How do you approach the symptomatic management of central vertigo in a patient with minimal improvement on (or contraindication to) meclizine?  

Central vertigo is a difficult symptom to manage and can be frustrating for the patient (and their doctor). Depending on the etiology, treating the underlying cause would be the best first step (e.g. migraine prophylaxis). However, some causes of vertigo may be intractable or take a long time to rec...