Dizziness and vertigo (2018)

Overview

Key points

• A systematic review showed that acupuncture can improve the symptoms of cervical vertigo to a greater extent than medication (Hou 2017)
• Acupuncture has also been shown to be beneficial for Ménière’s disease(Long 2011)
• Acupuncture reduced acute dizziness and vertigo following 30 minutes of treatment in a hospital emergency department (Chiu 2015)

Background

Dizziness and vertigo are common conditions, which make a person falsely feel that the environment is moving about them, or that they are moving with respect to the environment. (DTB 2009, Chiu 2015) The condition usually originates in the peripheral nervous system, for example, due to a disorder of the inner ear such as Ménière’s disease, benign paroxysmal positional vertigo (BPPV), or labyrinthitis and vestibular neuritis. Less commonly, dizziness and vertigo may be due to a disorder of the central nervous system such as haemorrhages, ischaemia, or tumours, infection or trauma. (Long 2011) Neck disorders can also result in cervical vertigo, which may be accompanied by headaches, blurred vision, nausea and vomiting. (Hou 2017) Treatment for BPPV usually comprises certain movements to reposition particles in the canals of the ear, known as the Epley manoeuvre. (Bhattacharyya 2008). Pharmacological therapy may be offered for dizziness and vertigo, including vestibular suppressants, anti-emetics and benzodiazepines. These medications, however, may result in unwanted side effects. (Chiu 2015)

Large, well-designed trials are needed to confirm the effectiveness of acupuncture in the treatment of dizziness and vertigo.

Systematic reviews

• A systematic review of 10 studies using acupuncture to treat cervical vertigo (n=914) found that acupuncture was significantly more effective than conventional medication overall (P<0.00001) and in terms of the rate of vertigo (P=0.009). (Hou 2017) Acupuncture was observed to increase the average blood flow velocity of the vertebral-basilar artery compared with conventional medication.
• Another systematic review looked at acupuncture in the treatment of Ménière’s disease. (Long 2011) A total of 27 studies were included. The authors concluded that there is a “beneficial effect from acupuncture, both for those in an acute phase and for those who have had Ménière’s syndrome for a number of years”.

Additional randomised controlled trials

• When acupuncture is combined with exercise, the dizziness caused by cervical myofascial pain syndrome is reduced compared with exercise alone. In this randomised trial, acupuncture in combination with exercise significantly reduced the frequency and severity of dizziness at weeks 1 and 4 compared with exercise alone (P<0.05). (Aydin 2019)
• In another study patients with acute vertigo (n=124) were randomised to receive either acupressure at the point P6 or placebo pressure at a point regarded to be ineffective. 85% of those receiving acupressure at P6 reported improvements in autonomic nervous system symptoms (for example nausea, vomiting, palpitations, sweating, anxiety) compared with 11% in the placebo group. (Alessandrini 2012)
• Several randomised controlled trials of acupuncture for cervical vertigo have been completed in China, largely to compare different acupuncture modalities rather than establish the effectiveness of the therapy per se (Li 2011; Kang 2008; Zhang 2008; Xiaoxiang 2006).

Controlled cohort study

• A single 30-minute acupuncture treatment for dizziness and vertigo was performed in a hospital emergency department (n=60) and was shown to significantly reduce symptoms and discomfort compared with control (P<0.001). The effects of acupuncture were apparent after 30 minutes of treatment and remained significant 7 days after the treatment. (Chiu 2015)

Safety of acupuncture treatment

• The safety of acupuncture was not reported in all the studies included in a systematic review of acupuncture to treat cervical vertigo, but in those that did the reported side effects were mild. (Hou 2017)
• In the hospital emergency department study described above, no adverse events were reported. (Chiu 2015)