Condition

Vertigo

Sensation of spinning or dizziness, often from inner ear problems

1.7B
People Affected
47
Active Trials
340M
New Cases/Year
2,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Epley maneuver
95% Effectiveness• 95% Confidence• 95% Safety• 25 trials• 12K participants
HIGH EvidenceExcellent ValueDose: Specific head and body movements performed by trained clinician or self-administered
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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Water💧
95
DangerousModerateSafe

Time to Effect

Immediate to 24 hours

Duration

Single session, repeated if necessary

Response Rate

90%

Remission Rate

85%

Number Needed to Treat (NNT)

3

Common Side Effects:

Temporary dizziness/nausea during maneuver: 30%
Neck discomfort: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.3

Cost per Remission

$117.65

Cost per Responder

$105.26

Treatment Outcomes
Primary Outcomes
Proportion of Positive Dix-Hallpike Tests1.0
-80% (-0.8)
Vertigo Symptom Severity (0-10 scale)7/10
-85.7% (-6 points)
Vertigo Episode Frequency (per day)5 episodes/day
-90% (-4.5 episodes/day)
Secondary Benefits
Dizziness Handicap Inventory (DHI) Score (0-100 scale)50/100
-70% (-35 points)
Activities of Daily Living (ADL) Limitation Score (0-10 scale)4/10
-75% (-3 points)
Generalized Anxiety Disorder (GAD-7) Score (0-21 scale)12/21
-58.3% (-7 points)
Common Side Effects
Temporary dizziness/nausea during maneuver
+30%
Neck discomfort
+7%

Clinical Trial Phases:

Phase 4
2
Vestibular Rehabilitation Therapy
85% Effectiveness• 90% Confidence• 95% Safety• 91 trials• 8.5K participants
HIGH EvidenceExcellent ValueDose: Individualized exercise program, e.g., 30 minutes, 1-3 times daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

2-12 weeks

Duration

6-12 weeks typically, ongoing home exercises

Response Rate

78%

Remission Rate

60%

Number Needed to Treat (NNT)

4

Common Side Effects:

Temporary increase in dizziness/nausea during exercises: 40%
Muscle soreness: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$20,000/QALY

Cost per Remission

$3,000

Cost per Responder

$2,307.69

Treatment Outcomes
Primary Outcomes
Dizziness Handicap Inventory (DHI) Score60/100
-40% (-24 points)
Berg Balance Scale (BBS) Score40/56
+15% (+6 points)
Timed Up and Go (TUG) Test Time15 seconds
-20% (-3 seconds)
Secondary Benefits
Hospital Anxiety and Depression Scale (HADS) - Anxiety Subscale12/21
-25% (-3 points)
SF-36 Physical Component Summary (PCS) Score40/100
+12.5% (+5 points)
Falls Efficacy Scale International (FES-I) Score45/64
-22.2% (-10 points)
Common Side Effects
Temporary increase in dizziness/nausea during exercises
+40%
Muscle soreness
+7%

Clinical Trial Phases:

Phase 4
3
Prednisone
75% Effectiveness• 80% Confidence• 50% Safety• 1 trials• 3.5K participants
MODERATE EvidenceExcellent ValueDose: 60 mg daily, tapered over 10-14 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

Days

Duration

7-14 day tapering course

Response Rate

78%

Remission Rate

68%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

15

Common Side Effects:

Insomnia: 30%
Mood changes (anxiety, agitation): 20%
Increased appetite: 15%
Indigestion/Heartburn: 15%

Annual Cost of Care

Drug Cost

$20

Monitoring

$1,000

Side Effects

$50

Total Annual

$1,070

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

Cost per Remission

$102.94

Cost per Responder

$89.74

Treatment Outcomes
Primary Outcomes
Vertigo Severity (VAS)8/10
-70% (-5.6 points)
Dizziness Handicap Inventory (DHI) Score55/100
-65% (-35.75 points)
Frequency of Vertigo Episodes5 episodes/month
-70% (-3.5 episodes/month)
Secondary Benefits
Nausea Severity (VAS)6/10
-70% (-4.2 points)
Health-Related Quality of Life (EQ-5D Index)0.65
+30% (+0.195 points)
Pure Tone Average (PTA) Hearing Threshold45 dB HL
-44.4% (-20 dB HL)
Common Side Effects
Insomnia
+30%
Mood changes (anxiety, agitation)
+20%
Increased appetite
+15%

Clinical Trial Phases:

Phase 4
4
Betahistine
65% Effectiveness• 70% Confidence• 70% Safety• 11 trials• 12.5K participants
MODERATE EvidenceGood ValueDose: 8-16 mg three times daily, up to 48 mg/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

Weeks to months for full benefit, some symptomatic relief sooner

Duration

Long-term, possibly indefinite for chronic conditions

Response Rate

60%

Remission Rate

40%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

30

Common Side Effects:

Headache: 12%
Nausea: 7%
Indigestion: 7%
Rash: 3%

Annual Cost of Care

Drug Cost

$200

Monitoring

$50

Side Effects

$20

Total Annual

$270

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$60,000/QALY

Cost per Remission

$675

Cost per Responder

$450

Treatment Outcomes
Primary Outcomes
Vertigo Attack Frequency8 attacks/month
-60% (-4.8 attacks/month)
Vertigo Attack IntensityVAS score: 7/10
-50% (-3.5 points on a 0-10 scale)
Dizziness Handicap Inventory (DHI) ScoreDHI score: 50/100
-35% (-17.5 points on a 0-100 scale)
Duration of Vertigo Attacks30 minutes/attack
-50% (-15 minutes/attack)
Secondary Benefits
Quality of Life (SF-36 General Health)SF-36 General Health score: 55/100
+15% (+8.25 points on a 0-100 scale)
Tinnitus Severity Index (TSI) ScoreTSI score: 40/84
-25% (-10 points on a 0-84 scale)
Social Activity ParticipationVAS score: 4/10
+50% (+2 points on a 0-10 scale)
Common Side Effects
Headache
+12%
Nausea
+7%
Indigestion
+7%

Clinical Trial Phases:

Phase 4
5
Meclizine
60% Effectiveness• 85% Confidence• 75% Safety• 2 trials• 5.5K participants
MODERATE EvidenceExcellent ValueDose: 12.5-50 mg daily, once a day or divided doses
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

Short-term for acute episodes (days), as needed

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

15

Common Side Effects:

Drowsiness: 25%
Dry mouth: 12%
Blurred vision: 8%
Constipation: 5%

Annual Cost of Care

Drug Cost

$30

Monitoring

$1,000

Side Effects

$10

Total Annual

$1,040

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

Cost per Responder

$53.33

Treatment Outcomes
Primary Outcomes
Vertigo Severity7/10 Visual Analog Scale (VAS)
-40% (-2.8 points)
Dizziness Severity6/10 Visual Analog Scale (VAS)
-35% (-2.1 points)
Nausea Severity5/10 Visual Analog Scale (VAS)
-50% (-2.5 points)
Secondary Benefits
Dizziness Handicap Inventory (DHI) Score50/100
-25% (-12.5 points)
Functional Impairment in Daily Activities3/5 Activity Limitation Scale
-30% (-0.9 points)
Anxiety Level12/21 GAD-7 score
-15% (-1.8 points)
Common Side Effects
Drowsiness
+25%
Dry mouth
+12%
Blurred vision
+8%

Clinical Trial Phases:

Phase 4