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DEAR DR. ROACH: I got vertigo for the first time; not knowing what was happening, I went to the hospital fearing that it could be an aneurysm or a stroke. The hospital told me it’s “just” vertigo, showed me the Epley maneuver, and prescribed meclizine for me to take for three days. A follow-up visit to my primary care doctor a couple days later confirmed the hospital’s diagnosis and treatment.
Since the hospital visit a month ago, I’ve had vertigo two or three times a week. Some episodes are so severe that I get nauseated and vomit, and it often takes me out for a full day until the meds kick in. Another checkup with my doctor yielded the same reply: “You just have to live with it and treat the symptoms with Epley and meds when they occur.” I’m only 64 years old. Do I really have to live with this for another 20 or so years? -- E.C.
ANSWER: There are several causes for vertigo, including some that are potentially dangerous. The goal of an initial evaluation is to separate the potentially dangerous causes of vertigo (those originating from the brain itself called “central vertigo,” including strokes and poor blood flow) from the much more common “benign” causes (also called “peripheral vertigo” -- those originating from the organ of balance or the nerve). A physical exam is usually sufficient to determine central vertigo from other vertigo causes.
The Epley maneuver is used when the diagnosis is benign paroxysmal peripheral vertigo (BPPV). This condition is vertigo that is caused by the crystals inside the semicircular canal in the organ of balance. This makes the brain unable to tell which way the head is moving, and we interpret this as vertigo -- a sense of movement when we’re actually still.
The maneuver is intended to clear calcium crystals from the ear canal, which can provide immediate relief. Even without treatment, most people will recover from BPPV, although my experience is that recurrent attacks are common for a month, even up to several months. (The “benign” description isn’t always accurate, as this condition impairs a person’s quality of life and contributes to fall risk.)
Meclizine, by contrast, doesn’t improve a person’s recovery, and although it can help stop symptoms temporarily, it doesn’t promote recovery and can even hinder it. I’ve seen many people take meclizine for months or even years and never get better. I never prescribe meclizine for more than a day or two.
In the cases of BPPV that isn’t getting better in the few months after the initial bout, I have the luxury of referring my patients to vestibular rehabilitation, which requires special expertise and isn’t always available. But it’s the best long-term treatment to control the condition.
DEAR DR. ROACH: I read your recent column on low ferritin levels. Isn’t iron deficiency an absolute indication for a colonoscopy, regardless of whether the patient is “due” for screening? -- M.C., MD
ANSWER: I’d say that an unexplained iron deficiency is a strong indication for colonoscopy. In a person with a clear reason for low iron levels, a colonoscopy needn’t be performed if the person doesn’t meet criteria for screening.
In the recent column that you’re referring to, the person had been given four units of blood in eight months, which is enough to explain their low ferritin levels. Still, I agree that any person with an iron deficiency should be considered for an evaluation of their colon. But I wouldn’t say that it’s an “absolute” indication.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved