A Full Review of Herbal Remedies for Managing Different Types of Vertigo

Dr. T. Harika, J. Lulika Kumari, J. Ambika, B. Nagavamsi, B. Thrishank Kumar,

doi:10.5281/zenodo.17168587

Review Paper | Open Access
Volume 03 | Issue 09 | Article Id IJPS/250309231

A Full Review of Herbal Remedies for Managing Different Types of Vertigo
Dr. T. Harika* J. Lulika Kumari J. Ambika B. Nagavamsi B. Thrishank Kumar
NRI College of Pharmacy, Pothavarappadu, Vijayawada 521212

Abstract

Vertigo is uncomfortable symptom of either vestibular or neurological pathology; it is a condition that is marked by a spinning feeling, lack of balance, nausea, and tinnitus. It is multifactorial in nature and some causes are peripheral ear disorders, lesions at the central nervous system, vascular insufficiency, metabolic diseases, infections and stress. The traditional management is using a vestibular suppressant, antiemetic, diuretics, corticosteroids and migraine prophylaxis. Such agents are acutely effective but have a limitation of sedation, dependence, or slow vestibular compensation, and hence safer, long-term approaches are warranted. Herbal medicines employed in traditional Ayurveda, Traditional Chinese Medicine (TCM) and folk medicine are finding their way as complements. Their clinical utility is based on the fact that they enhance microcirculation, lessen oxidative stress, alter neurotransmitters and have anti-inflammatory and antiemetic effects. Ginkgo biloba improves cerebral and inner ear blood circulation with evidence in Méniere disease and vascular vertigo. Ginger treats nausea and inflammation of the vestibular in connection with motion sickness. Neuroprotective adaptogenic herbs such as Ashwagandha, Brahmi and Gotu kola relieve stress, enhance cognitive and balance capabilities. Coriander, Tulsi, Chamomile, Lemon balm and Valerian are antioxidants, anxiolytic, and sedatives that can be used in psychogenic or stress-related vertigo. Plants like Garlic, Cinnamon, Clove, Licorice, Feverfew, and Skullcap are known to aid a circulatory or anti-inflammatory or neuroprotective activity. Although usually safe, herb-drug interactions (e.g. with anticoagulants, sedatives, and antihypertensives) and changeability in phytochemical composition are of concern. More standardization and clinical trials should be conducted to prove efficacy. Overall, herbal interventions provide a multi-factorial, holistic management method of vertigo, and their combination with standard treatment could help better treat patients with minimal side effects.

Keywords

Vertigo; Herbal medicine; Ayurveda; Ginkgo biloba; Neuroprotective herbs; Complementary therapy

Introduction

Vertigo is a frequent complaint in primary care and emergency settings, characterized as a sensation of motion, generally rotational, due to vestibular dysfunction. Accurate isolation of vertigo from other forms of dizziness, such as presyncope, disequilibrium, or flightiness, is essential for effective opinion and operation. [1] This symptom affects individualities across all age groups. In adolescent cases, vertigo generally arises from inner ear pathology. In aged grown-ups, targeted assessment is critical, as central causes of vertigo, which are more current in this population, increase the threat of falls and related complications, challenging precise evaluation to ensure applicable treatment and enhanced patient outcomes. [2]

Traditionally, plants have been used as the main drug source by humankind since ancient times and are the base of traditional drug systems like Ayurveda, Traditional Chinese Medicine and Unani. To this day, herbal remedies still form an essential part of healthcare system because they're available, considered safe to use and applicable within societies. Herbal drugs have many bioactive compounds of which they belong to alkaloids, flavonoids, glycosides, tannin and essential oils which are came by using different parts of plants stems, leaves, flowers, fruits and seeds. These phytochemicals play functions in a wide variety of pharmacological actions to carry these out there areanti-inflammatory, antimicrobial, antioxidant, analgesic, and immune modulators.

Herbal remedies are also being researched in the current healthcare culture as an alternative or addition to treatment of many kinds of conditions in healthcare-chronic conditions, like diabetes, hypertension and arthritis to the common illnesses buried forehead, fever and skin infections. Herbal formulations could have a synergistic action on various pathways unlike synthetic medicines which tend to affect only one mechanism which results in action being holistic in nature therefore profitable in the operation of the disease. Also, the maturity of cases allow using herbal remedies because they've smaller side effects, reduced cost, and have long traditions in use. The significance of herbal drug has been conquered to increased interest around the world in the once decades, which can be explained by the increasing popularity and necessity of natural products, lifestyle related diseases and thefailings of conventional treatment. WHO also estimates that about 80 percent of the global community depends on herbs in terms of access to primary healthcare requirements. still, it must be scientifically validated to be safe, effective and to have a system of controlling quality. To incorporate herbal drugs into confirmation based on healthcare, standardization, pharmacological assessment and clinical trials are getting common.

EPIDEMIOLOGY:

Vertigo affects both men and women, but it's around 2 to 3 times more common in women than men( 1). This condition has been companied with various comorbid conditions, including depression and cardiovascular complaint. frequency increases with age and varies depending on the bolstering opinion; predicated on a general population check, the 1- time frequency of vertigo is about 5, and the periodic frequency is 1.4. Dizziness, including vertigo, affects about 15 to over 20 of grown- ups yearly. For benign ferocious positional vertigo, the 1- time frequency is about 1.6, and is lower than 1 for vestibular migraine.[3] The impact of vertigo should not be underrated, as nearly 80 of check attesters reported an interruption in exertion of quotidian living, including employment and the need for fresh medical attention. The frequency of Meniere complaint has been recently reported to be 0.51, which is important advanced than former reports. [3][4]

PATHOPHYSIOLOGY:

Abnormalities in the vestibular system account for the symptoms of vertigo and may affect from damage or dysfunction in the supplemental vestibular system, similar as the vestibular maze or vestibular whim-whams, or a disturbance in the central vestibular system set up in the brainstem and cerebellum.[1] Though there may be a endless vestibular disturbance, the symptom of vertigo is no wayendless as the central nervous system adapts over days to weeks.[5] Tumours can bring vertigo by contraction of the structures in the central vestibular system. Schwannoma is the most common lesion in the cerebellopontine angle. [6]Meningioma is the most common extra-axial tumour in grown-ups, and is the alternate most common lesion in the cerebellopontine angle. Glomus jugulare and glomus jugulotympanicum are the chemoreceptor system's main primary tumours of the jugular foramen. Metastases should be a consideration in cases with known primary tumors or multiple brain lesions. Infections can beget vertigo by involving the supplemental or central vestibular system, with viral labyrinthitis being the most common sample. Otomastoiditis is an infection of the tympanic and mastoid depressions commonly caused by bacterial agents, the most common being Streptococcus pneumoniae and Haemophilus influenza. Acute cerebellitis is an encephalitis that’s confined to the cerebellum. This condition is most common in children, and Varicella- zoster cancer is the leading cause. Cholesteatoma can be acquired or natural, being in the pars flaccida or pars tensa, caused by the abnormal proliferation of keratinized stratified squamous epithelium. [7]

Types of Vertigo

There are 2 types of vertigo -

Peripheral vertigo
Central vertigo

1. Peripheral vertigo

Peripheral vertigo is the most common type of vertigo and is caused by problems in the inner ear, which controls our balance. It presents with symptoms such as spinning sensation, sweating, nausea, vomiting and ear problems. However, there can be pain or feeling of completeness in the ear, If supplemental vertigo is due to an infection in the inner ear.[8][9]

Causes of peripheral vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo. This type of vertigo is easy to treat and hence correct diagnosis avoids inessential testing and costly treatment. BPPV is characterized by short-lived episodes of rotatory dizziness along with head movements. The usual time frame is nearly 45 seconds.

Vestibular neuritis causes a monophasic occasion of vertigo that lasts for days or indeed weeks in worst cases. In the acute phase, it's generally accompanied by severe nausea & vomiting.[8]
Ménière's disease is another cause of peripheral vertigo and is a result of endolymphatic regulatory dysfunction. Spells of dizziness generally last for hours, and are frequently preexisted by pressure or completeness in the ear. High salt input might make matters worse.[9]

Trauma can also cause many types of vertigo including BPPV.

In treating BPPV, the Epley maneuver and Brandt-Daroff exercises that involve a series of guided head movements have been found to be helpful. Any hearing loss or ringing in the ears is treated with medication and hearing aids. A low salt diet, diuretic medications, and abstaining from alcohol can help with recovery.[8]

2. Central vertigo

Central vertigo mainly occurs due to brain injury or disease. It often appears suddenly and lasts longer than peripheral vertigo. The intensity is also greater. Patients may need assistance to walk or even stand.[10]

Causes of central vertigo

Transient ischemic attack (TIA) and brainstem infarction are significant causes of central vertigo because ischemia in the brainstem can be life threatening. Like all strokes and TIAs, common risk factors for this condition include diabetes, high blood pressure, and high cholesterol. This type of vertigo usually shows up with dizziness, double vision, numbness, and poor coordination. Patients often experience vertigo, double vision, loss of balance on one side, and decreased pain sensation on the face on the same side.
Central vertigo can only be treated by identifying and addressing the underlying cause. Migraines can often be managed with preventive migraine medications. For conditions like multiple sclerosis and tumors, treating symptoms with medications for nausea and dizziness usually provides relief.[10][11]

Vertigo associated with present day diseases

1. Neurological Disorders

Stroke / Transient Ischemic Attack (TIA) – reduced blood flow to brain regions (especially cerebellum/brainstem) can cause central vertigo.[12]
Multiple Sclerosis (MS) – demyelination affects brain areas controlling balance.[13]
Migraine (Vestibular Migraine) – one of the most common present-day causes of recurrent vertigo.[14]

2. Cardiovascular & Metabolic Diseases

Hypertension & Hypotension – altered blood flow to the brain can cause dizziness and vertigo.
Atherosclerosis – reduced blood supply to inner ear/brainstem.
Diabetes Mellitus – damages small blood vessels and nerves (diabetic neuropathy affecting vestibular system).[15]
Obesity & Dyslipidemia – increase risk of stroke and vestibular dysfunction.[16]

3. Ear & Vestibular Disorders

Benign Paroxysmal Positional Vertigo (BPPV) – most common cause, often seen in sedentary lifestyle/aging.
Meniere’s Disease – associated with modern dietary factors (salt, caffeine, stress).[17]
Vestibular Neuritis/Labyrinthitis – often viral infections (common with weakened immunity).
Chronic Otitis Media – recurrent infections in developing regions.[18]

4. Psychiatric & Stress-Related Disorders

Anxiety Disorders – “psychogenic dizziness” often worsened by modern stress.
Depression – associated with imbalance and dizziness.
Panic Attacks – sudden vertigo-like sensations.[19]

5. Modern Lifestyle & Environmental Causes

Cervical Spondylosis / Cervicogenic Vertigo – prolonged computer/mobile use leading to neck problems.
Sedentary Lifestyle – weak vestibular compensation.
Medication-induced Vertigo – antibiotics (aminoglycosides), antihypertensives, sedatives, chemotherapy.
Post-COVID Syndrome – viral infection and inflammation of the vestibular system linked to vertigo.[20]

Conventional Management of Vertigo

Vertigo is not a disease itself but a symptom of underlying vestibular or neurological disorders. Its management involves both pharmacological treatments to control acute symptoms and non-pharmacological interventions to address the root cause, promote central compensation, and improve quality of life. [21]

1. Pharmacological Management

Pharmacological treatment initialy aimed at reducing the intensity of vertigo, controlling nausea/vomiting, and addressing specific causes.These agents are usually used in the acute phase and for short duration, as prolonged use may delay vestibular compensation.

a) Vestibular suppressants

Antihistamines (H1 receptor blockers):
Meclizine, Dimenhydrinate, Cinnarizine
Reduce excitability of the vestibular system, alleviate motion sickness, dizziness, and nausea.
Commonly used in BPPV, vestibular neuritis, labyrinthitis.[21]

Anticholinergics:

Scopolamine (transdermal patches).
Useful for motion-induced vertigo but limited by side effects like dry mouth, blurred vision.
Benzodiazepines (GABA agonists):[22]
Diazepam, Lorazepam, Clonazepam.
Reduce vestibular excitability and have anxiolytic effects.
Reserved for severe acute vertigo due to risk of dependence and sedation.[23]

b) Antiemetics

Metoclopramide, Domperidone, Promethazine, Ondansetron.
Control nausea and vomiting associated with acute vertigo.[24]

c) Corticosteroids

Prednisone, Methylprednisolone.
Given in acute vestibular neuritis to reduce inflammation of the vestibular nerve.
Evidence suggests early steroid use may improve recovery.[25]

d) Diuretics

Hydrochlorothiazide, Triamterene, Acetazolamide.
Reduce inner ear fluid pressure in Ménière’s disease.
Combined with salt restriction for better outcomes[26]

e) Betahistine

Mostly prescribed in Asia and Europe, less common in the US.
Improves microcirculation in inner ear, reduces endolymphatic pressure.
Beneficial in Ménière’s disease for reducing frequency and severity of vertigo attacks.

f) Migraine Prophylaxis Drugs (in Vestibular Migraine)

Calcium channel blockers (flunarizine, verapamil), beta-blockers (propranolol), tricyclic antidepressants, and topiramate.
Reduce recurrence of vertigo episodes linked with migraine.[27]

2. Non-Pharmacological Interventions

Long-term management focuses on rehabilitation, repositioning techniques, and lifestyle modifications. These interventions address the underlying pathology, enhance vestibular compensation, and reduce recurrence.

a) Vestibular Rehabilitation Therapy (VRT)

Individually tailored exercise programs developed by physiotherapists.
Include gaze stabilization, balance training, and habituation exercises.
Promotes central nervous system compensation and improves postural stability.
Specifically effective in chronic vertigo, vestibular neuritis, bilateral vestibulopathy.[28]

b) Repositioning Maneuvers (for BPPV)

Epley’s Maneuver (Canalith Repositioning): Moves displaced otoliths from semicircular canals back to utricle. First-line treatment for BPPV.
Semont Maneuver: Quick side-lying maneuver useful in some cases of posterior canal BPPV.
Brandt–Daroff Exercises: Home-based habituation exercises for recurrent BPPV.[29]

c) Lifestyle & Dietary Measures

For Ménière’s disease:
Restriction of dietary salt (<1.5–2 g/day).
Avoid caffeine, alcohol, nicotine (reduce triggers).
Maintain adequate hydration.
Regular sleep, stress reduction, and avoidance of sudden head movements help reduce episodes.[26]

d) Safety Measures

During acute vertigo attacks, patients should lie still in a quiet room.
Avoid driving or operating machinery.
Home modifications: good lighting, handrails, nonslip mats to prevent falls.[30]

e) Psychological Support

Anxiety and depression are common in chronic vertigo patients.
Cognitive behavioral therapy (CBT) and counseling can help improve coping strategies.[31]

f) Surgical / Interventional (for refractory cases)

Endolymphatic sac decompression, vestibular nerve section, labyrinthectomy – considered in severe, intractable Ménière’s disease.[32]
Injections (e.g., intratympanic gentamicin or steroids): Chemical ablation or inflammation control.[33]

ROLE OF HERBAL MEDICINE IN VERTIGO

For managing vertigo and associated symptoms like dizziness imbalance nausea and tinnitus, various systems of medicines are used traditionally such as ayurveda traditional Chinese medicine (TCM) and folk medicine.

Their benefits are stem from improving cerebral and vestibular circulation reducing oxidative stress regulating neuro transmitters and providing anti-inflammatory and antiemetic effects

The herbs used in vertigo includes:

Ginkgobiloba – enhances inner ear and brain microcirculation.
Ginger – strong antiemetic, reduces nausea and vomiting.
Brahmi and Ashwagandha – neuroprotective, adaptogenic, and stress-relieving.
Coriander seeds and Holy basil – having antioxidant property for vestibular health.
Gastrodiaelata and Uncariarhynchophylla (TCM) – neuroprotective and antihypertensive.

The main role of herbal medicine offers a multi targeted approach by addressing vascular insufficiency, inflammation and inner ear disfunction making them useful for long term management and can be combined with conventional therapies into patient outcomes.[34]

Herbs used in vertigo

Herb Name	Major Chemical Constituents	Type of Vertigo Treated	Mechanism of Action	Pharmacological Action
Ginkgo biloba	Flavonoids, Ginkgolides, Bilobalide	Vestibular vertigo, Meniere’s disease	Improves cerebral & inner ear blood flow, antioxidant	Neuroprotective, vasodilatory [35]
Ginger (Zingiber officinale)	Gingerols, Shogaols, Zingerone	Motion sickness–induced vertigo	5-HT3 receptor antagonist, reduces vestibular sensitivity	Anti-emetic, anti-inflammatory [36]
Peppermint (Mentha piperita)	Menthol, Menthone, Rosmarinic acid	Motion sickness, nausea vertigo	Calcium channel modulation, CNS effect	Antispasmodic, antiemetic[37]
Turmeric (Curcuma longa)	Curcumin, Turmerone, Zingiberene	Vestibular migraine, inflammatory vertigo	NF-κB inhibition, antioxidant	Anti-inflammatory, neuroprotective[38]
Coriander (Coriandrum sativum)	Linalool, Flavonoids, Coumarins	Anxiety-related vertigo	GABAergic modulation, antioxidant	Anxiolytic, neuroprotective[39]
Valerian (Valeriana officinalis)	Valerenic acid, Alkaloids, Iridoids	Stress/anxiety vertigo	Enhances GABA activity	Sedative, anxiolytic[40]
Brahmi (Bacopa monnieri)	Bacosides A & B, Alkaloids	Vestibular migraine, cognitive-related vertigo	Enhances cholinergic transmission, antioxidant	Cognitive enhancer, adaptogen[41]
Cinnamon (Cinnamomum zeylanicum)	Cinnamaldehyde, Eugenol, Proanthocyanidins	Circulatory vertigo	Improves blood flow, CNS stimulation	Circulatory stimulant, antioxidant[42]
Ashwagandha (Withaniasomnifera)	Withanolides, Alkaloids	Stress-related vertigo	Reduces cortisol, neuroprotective	Adaptogen, anxiolytic[43]
Tulsi (Ocimum sanctum)	Eugenol, Ursolic acid, Rosmarinic acid	Stress & inflammatory vertigo	Antioxidant, reduces oxidative stress in CNS	Adaptogen, anti-inflammatory[44]
Chamomile (Matricaria chamomilla)	Apigenin, Bisabolol, Flavonoids	Anxiety-related vertigo	Binds benzodiazepine receptors, GABA agonist	Sedative, anxiolytic[45]
Garlic (Allium sativum)	Allicin, Sulfur compounds, Flavonoids	Circulatory vertigo, atherosclerotic vertigo	Improves blood circulation, reduces cholesterol	Antiplatelet, cardioprotective[46]
Lemon balm (Melissa officinalis)	Rosmarinic acid, Citral, Flavonoids	Anxiety & sleep-related vertigo	Enhances GABAergic activity	Sedative, anxiolytic[47]
Gotu kola (Centella asiatica)	Asiaticoside, Madecassoside, Triterpenes	Cognitive impairment–related vertigo	Enhances neuronal repair, antioxidant	Neuroprotective, cognitive enhancer [48]
Licorice (Glycyrrhiza glabra)	Glycyrrhizin, Flavonoids, Saponins	Meniere’s disease, vestibular vertigo	Anti-inflammatory, cortisol modulation	Anti-inflammatory, immunomodulator [49]
Cardamom (Elettaria cardamomum)	Cineole, Terpenes, Flavonoids	Nausea & dizziness vertigo	CNS stimulation, improves circulation	Digestive stimulant, antioxidant [50]
Shankhpushpi (Convolvulus pluricaulis)	Flavonoids, Alkaloids, Coumarins	Cognitive stress-related vertigo	Enhances cholinergic activity, antioxidant	Memory enhancer, anxiolytic[51]
Clove (Syzygium aromaticum)	Eugenol, Flavonoids, Tannins	Motion sickness, nausea vertigo	CNS depressant effect, antioxidant	Anti-nausea, mild sedative[52]
Feverfew (Tanacetum parthenium)	Parthenolide, Sesquiterpene lactones	Vestibular migraine	Inhibits serotonin release, reduces inflammation	Antimigraine, anti-inflammatory[53]
Skullcap (Scutellarialateriflora)	Baicalin, Flavonoids, Alkaloids	Anxiety-related vertigo	GABA receptor modulation, CNS calming	Sedative, anxiolytic[54]

Safety, side effects and herb drug interactions

Gingko biloba turmeric brahmi,valeriam, ashwagandha and pippermentthese are used as herbal medicine for vertigo these are generally safe when consumed recommended therapeutic doses. The safety depends on some factors such as dosage and duration of use prolonged or high dose consumption may lead to toxicity

CAUTION

Majorly required in children, pregnant or lactating women, elderly patients and individuals affected with liver or kidney disorders.

Side Effects of Herbs Used in Vertigo

1. Ginkgo biloba:

Mild gastrointestinal upset, headache, dizziness, or skin reactions.
Rare but serious adverse effect: Increased risk of bleeding in sensitive individuals.

2. Ginger (Zingiber officinale):

Heartburn, mouth irritation, abdominal discomfort, or diarrhea when taken in large doses.
May lower blood pressure and blood sugar.

3. Turmeric (Curcuma longa):

Generally safe, but high doses may cause nausea, bloating, or diarrhea.
Long-term use may affect gallbladder and increase risk of kidney stones due to oxalate content.

4. Bacopa monnieri (Brahmi):

Dry mouth, stomach upset, increased bowel movements, or fatigue.
Rarely, it may cause bradycardia in predisposed individuals.

5. Valerian (Valeriana officinalis):

Drowsiness, vivid dreams, mild headache, and stomach upset.
Sudden withdrawal after long-term use may cause mild withdrawal symptoms.

6. Ashwagandha (Withania somnifera):

Possible side effects: drowsiness, mild gastrointestinal discomfort, or allergic reactions.
Large doses may cause vomiting or diarrhea.

7. Peppermint (Mentha piperita):

Some individuals may cause heartburn, mouth irritation, or allergic reactions.
Excessive intake may worsen gastroesophageal reflux.[34]

Herb–Drug Interactions

Ginkgo biloba:

Potentiates the effect of anticoagulants (warfarin, heparin), antiplatelet agents (aspirin, clopidogrel), and NSAIDs → ↑ bleeding risk. May interact with anticonvulsants, decreasing seizure threshold.

Ginger:

Enhances the effect of anticoagulants and antiplatelet drugs ↑ bleeding risk. Lowers blood sugar levels, care for diabetic patients. Potentiates antihypertensive drugs, leading to hypotension.

Turmeric:

Interacts with anticoagulants (warfarin, aspirin), enhancing bleeding tendency. May interfere with drugs affecting liver metabolism (CYP enzymes).May reduce the effectiveness of proton pump inhibitors and increase risk of GI upset with NSAIDs.

Brahmi:

Enhances sedative and hypnotic effects when combined with CNS depressants (benzodiazepines, antihistamines, barbiturates). May potentiate thyroid hormone replacement therapy.

Valerian:

Potentiates sedatives, hypnotics, alcohol, antidepressants, and antihistamines causes excessive CNS depression. Should be avoided with anesthesia due to additive depressant effect.

Ashwagandha:

Use of benzodiazepines, barbiturates, or alcohol causes sedative effect. Can interact with immunosuppressants, thyroid medications, and antihypertensive drugs.

Peppermint:

May reduce absorption of certain drugs by accelerating gastric emptying. Can inhibit cytochrome P450 enzymes, leading to altered drug metabolism. Interacts with antacids and proton pump inhibitors.[55]

CONCLUSION

Vertigo is a frequent neurological symptom defined as an illusory sensation of spinning, imbalance, and dizziness and is generally accompanied by nausea, vomiting, and psychological distress. It can affect from various causes including inner ear disorder, central nervous system disorder, vascular insufficiency, or psychosomatic causes. Traditional pharmacologic treatment consists of vestibular suppressants, antihistamines, antiemetics, and anxiolytics, which exert relief that is temporary but accompanies side effects in the form of sedation, dependency, and symptom relapse. This has generated interest in safer and natural options like herbal remedies, which are traditionally accepted in systems of traditional medicine and increasingly researched in contemporary pharmacology.

Some medicinal plants have been traditionally and scientifically documented to be involved in the management of vertigo. Ginkgo biloba is a most studied herb, which improves cerebral circulation, attenuates oxidative stress, and enhances balance disorders, especially in Meniere's disease and vertigo of vascular origin. Zingiber officinale or ginger is a well-documented herb with antiemetic, anti-inflammatory, and vestibular-modulating action and is very effective in motion sickness and vertigo with nausea. Withania somnifera (ashwagandha), Bacopa monnieri (brahmi), and Centella asiatica (gotu kola) are adaptogens and neuroprotective substances that counteract stress, anxiety, and cognitive impairment, which usually exacerbate vertigo symptoms. Coriandrum sativum, Glycyrrhiza glabra, Tinospora cordifolia, and Convolvulus pluricaulis are also mentioned in Ayurveda and Unani texts for their action of soothing the nervous system, enhancing blood flow, and maintaining ear health.

The modes of action of these herbs are varied and comprise vasodilation, antioxidant activity, anti-inflammatory action, modulation of neurotransmitters, neuroprotection, and facilitation of vestibular function. In contrast to synthetic medications, which tend to affect one pathway only, herbal preparations affect many physiological processes and thus are especially appropriate for a multifactorial symptom such as vertigo. In addition, their safety profile, low cost, and cultural acceptability contribute to their therapeutic utility.

But challenges persist in their use in the clinic. The majority of studies available are small-scale clinical trials or preclinical studies, and few large, well-controlled studies exist to determine efficacy. Problems with consistency in phytochemical content, dosing, and possible herb–drug interactions (e.g., ginkgo with anticoagulants, ginger with antiplatelet drugs) need to be resolved before these remedies become a part of mainstream medicine.

In summary, herbal medicine presents a promising complementary intervention for the management of various forms of vertigo. By leveraging traditional information with contemporary scientific investigation, natural therapies have the potential to improve patient outcomes, decrease reliance on chemical drugs, and create a holistic approach to the management of balance disorders. Future research aimed at standardization, pharmacological validation, and clinical trials will be invaluable in ensuring their evidence-based place in vertigo management.

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