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Meniere's Disease

NICE CKS Meniere's disease. Last revised: Mar 2023.

Guidelines

Counsel the patient that:

Ménière's disease is a long-term condition, vertigo usually significantly improves with treatment
Acute attack of vertigo usually settle within 24 hours

Advise the patient to:

Keep their medication readily accessible
Consider risks before undertaking activities such as driving, swimming, operating dangerous machinery, using ladders or scaffolding

The DVLA states that people with 'liability to sudden and unprovoked or unprecipitated episodes of disabling dizziness' should stop driving and inform the DVLA.

1st line: short course (up to 7 days) of oral

Prochlorperazine, or
Antihistamine (e.g. cyclizine, promethazine, cinnarizine)

For rapid relief of severe symptoms:

Buccal prochlorperazine, or
IM prochlorperazine / cyclizine

Consider betahistine

A histamine analogue (H3 antagonist + partial H1 agonist)
MoA: increases inner ear microcirculation and reduces endolymphatic pressure

Note that vestibular rehabilitation has NO role in Meniere's disease, it is not helpful to prevent attacks.

However, vestibular rehabilitation is useful in the other 3 most common peripheral vestibular disorders (BPPV, vestibular neuritis, labyrinthitis).

But betahistine only has a role in Meniere's disease, not the other 3.

References

NICE CKS Meniere's disease

Author: Adams Lau
Reviewer:
Last edited: 12/07/25

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