The most appropriate pharmacological management of a single acute severe vertigo attack with vomiting is:
- A Betahistine continued indefinitely to prevent recurrence
- B A short course of a vestibular sedative such as meclizine or dimenhydrinate, limited to about 3 days ✓
- C Continuous oral diazepam for 6 weeks to ensure full symptom control
- D Prophylactic intratympanic steroid instillation
Correct answer: B. A short course of a vestibular sedative such as meclizine or dimenhydrinate, limited to about 3 days
Explanation
Acute vertigo is managed with vestibular sedatives (antihistamines such as meclizine or dimenhydrinate, phenothiazines, or benzodiazepines) given briefly, usually no more than 3 days. Prolonged use suppresses vestibular input and retards the central compensation process that is essential for recovery. Betahistine is a prophylactic agent for Meniere's disease and does not abort an acute attack. Intratympanic steroids are reserved for specific indications such as refractory Meniere's disease or sudden sensorineural hearing loss, not routine acute vertigo.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
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