25/03/2026
Ginkgo biloba is one of the most extensively studied herbal medicines in modern clinical research, with hundreds of randomised controlled trials (RCTs) across conditions such as cognitive decline, stroke recovery, tinnitus, peripheral arterial disease, anxiety and age-related vascular complaints. A common thread through much of this literature is circulatory physiology, particularly effects on endothelial function, blood flow regulation and microvascular perfusion. Rather than acting as a simple symptomatic agent, Ginkgo extract can be framed as a modulator of microcirculatory dynamics. Dizziness and vertigo, especially when aetiology is mixed or unclear, frequently have a vascular or microvascular component, which makes the therapeutic use of Ginkgo biologically plausible.
A 2026 trial directly compared standardised Ginkgo extract (120 mg/day) with betahistine (36 mg/day, best known under the proprietary name Serc) in 86 adults with dizziness or vertigo of unclear cause. It was randomised, double blind and placebo-matched, a methodologically sound design for a largely subjective symptom complex. Over 12 weeks, both groups improved significantly on validated measures (the 11-Point Box Scale and the Dizziness Handicap Inventory).
Betahistine showed a faster early response at week 2, with a large short-term effect size, but by week 12 there was no meaningful difference between the two treatments. In practical terms, both interventions were effective, and neither demonstrated clear superiority at the study endpoint. That said, with only 43 participants per arm, the study was likely underpowered to identify more modest, yet still clinically meaningful, between-treatment effects, and it was not designed as a formal non-inferiority trial.
This finding aligns with earlier research. A larger European multicentre RCT (n=160) in 2014 using 240 mg/day of Ginkgo extract also found it comparable to betahistine over 12 weeks. With 27 adverse events in 19 patients, Ginkgo showed better tolerability than betahistine with 39 adverse events in 31 patients.
Across multiple trials and pooled analyses, Ginkgo extract has shown consistent benefit in vertigo syndromes, particularly where vascular regulation may be relevant. The newer study is notable for demonstrating similar long-term outcomes at a lower Ginkgo dose, suggesting clinical activity even at 120 mg/day (about 6 g of the starting dried leaf).
Taken together, the evidence does not suggest that Ginkgo outperforms betahistine, but it does support the view that it performs similarly within standard dosing ranges. Betahistine may act more quickly, but Ginkgo appears to exert equal benefit over time. For clinicians, this positions Ginkgo extract as a legitimate therapeutic option in dizziness and vertigo, particularly where an altered microcirculatory rationale is compelling.
For more information see: https://pubmed.ncbi.nlm.nih.gov/41487075/