Can Medication Fix Dizziness?

⚠️ Acute central dizziness: rule out stroke before suppressing symptoms

In patients presenting with acute, continuous dizziness or vertigo, posterior circulation stroke must always be considered. Early symptoms can mimic benign vestibular conditions, which may lead to misdiagnosis.

Contemporary emergency care guidelines emphasize:

• Using timing and trigger patterns, focused eye-movement examination (HINTS), and gait assessment by trained clinicians

• Avoiding reliance on symptom suppression or routine imaging alone, which can miss early posterior circulation strokes (Edlow et al., 2023)

Clinical implication: Medications may be used briefly to allow hydration or examination, but they should never delay or replace diagnostic evaluation when a central cause is possible (Edlow et al., 2023).

🧠 Multiple sclerosis (MS): rule out peripheral vestibular causes then treat relapses

In MS, dizziness and vertigo may result from central demyelinating lesions affecting vestibular pathways. However, common peripheral conditions—especially BPPV—still occur in MS and must be ruled out to avoid unnecessary corticosteroid treatment or prolonged vestibular suppression (Frohman et al., 2003).

• If dizziness is part of a true MS relapse, high-dose corticosteroids are often used to speed recovery, though they do not alter long-term disease progression (National MS Society)

• Short-term symptom medications may be used to support hydration and function

• Evidence supports combining symptom management with cause-directed evaluation and vestibular rehabilitation, which can improve balance and dizziness in MS (Marsden et al., 2025)

Clinical implication: In MS, determining the cause of dizziness is important prior to prescribing medications.

🧬 CANVAS: no disease-modifying dizziness medication

CANVAS (cerebellar ataxia with neuropathy and vestibular areflexia syndrome) is a progressive neurodegenerative disorder, most commonly associated with biallelic RFC1 repeat expansions. Because the condition reflects degenerative dysfunction of cerebellar, vestibular, and sensory pathways, no medication currently reverses or halts the underlying disease process (Cortese et al., 2020).

• A published case report demonstrated improved functional outcomes after vestibular rehabilitation, including improvements in gait and functional mobility (Harrell et al., 2023)

Clinical implication: For CANVAS-related dizziness and imbalance, rehabilitation and fall-risk management provide greater benefit than chronic vestibular suppressants.

🎯 Degenerative ataxias: symptom-targeted pharmacology + address eye-movement drivers

In degenerative cerebellar ataxias, treatment focuses on reducing specific symptoms, as disease-modifying options are limited (Perlman, 2024).

Evidence includes:

• 4-aminopyridine reducing attack frequency in episodic ataxia type 2 (Strupp et al., 2011). 

• Riluzole: A 2022 systematic review found that riluzole showed modest improvement in ataxia severity in some hereditary ataxia subtypes, but results were inconsistent across studies, limiting its reliability as a broadly effective treatment (Ayala et al., 2022).  

When dizziness is driven by abnormal eye movements (central nystagmus):

• 4-aminopyridine can improve downbeat nystagmus (Claassen et al., 2013)

• Gabapentin or memantine may reduce oscillopsia and visual blur (Thurtell et al., 2010)

For Friedreich ataxia, omaveloxolone (Skyclarys) is FDA-approved as a disease-specific therapy, though it is not a direct treatment for dizziness (FDA, 2023).