Background:

A patient-professional priority setting group (James Lind Alliance with input from The Meniere’s Society) identified topics most in need of Cochrane Review in the field of balance disorders. The topic “betahistine to treat symptoms of vertigo” was allocated high priority, because symptoms of vertigo are common and betahistine is frequently used worldwide in clinical practice for vertigo of any cause.

Objectives:

To assess the effect of betahistine compounds in patients with vertigo.

Methods:

We selected randomised controlled trials of betahistine versus placebo in patients of any age with vertigo from any neurotological diagnosis in community or other settings. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected information on overall improvement and on adverse events.

Results:

We included 17 studies, with a total of 1025 participants. Sixteen studies (953 people) compared betahistine with placebo.
The proportion of patients with reduction in vertigo symptoms was higher in the betahistine group (224/308 (73%)) than the placebo group (144/298 (48%)) with a pooled risk ratio of 1.45 (confidence interval (CI) 1.09 to 1.94), but statistical and clinical heterogeneity were both high.
The proportion of patients with adverse effects was low (98/142 (24%) in the betahistine group and 86/397 (22%) in the placebo group). There was no overall difference between placebo and betahistine groups (pooled risk ratio 1.02, CI 0.79 to 1.31).
The review process was also used to inform the setting of standard outcome measures for clinical trials into balance disorders, as these conditions set particular challenges for researchers.

Conclusions:

Evidence which is largely of low quality suggests there may be a small effect on the proportion of patients who report an overall benefit in terms of reduction in vertigo symptoms. Betahistine is generally well tolerated with a low risk of adverse events. Future research needs to take into account the need for rigorous trial design, particularly in terms of blinding and of validated patient-centred outcome measures.