Vertigo is often caused by an inner ear problem. Some of the most common causes include: 

Betahistine is effective in improving vertigo-associated symptoms, with longer treatment periods leading to greater improvements

Benign paroxysmal positional vertigo (BPPV): This occurs when tiny calcium particles (canaliths) clump up in canals of the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. 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.


Betahistine is effective in improving vertigo-associated symptoms, with longer treatment periods leading to greater improvements. However, it was not known whether these effects persist after treatment cessation. 

VIRTUOSO was a prospective, multinational, non-comparative, post-marketing observational programme investigating the effectiveness of betahistine (48mg/day) and the course of vertigo after the discontinuation of treatment. Patients with vestibular vertigo who were prescribed 48mg/day betahistine were enrolled in Russia and Ukraine. Treatment duration was up to two months, and patients were followed up for two months after discontinuation of betahistine. Efficacy endpoints included clinical response (assessed by change in vertigo severity), monthly attack frequency, and physician and patient grading of overall clinical response and improvement of vertigo-associated symptoms. 


Overall, 309 patients were enrolled and 305 completed the study. Clinical response was rated as good, very good or excellent in 74% of patients at end of treatment, with vertigo severity significantly decreased from baseline (p < 0.001). Monthly vertigo attack frequency decreased significantly during the two months of treatment (p < 0.001 from baseline) and further decreased during the two-month follow-up (p < 0.001 from the end of treatment). Overall, clinical response was graded as good or excellent by 94% of physicians and 95% of patients.  

Clinical improvement was considered either good or excellent by 82.6–90.5% of physicians and patients for nausea, vomiting and faintness. Only one adverse event was reported, with no serious adverse events.  


Parfenov et al’s findings suggest that betahistine (48mg/day) therapy is effective in treating vertigo in routine clinical settings. The observed effects persisted for two months after treatment cessation, suggesting that betahistine may facilitate lasting vestibular compensation.  


Parfenov VA, Golyk VA, Matsnev EI, et al. Effectiveness of betahistine (48 mg/day) in patients with vestibular vertigo during routine practice: The VIRTUOSO study. PLoS One 2017;12(3):e0174114. doi:10.1371/journal.pone.0174114