10 Treatments to Help You Manage Meniere’s Disease Attacks

Meniere’s disease is caused by fluid buildup in the inner ear, which controls hearing and balance. People with Meniere’s disease have sudden, unpredictable attacks of dizziness (vertigo), nausea, and headaches. They may also experience hearing loss that comes and goes, and ringing in the ears (tinnitus). These attacks can last for hours and make it difficult — or even impossible —- to do everyday activities. Because attacks can start without warning, it’s easy to be caught off guard. 

Here are 10 helpful tips you can use to manage Meniere’s attacks. 

1. Trigger avoidance

Certain actions or events can trigger Meniere’s attacks or make them last longer. These triggers can be different for different people, but the most common ones are:

• High-exertion activities or sudden head movements, like tilting your head back

• Bright lights or flashes of light

• Strong smells, like smoke or cleaning products

• Exposure to allergies like pollen and dander

• Humidity changes

• Foods containing tyramine, like smoked meats, beer, and pickles

• Smoking

• Stress

• Travel

Avoid these triggers when possible. During your next attack, see if anything specific makes your symptoms worse. You can also time your attacks to see if they last longer when you’re doing certain activities. This will help you identify your triggers so you can avoid them in the future. 

2. Low-sodium diet

Research suggests that high-sodium foods can trigger attacks by increasing fluid buildup in the inner ear. Monosodium glutamate (MSG) can also increase fluid buildup in your inner ear. Following a low-sodium, low-MSG diet may help you avoid Meniere’s attacks. 

In one study, people with Meniere’s disease who limited their salt intake to 1,500 mg each day had fewer vertigo symptoms and better audiology test results than those who didn’t limit salt.

Experts suggest limiting your sodium intake to no more than 2,300 mg each day. You can do this by: 

• Reading food labels to track sodium content in food

• Choosing fresh fruits and vegetables whenever possible

• Choosing fresh beef, poultry, or fish instead of processed meats

• Avoiding adding extra salt to your food

3. Limit caffeine and alcohol

Some people notice that caffeine or alcohol can make Meniere’s attacks worse. It’s not clear why this happens. Caffeine causes blood vessels to clamp down, which may reduce how much blood flow gets to your inner ear. This can stress your inner ear and trigger an attack. 

Alcohol can cause fluid and electrolyte levels to shift in your inner ear. This may also trigger attacks in some people. 

You can try lowering your caffeine or alcohol intake to see if it improves your symptoms. 

4. Vestibular rehabilitation

Vestibular rehabilitation is a type of physical therapy. It uses exercises to help manage inner ear symptoms like vertigo, dizziness, and balance problems. Many people with Meniere’s disease find relief with vestibular rehabilitation. You may need to continue it long-term to help manage your symptoms. 

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5. Diuretic therapy

Diuretics are prescription medications that help control fluid balance in your body. They may help limit fluid buildup in your inner ear. Diuretics that may help treat Meniere’s disease include:

• Maxzide (hydrochlorothiazide / triamterene)

• Aldactone (spironolactone)

• Diamox (acetazolamide)

These medications aren’t FDA approved to treat Meniere’s disease, but they may be prescribed off-label to treat Meniere’s attacks. These medications may not work for everyone with Meniere’s disease. And they aren’t safe for people with certain medical conditions. Work with your healthcare team to decide if these medications are right for you. 

6. Intratympanic injections

Intratympanic injections are medications given directly to your inner ear. An otolaryngologist (ear, nose, and throat doctor) can give these injections in the office. The medication is injected through your eardrum using a syringe and needle. 

Medications used this way to treat Meniere’s disease include:

• Gentamicin (an antibiotic)

• Dexamethasone (a steroid)

7. Rescue medications

Many people take daily medication to help prevent fluid buildup in the inner ear. But they may also need medication to get through attacks. These are called emergency medications. Some people need more than one during an attack. Some common options include:

• Clonazepam (Klonopin)

• Diazepam (Valium)

• Ondansetron (Zofran)

8. Antihistamines

Antihistamines are oral medications that stop your body from releasing a substance called histamine. Histamine causes allergy symptoms like itching, sneezing, and hives. They can help stop Meniere’s attacks for some people. Commonly prescribed antihistamines for Meniere’s attacks include:

• Dramamine (dimenhydrinate)

• Antivert (meclizine)

• Benadryl (diphenhydramine)

• Phenergan (promethazine)

9. Stress management

There’s no cure for Meniere’s disease. But with treatment, you can go years — or even decades — without an attack. Studies also show that with treatment, most people with Meniere’s disease can go about their usual activities. 

While that’s good news, it’s important to recognize that attacks are stressful. Many people with Meniere’s disease report higher levels of stress and depression. Taking care of your mental health is important. Consider:

• Working with a therapist

• Joining a support group

• Talking to your healthcare team about other treatment options

10. Create an attack plan

Meniere’s attacks can be unpredictable. You can lose your balance and fall or have an accident while driving during an attack. An attack plan can keep you safe during an attack. 

The first step in creating an attack plan is to pinpoint your “auras.” Auras are a set of mild symptoms that can warn you that you’re about to have an attack. You might miss your aura if you aren’t paying attention. Aura symptoms include:

• Lightheadedness

• Feeling off balance

• Headache

• Ear pressure

• Sensitivity to sound

• Feeling uneasy

The next step is to prepare an emergency kit. This should include your medications. If possible, keep one in places where you spend a lot of time, like your car or office. Your emergency kit should also include a list of medications that could make your symptoms worse. 

Friends and family naturally want to help when you’re having an attack. Make sure they know which medications to avoid. Some medicines can actually worsen your symptoms, including:

• Aspirin

• Antacids, like calcium carbonate

• Ibuprofen (Advil, Motrin)

• Naproxen (Aleve, Naprosyn)

• Caffeine-containing medications, like Excedrin

The final part of your plan includes “next-step” actions. It can be hard to think of what to do in the moment to keep yourself safe. Practicing a routine can help. Here are some things to decide ahead of time:

• Safe space: When your symptoms start, you’ll need a safe place to sit or lie down. Pick places near locations where you spend a lot of time, like work, school, or the gym. 

• Safe driving: If you’re driving, pull over at the first sign of an attack so you don’t get into an accident. Have items on hand that can help, like flares or roadside assistance numbers programmed into your phone.

• Weather notifications: Changes in barometric pressure can also trigger attacks. Keep a weather or barometer app on your phone. If you see a storm or rain alert, consider changing your plans and don’t drive.

• Medication plan: Keep your rescue medications nearby at all times. Store a single dose in an easy-to-open container, like a pillbox. That way you don’t have to worry about counting out pills or giving instructions to friends or family. Also keep water or liquids nearby so you can take your pills easily. 

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Written by:

Ronald W. Dworkin, MD, PhD

Ronald W. Dworkin, MD, is a board-certified anesthesiologist who has been practicing anesthesiology in a community hospital for 30 years. He has taught in the honors program at George Washington University for over 10 years and works as a senior fellow at the Hudson Institute.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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