the probability of complete improvement as a function of time.  

After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one per cent of the patients had achieved complete improvement at the end of the second week.  

After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19).  

The study authors concluded that betahistine (48mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile. 

References available on request.