When a practice is used along with conventional medicine (the system used by licensed medical doctors and allied health professionals in Canada), it often referred to as “complementary” or “integrative” health care. When it is used in place of conventional medicine, it is called “alternative." In practice, these terms are often used interchangeably and there are a number of grey areas. Inform yourself before trying any CAM treatments.

New drugs and medical devices must be approved by Health Canada. The approval process includes research reports and peer reviews. The final stage of conventional medical research involves evaluation through controlled double-blind studies. This means that neither the researchers nor volunteer subjects are aware of who is receiving the treatment being tested and who is receiving a placebo (an inactive medicine or procedure). Effects are documented meticulously to ensure accurate reporting and to stop the study if there are problems.

Very few evidence-based scientific studies have been carried out to see how well complementary and alternative therapies work specifically for people with balance and dizziness disorders. If verification of effectiveness through careful research is not provided, then you may wish to give the treatment a pass. It may be ineffective or harmful as well as costly.

The story of Dr. John Epley and his eponymous manoeuvre, however, is a lesson in keeping an open mind about new treatments and waiting for evidence. Dr. John Epley first presented his elegant idea that a single set of guided head movements could cure most cases of BPPV to colleagues at a meeting in 1980. Skeptical muttering filled the room. Some doctors even walked out. One comment card read, “I resent having to waste my time listening to some guy’s pet theory.”

Since then, the Epley manoeuvre has been extensively tested in clinical settings. It has proven to be an effective lasting treatment for the vast majority of people with the most common type of BPPV.

Dr. Epley’s story is a cautionary reminder of the importance of being open-minded about any new treatment. Until something has been clinically tested, there is no way to know if it works or not.

Complementary therapies

Complementary therapies can be used alongside conventional medical treatment to help you feel and cope better with dizziness and imbalance. Just because a complementary practice is popular or works for someone else, however, does not necessarily make it right for you.

A good complementary therapist will not claim their treatments are a cure for your dizziness or imbalance. They will encourage you to discuss these treatments with your medical doctor.

Many doctors are supportive of patients using complementary therapies. Others are reluctant, usually because many therapies have not been as rigorously tested as conventional treatments.

Therapies some people find helpful for dizziness and balance include:

Mindfulness meditation and other relaxation techniques

Practicing relaxation techniques can help reduce stress or anxiety, improve sleep, and promote a general feeling of well-being.

Mindfulness meditation can be performed anywhere; it only takes a few minutes a day. There are many techniques. It is a matter of finding which one works best for you. It takes time and diligence to see results. It does not work for everyone, however. Recent research shows that it does not have consistent results for everyone - some people feel even more stressed when feeling like they are "failing" at harnessing the practice.

Therapeutic massage

Many people with dizziness have a lot of neck and shoulder muscle tension as well as pain. This is often misinterpreted as dizziness provoked by a neck problem (cervicogenic dizziness). However in most cases, the neck and shoulder problem is caused by the patient’s natural reaction of avoiding neck movement. Since head movements often trigger dizziness, such movements frequently are avoided. The result is neck and shoulder stiffness. Massage therapy can often be effectively combined with vestibular rehabilitation to provide relief.

Massage therapy is not yet a regulated healthcare profession in all Canadian provinces. Follow links on the Canadian Massage Therapist Alliance website to find links to provincial massage therapy associations.

Chiropractic treatment

There is much debate in the medical literature about whether chiropractic treatments work - and, in cases where they seem to work, why. Many medical professionals remain skeptical and consider it a pseudoscience.

Balance and dizziness problems have many causes. Some may include neck, shoulders and back problems. Sometimes, these problems are secondary to dizziness and vertigo – muscle tension and pain may develop as head and neck movements are reduced to not trigger dizziness. In these instances, chiropractic treatments may be helpful. People who have suffered neck injuries may also find relief with chiropractic adjustments.

On the other hand, several dizziness and balance problems most likely will not improve with chiropractic treatments. Some people, such as those with vestibular migraine, may have worse dizziness after chiropractic treatments.

Provincially legislated regulatory and licensing authorities govern chiropractic practice in Canada. Follow links on the Canadian Chiropractic Association website to find a registered chiropractor.

Biologically based therapies

Biologically based therapies involve the use of nature-based substances such as botanicals and herbs to ease symptoms. Keep in mind that just because something is natural does not mean it is harmless. Inform your medical doctor of any over-the-counter preparations you take. Some can cause illness, allergic reaction, or a serious interaction with other medications.

Some people find ginger to be an effective treatment for the nausea and vomiting that goes along with some dizziness disorders. But there is no good evidence to support ginger as an effective treatment for dizziness. Products include Gravol® Natural Ginger Tablets or tea made with freshly grated ginger. Crystallized ginger is tasty but high in sugar.

Aromatherapy (essential oil therapy) may help promote relaxation, particularly when used in combination with massage therapy. There is some evidence that lavender oil may play a small role in promoting better sleep. Essential oils, such as lavender or peppermint, dabbed on the temples or under the nose may be helpful for those with vestibular migraine.

Aromatherapy is not a recognized health profession in Canada. Despite certification programs from self-regulated groups such as the Canadian Federation of Aromatherapists, there is no equivalent of a formally educated health professional in the field of essential oils.

Acupuncture

Acupuncture is promoted as both a complementary practice and an alternative medical treatment. Acupuncture is a grey area – while the World Health Organization lists 31 symptoms and conditions shown in controlled trials to be effectively treated by acupuncture (including neck pain, headache, nausea and vomiting, and depression), the National Council Against Health Fraud maintained there is inadequate or nonexistent scientific evidence to support these claims.

Not all Canadian provinces have set standards for acupuncture training. For those that do, the CAFCI or ACC designation from Acupuncture Canada is accepted. Follow links on the Acupuncture Canada website to find a registered acupuncturist.

Alternative therapies

Alternative therapies are generally used by people as a replacement for conventional medical treatment. People with balance and dizziness disorders have various reasons for trying alternative treatments. Some therapies sound promising but there is no scientific or medical evidence to show they work.

Some types of alternative therapy may not be safe and could be harmful. Ear candling, for example, can cause burns and even damage the eardrum. It has been proven to be ineffective in removing earwax. And some fad diets may fail to include important nutrients while over-doing others.

Alternative treatments for dizziness and imbalance that are supported neither by evidence-based research nor most medical doctors include:

Homeopathy

Homeopathic medicine was developed in Germany over 200 years ago before the basic principles of modern medicine had been developed. Homeopathy is based on two ideas: the “Law of Similars”, also known as “like cures like” (meaning a disease can be cured by a substance that produced similar symptoms in healthy people), and the “law of minimum dose” (meaning the lower the dose of the medication, the greater its effectiveness).

Many homeopathic products are diluted to the point that no molecules of the original substance remain. They are derived from plants (such as red onion, arnica, deadly nightshade, and stinging nettle), minerals (such as white arsenic) and animals (such as crushed whole bees). A comprehensive assessment of evidence has concluded that there is no reliable evidence that homeopathy is effective for any health condition. It is no more effective than a placebo (inactive medicine or procedure).

Homeopathy is a controversial topic. A number of its key concepts do not agree with fundamental scientific concepts. For example, it is not possible to explain in scientific terms how a product containing little or no active ingredient can have any effect. This, in turn, creates major challenges to rigorous clinical investigation of such products. For example, researchers cannot confirm that an extremely dilute mixture contains what is listed on the label. Nor have they been able to develop objective measures that show effects of extremely dilute products in the human body.

Another research challenge is that homeopathic treatments are highly individualized. There is no uniform prescribing standard for practitioners. There are hundreds of different remedies that can be prescribed in a variety of dilutions for thousands of symptoms.

Health Canada regulates homeopathic products as a type of natural health product. It reviews homeopathic products to ensure that they are safe and that the health claims are supported by traditional homeopathic evidence. There is no requirement for support by modern scientific evidence. Since 2015, however, labels on products marketed in Canada for children are required to include that claims for efficacy are “based on traditional homeopathic references and not modern scientific evidence".

Most homeopathic products contain little more than water and sometimes sugar. The biggest risk of homeopathy in the treatment of dizziness and balance disorders is that scientific diagnosis and effective treatment or management of a condition can be delayed.

So far, research into balance and dizziness disorders has not come up with any miracle cures. Until then, stick to prescribed treatment plans and work on building your wellness toolkit.

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