Vertigo is one of the most distressing neurological symptoms a person can experience. The sensation that the room is spinning, that the body is moving when it is not, or that balance is suddenly lost can significantly interfere with daily life. One of the most commonly prescribed medications for the treatment of vertigo is betahistine.
What Is Betahistine?
Betahistine is a medication structurally similar to histamine. It is mainly used to treat disorders of the inner ear (vestibular system), especially those associated with recurrent vertigo and balance disturbances.
It is most commonly prescribed for:
- Ménière’s disease
- Recurrent peripheral vertigo
- Vestibular dizziness
- Balance disorders related to inner ear dysfunction
Betahistine does not act as a sedative and does not suppress the vestibular system. Instead, it improves the underlying inner ear circulation and function.
How Does Betahistine Work?
Betahistine acts on histamine receptors in the brain and inner ear:
- It stimulates H1 receptors, leading to vasodilation (widening of blood vessels) in the inner ear.
- It blocks H3 receptors, which increases the release of neurotransmitters such as histamine, acetylcholine, and norepinephrine in the vestibular nuclei.
This combined effect:
- Improves microcirculation in the inner ear
- Reduces abnormal pressure in the labyrinth
- Enhances central vestibular compensation
As a result, vertigo attacks become less frequent and less intense over time.
When Is Betahistine Most Effective?
Betahistine is particularly effective in conditions involving vestibular dysfunction, including:
- Ménière’s disease — reducing frequency and severity of vertigo attacks
- Vestibular neuritis — supporting central compensation
- Chronic vestibular dizziness
- Post-viral or idiopathic vertigo
It is not effective for vertigo caused by:
- Stroke
- Brain tumors
- Multiple sclerosis
- Cervical spine disorders
- Anxiety-related dizziness
This is why accurate neurological and ENT evaluation is essential before starting treatment.
Side Effects and Safety
Betahistine is generally well tolerated. Possible side effects include:
- Mild gastrointestinal discomfort
- Headache
- Nausea
- Rare allergic skin reactions
It should be used cautiously in patients with:
- Active peptic ulcer disease
- Severe asthma
- Pheochromocytoma
Betahistine is not known to cause sedation, dependence, or cognitive impairment.
Betahistine and Vestibular Rehabilitation
Medication alone is often not sufficient. The best outcomes are achieved when betahistine is combined with:
- Vestibular rehabilitation exercises
- Balance training
- Physiotherapy
- Lifestyle modifications (salt reduction in Ménière’s disease, hydration, sleep regulation)
This integrated approach accelerates central compensation and long-term recovery.
When Should You See a Neurologist?
Vertigo should always be properly evaluated, especially if it is accompanied by:
- Double vision
- Weakness or numbness
- Speech difficulties
- Severe headache
- Sudden hearing loss
These symptoms may indicate a central neurological cause and require urgent assessment.
Betahistine is a safe and effective treatment for many forms of peripheral vertigo, particularly those arising from inner ear dysfunction. It works by improving inner ear blood flow and supporting the brain’s natural compensation mechanisms. When used appropriately and combined with rehabilitation, it can significantly reduce the burden of vertigo and improve quality of life.
If you suffer from persistent or recurrent vertigo, consult a neurologist or ENT specialist to determine whether betahistine is appropriate for you.