From the Guidelines
The primary treatment for Benign Paroxysmal Positional Vertigo (BPPV) is the Epley maneuver, a series of head movements that can be performed by a healthcare provider or taught to patients for self-administration at home. This recommendation is based on the strongest and most recent evidence, including a 2017 clinical practice guideline update 1. The Epley maneuver has been shown to be effective in resolving BPPV symptoms, with a meta-analysis finding that patients treated with the Epley maneuver had a 6.5-times greater chance of improvement in clinical symptoms relative to controls 1.
To perform the Epley maneuver:
- Sit on a bed with your head turned 45 degrees toward the affected ear.
- Quickly lie back with your shoulders on the bed and head reclined. Hold for 30 seconds.
- Turn your head 90 degrees to the opposite side. Hold for 30 seconds.
- Roll your body to the side in the same direction, turning your head another 90 degrees. Hold for 30 seconds.
- Slowly sit up on that side. Repeat this procedure three times daily until symptoms resolve, typically within a few days to weeks.
Additional treatments may include:
- Brandt-Daroff exercises: A series of movements done 3-4 times daily to help with symptom relief.
- Vestibular rehabilitation: Specialized physical therapy to improve balance and reduce dizziness, which may be offered as an option based on controlled observational studies and a balance of benefit and harm 1.
- Medications: In severe cases, anti-vertigo drugs like meclizine may be prescribed for short-term symptom relief, but vestibular suppressant medications are not routinely recommended for treatment of BPPV due to the potential for significant harm, including drowsiness, cognitive deficits, and increased risk of falls 1.
The Epley maneuver works by using gravity to guide displaced otoconia (tiny calcium carbonate crystals) back into the correct part of the inner ear, resolving the cause of vertigo. It's essential to perform these maneuvers correctly and consistently for the best results. If symptoms persist or worsen, consult a healthcare provider for further evaluation and treatment.
From the Research
Treatment Options for Benign Paroxysmal Positional Vertigo (BPPV)
- The treatment for BPPV generally consists of physical exercises, including the Epley or Semont maneuvers 2.
- Canalith repositioning maneuvers (CRP) are also effective in treating BPPV, with a high success rate in patients with posterior canal BPPV 3.
- The Epley maneuver is one of the most effective canalith repositioning procedures for treating posterior canal BPPV 4.
- Modified Brandt-Daroff exercises, such as lateral modified Brandt-Daroff exercises (LMBDEs), can be used to treat horizontal canal BPPV 5.
- A comparison of the efficacy of four repositioning maneuvers (Epley, Semont, Li, and Gans) found that the Epley maneuver is comparable to the other maneuvers in treating posterior BPPV 6.
Effectiveness of Treatment
- The cure rate for BPPV using physical therapy (Epley maneuvers) is around 88.37%, with 53.5% of patients being cured after a single maneuver 2.
- In patients with posterior canal BPPV, 37.69% were asymptomatic after the first CRP session of Epley's maneuver, while repeated sessions were required in 61.52% of cases 4.
- The treatment outcomes for patients with BPPV can vary, with some patients experiencing complete resolution of symptoms and others requiring repeated sessions or experiencing partial response 3, 4.
Considerations for Treatment
- Repeated testing and treatment of BPPV within the same session is a safe and effective approach to management, with a low risk of canal conversion 3.
- Vertigo and nystagmus throughout the Epley maneuver are not indicative of treatment success, and clinicians should remain vigilant for the possibility of post-treatment otolithic crisis 3.
- Proper training and commitment from healthcare professionals are necessary for effective treatment of BPPV using the Epley maneuver 4.