From the Guidelines
Treatment options for recurrent benign paroxysmal positional vertigo (BPPV) include repositioning maneuvers, such as the Epley maneuver, as the primary treatment, with vestibular rehabilitation therapy and lifestyle modifications also playing a role in management. The Epley maneuver is most effective for posterior canal BPPV, while the Lempert (BBQ) roll and Gufoni maneuvers are used for horizontal canal involvement, as noted in the clinical practice guideline update 1. These procedures move displaced calcium carbonate crystals from the semicircular canals back to the utricle where they belong. For persistent cases, patients can be taught to perform modified Epley or Brandt-Daroff exercises at home daily until symptoms resolve.
Some key points to consider in the management of recurrent BPPV include:
- The importance of patient education regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up, as emphasized in the guideline update 1.
- The role of vestibular rehabilitation therapy in improving balance and reducing fall risk in patients with lingering symptoms, as suggested in the guideline executive summary 1.
- The limited use of medication, such as vestibular suppressants like meclizine or diazepam, in managing acute symptoms, but with caution to avoid delaying central compensation, as recommended against in the guideline 1.
- The consideration of surgical options, like posterior canal occlusion or singular neurectomy, for extremely refractory cases that significantly impact quality of life, though these are rarely necessary.
- Lifestyle modifications, including sleeping with the head elevated 30 degrees, avoiding sudden head movements, and rising slowly from bed, can help prevent recurrences, as part of a comprehensive management plan.
Overall, the management of recurrent BPPV requires a multifaceted approach that includes professional interventions, patient education, and lifestyle modifications, with the goal of improving symptoms, reducing fall risk, and enhancing quality of life, as supported by the clinical practice guideline update 1 and other evidence 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults The treatment options for recurrent BPPV include meclizine.
- The recommended dosage is 25 mg to 100 mg daily, in divided doses 2.
- Vertigo associated with diseases affecting the vestibular system can be treated with meclizine hydrochloride tablets 2 2.
From the Research
Treatment Options for Recurrent BPPV
The treatment options for recurrent Benign Paroxysmal Positional Vertigo (BPPV) include:
- Canalith repositioning procedures (CRPs) such as the modified Epley maneuver or a barbecue rotation 3
- Repetition of CRPs every 2 or 3 days in the outpatient clinic 3
- Self-administration of a specific canalith repositioning procedure based on the previous type of BPPV, although this may have limited efficacy 4
- The Epley maneuver, which is considered a standard technique for managing BPPV 5, 6
- Other particle repositioning maneuvers, such as the Semont, Brandt-Daroff, and Gans maneuvers 6
Effectiveness of Treatment Options
The effectiveness of these treatment options is supported by various studies, including:
- A study that found 91.7% and 86.7% of patients with recurrent or persistent BPPV had resolution of nystagmus and vertigo after frequently repeated CRPs 3
- A study that reported a total success rate of 92.1% for the canalith repositioning procedure in treating BPPV 7
- A study that found the Epley maneuver to be a safe and effective treatment for posterior canal BPPV, with complete resolution of vertigo occurring significantly more often in the Epley treatment group compared to a sham maneuver or control 6
Considerations for Treatment
When treating recurrent BPPV, it is essential to consider the following: