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Positional vertigo: Can the Epley maneuver help against sudden attacks of dizziness?

The Epley maneuver is a simple treatment for the relief of a type of vertigo known as “benign paroxysmal positional vertigo” (BPPV). It is considered as a treatment option if the vertigo is being caused by deposits in the ear’s organ of balance.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 30, 2014

Vestibular rehabilitation to improve dizziness, balance and mobility in patients with unilateral peripheral vestibular dysfunction

People with vestibular problems often experience dizziness and trouble with vision, balance or mobility. The vestibular disorders that are called unilateral and peripheral (UPVD) are those that affect one side of the vestibular system (unilateral) and only the portion of the system that is outside of the brain (peripheral ‐ part of the inner ear). Examples of these disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, one‐sided Ménière's disease or vestibular problems following surgical procedures such as labyrinthectomy or removal of an acoustic neuroma. Vestibular rehabilitation for these disorders is becoming increasingly used and involves various movement‐based regimes. Components of vestibular rehabilitation may involve learning to bring on the symptoms to 'desensitise' the vestibular system, learning to co‐ordinate eye and head movements, improving balance and walking skills, and learning about the condition and how to cope or become more active.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Psychotherapy in dizziness: a systematic review

BACKGROUND: About 30-50% of complex dizziness disorders are organically not sufficiently explained or related to a psychiatric disorder. Of patients with such dizziness disorders, 80% are severely impaired by dizziness in their daily and working lives; nevertheless, they are often not diagnosed or treated adequately.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review

BACKGROUND: Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Manual therapy treatment of cervicogenic dizziness: a systematic review

This review assessed the efficacy of manual therapy for cervicogenic dizziness. The authors concluded that there is limited evidence to support the use of manual therapy and that further research is required. The small number of poor-quality studies included in the review justify these conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Off-Label Use of Atypical Antipsychotics: An Update [Internet]

Antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for treatment of schizophrenia, bipolar disorder, and for some drugs, depression. We performed a systematic review on the efficacy and safety of atypical antipsychotic drugs for use in conditions lacking FDA approval.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2011
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Drug Class Review: Newer Drugs for Insomnia: Final Report Update 2 [Internet]

Insomnia is a serious health problem that affects millions of people. Population surveys have estimated the prevalence of insomnia to be about 30% to 50% of the general population. About three-fourths of people who have trouble sleeping say that the problem is "occasional," averaging about 6 nights per month, with one-fourth having frequent or chronic insomnia, averaging about 16 nights per month. Individuals with insomnia most often report a combination of difficulty falling asleep and intermittent wakefulness during sleep. Treatment of insomnia involves behavioral changes, such as minimizing habits that interfere with sleep (for example, drinking coffee or engaging in stressful activities in the evening), and pharmacotherapy with sedating antidepressants (for example, trazodone), sedating antihistamines, anticholinergics, benzodiazepines, or nonbenzodiazepine hypnotics. The benzodiazepines and the newer sedative hypnotics zolpidem, zaleplon, zopiclone, and eszopiclone work through gamma-aminobutyric acid receptors. Ramelteon, a hypnotic approved by the United States Food and Drug Administration (FDA) in July 2005, is a selective melatonin receptor (MT1 and MT2) agonist. New nonbenzodiazepine drugs have been sought for multiple reasons, including reduction of the risk of tolerance, dependence, and abuse associated with benzodiazepines. The purpose of this review is to evaluate the comparative evidence on benefits and harms of these medications in people with insomnia to help policymakers and clinicians make informed choices about the use of newer drugs for insomnia.

Drug Class Reviews - Oregon Health & Science University.

Version: October 2008
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Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]

Nausea and vomiting are major concerns for patients undergoing chemotherapy, radiation therapy and surgery with general anesthesia. Risk factors associated with chemotherapy-induced nausea and vomiting include emetogenicity of the chemotherapy regimen, dose, speed of intravenous infusion, female gender, age under 50 years, history of ethanol consumption, and history of prior chemotherapy. Factors predictive of radiation therapy-induced nausea and vomiting include site of irradiation (in particular, total body irradiation and radiation fields that include the abdomen), total field size, dose per fraction, age, and predisposition for emesis (history of sickness during pregnancy or motion sickness). Female gender, a history of motion sickness or prior postoperative nausea and vomiting, nonsmoking status, and use of postoperative opioids have been suggested as factors predictive of postoperative nausea and vomiting. The objective of this review was to evaluate the comparative effectiveness and harms of newer antiemetic drugs including the 5-HT3 and NK-1 antagonists.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2009
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Drug Class Review: Beta Adrenergic Blockers: Final Report Update 4 [Internet]

Beta blockers inhibit the chronotropic, inotropic, and vasoconstrictor responses to the catecholamines, epinephrine, and norepinephrine. Beta blockers differ in their duration of effect (3 hours to 22 hours), the types of beta receptors they block (β1-selective or β1/β2-nonselective), whether they are simultaneously capable of exerting low level heart rate increases (intrinsic sympathomimetic activity [ISA]), and in whether they provide additional blood vessel dilation effects by also blocking alpha-1 receptors. All beta blockers are approved for the treatment of hypertension. Other US Food and Drug Administration-approved uses are specific to each beta blocker and include stable and unstable angina, atrial arrhythmias, bleeding esophageal varices, coronary artery disease, asymptomatic and symptomatic heart failure, migraine, and secondary prevention of post-myocardial infarction. The objective of this review was to evaluate the comparative effectiveness and harms of beta blockers in adult patients with hypertension, angina, coronary artery bypass graft, recent myocardial infarction, heart failure, atrial arrhythmia, migraine or bleeding esophageal varices.

Drug Class Reviews - Oregon Health & Science University.

Version: July 2009
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Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin [Internet]

Chest pain or discomfort caused by acute coronary syndromes (ACS) or angina has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence the need for this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: March 2010
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Efficacy and safety of perioperative pregabalin for post-operative pain: a meta-analysis of randomized-controlled trials

We calculated in a meta-analysis the effect size for the reduction of post-operative pain and post-operative analgesic drugs, which can be obtained by the perioperative administration of pregabalin. Three end-points of efficacy were analysed: early (6 h-7 days) post-operative pain at rest (17 studies) and during movement (seven studies), and the amount of analgesic drugs in the studies that obtained identical results for pain at rest (12 studies). Reported adverse effects were also analysed. The daily dose of pregabalin ranged from 50 to 750 mg/day. The duration of treatment in patients assessed for pain ranged from a single administration to 2 weeks. Pregabalin administration reduced the amount of post-operative analgesic drugs (30.8% of non-overlapping values - odds ratio=0.43). There was no effect with 150, and 300 or 600 mg/day provided identical results. Pregabalin increased the risk of dizziness or light-headedness and of visual disturbances, and decreased the occurrence of post-operative nausea and vomiting (PONV) in patients who did not receive anti-PONV prophylaxis. The administration of pregabalin during a short perioperative period provides additional analgesia in the short term, but at the cost of additional adverse effects. The lowest effective dose was 225-300 mg/day.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Do surgical patients benefit from perioperative gabapentin/pregabalin: a systematic review of efficacy and safety

BACKGROUND: Gabapentin and pregabalin have antiallodynic and antihyperalgesic properties useful for treating neuropathic pain. These properties may also be beneficial in acute postoperative pain. In this study we evaluated randomized, controlled trials examining the analgesic efficacy, adverse effects, and clinical value of gabapentinoids in postoperative pain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials

BACKGROUND: Systemic magnesium has been used to minimize postoperative pain with conflicting results by clinical studies. It remains unknown whether the administration of perioperative systemic magnesium can minimize postoperative pain. The objective of the current investigation was to evaluate the effect of systemic magnesium on postoperative pain outcomes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Alzheimer's disease: How effective are cholinesterase inhibitors?

Cholinesterase inhibitors can slightly delay the loss of mental abilities in people who have mild to moderate Alzheimer’s disease. But these medications may also cause nausea, vomiting or dizziness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 18, 2013

Tick bites: Tick-borne encephalitis (TBE)

The risk of getting tick-borne encephalitis (TBE) is much lower than the risk of getting Lyme disease. Only a small number of ticks are infected with the virus. And even if a tick is infected, the virus will not necessarily spread to the people the tick feeds on.A TBE infection can cause symptoms, but it doesn't have to. It often goes unnoticed in children, or the symptoms are only mild and temporary. The symptoms of a mild TBE infection are similar to flu symptoms and include fever, headaches, vomiting and dizziness.TBE is diagnosed by testing blood or cerebrospinal fluid for the TBE virus. Because the disease is caused by a virus, antibiotics won't help. Antiviral drugs are not available for TBE, so there is no anti-TBE therapy. Instead, treatment focuses on relieving the symptoms.Although TBE usually clears up without any lasting health problems, symptoms may last for months. Serious complications are much more common in adults than they are in children. In most children, the course of the disease is mild and long-lasting consequences are very rare.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 20, 2016

Effectiveness and Safety of Antiepileptic Medications in Patients With Epilepsy [Internet]

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center examining the comparative efficacy, safety, and tolerability of newer versus older and innovator versus generic antiepileptic medications.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2011
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Neuropathic Pain: The Pharmacological Management of Neuropathic Pain in Adults in Non-specialist Settings [Internet]

This short clinical guideline aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

NICE Clinical Guidelines - Centre for Clinical Practice at NICE (UK).

Version: November 2013
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What do ear examinations involve?

Your doctor may recommend an ear examination, if you have sudden or gradual hearing loss, ringing in your ears (tinnitus), earache, dizziness or if they think you might have a middle ear infection. Also, if a fluid comes out of your ear or if you have injured your lower jaw. Read about what types of ear examination there are.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 22, 2016

Low back pain: Medication for chronic back pain

Over-the-counter painkillers can sometimes relieve chronic low back pain. Studies have also found that some prescription painkillers like opioids may have a benefit. There is no proof that muscle relaxants or antidepressants help relieve chronic low back pain.Low back pain is one of the ten most common diagnoses made by family doctors. It often goes away on its own without treatment, but sometimes it persists or keeps coming back. The causes of chronic low back pain are usually unclear, and treating it is often difficult.Good-quality studies have so far found that only few treatments help. Besides medication, treatments such as exercise therapy, psychological therapy, physiotherapy and acupuncture are used. The medications used include over-the-counter and prescription painkillers, muscle relaxants and antidepressants.Because medication can have side effects – especially when taken over longer periods of time – experts recommend not taking it continuously, but rather only for a short while, for example if the pain is especially severe.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 2, 2015

Benign enlarged prostate: Medication and herbal products

Most men who have prostate problems either wait a while to see how their symptoms develop, or take medication. Medication is often used when the symptoms are not bad enough for surgery to be needed, but have become too bothersome to be left untreated.This might be the case if you have to go to the bathroom several times a night, or constantly feel the need to urinate during the day too because your bladder no longer empties properly. These typical symptoms of an enlarged prostate can become a real burden.Several types of medications and combinations of medications are available for the relief of problems associated with an enlarged prostate. Like with any medication, it is important to carefully consider the advantages and disadvantages of these medications, and be aware of possible interactions between different medications. The majority of men with an enlarged prostate are over the age of 50, and often on other medications too, like drugs for high blood pressure (hypertension).For instance, if a man is taking alpha blockers for the treatment of prostate problems, he should not use impotence drugs as well. This is because both of these medications have a blood-pressure-lowering effect, so his blood pressure could become too low otherwise.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Systematic Reviews in PubMed

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