Performing a series of head movements for a few minutes every day can improve symptoms of chronic dizziness for many patients, British researchers report.

Chronic dizziness is common, especially among older people, Dr. Lucy Yardley of the University of Southampton and colleagues note, and no medications are truly effective in treating it. The movements, known as vestibular rehabilitation exercises, are designed to retrain the body's system for maintaining balance, and are currently rarely prescribed, Dr. Yardley noted in an interview.

"They have previously been available only at specialist centers that only a small minority of dizzy patients are referred to," she explained.

The exercises, which take up to 10 minutes to perform and are done twice daily, involve moving the head from side to side and lowering and raising the head, with the eyes closed, open and focused on an object, or open and unfocused. A person first performs them slowly while sitting down, working up to performing them more quickly and then while standing and walking.

Because the movements can worsen dizziness at first, Yardley noted, training and support is critical.

"In the past, sometimes patients have simply been given a sheet of the exercises and told to go away and do them," she said. "When this happens they try them, get dizzy, and come back and report that they do not work with the result that both patients and clinicians become disillusioned about their efficacy."

In Yardley's study, patients had a 30- to 40-minute appointment with a primary care nurse, who reviewed their symptoms and instructed them on how to perform the exercises. The nurses telephoned the patients at one and three weeks after the instruction session to provide additional support.

The researchers reviewed patients' dizziness symptoms three and six months after they began performing the exercises. By six months, 56 of the 83 patients prescribed the exercises, or 67 percent, had shown significant clinical improvement in dizziness, compared to 38 percent of 87 patients who did not perform the exercises.

"It is important for patients to see their doctor first to rule out the possibility that their dizziness is due to a disease that may need other medical treatment," Yardley stressed. "The exercises only work if you do them (correctly), so proper education, advice and support are very important."

SOURCE: Annals of Internal Medicine, October 19, 2004.

Reference Source 89
October 19, 2004

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