What is the treatment for vertigo, specifically benign paroxysmal positional vertigo (BPPV)?

From the Guidelines

The primary treatment for benign paroxysmal positional vertigo (BPPV) is a series of head positioning maneuvers, with the Epley maneuver being the most effective for the common posterior canal BPPV, as supported by the 2017 clinical practice guideline update 1. This procedure involves moving the head through specific positions to relocate displaced calcium crystals from the semicircular canals back to the utricle where they belong. For home management, the modified Epley or Brandt-Daroff exercises can be performed daily until symptoms resolve. Medications generally play a limited role in BPPV treatment but may include vestibular suppressants like meclizine (25mg every 4-6 hours as needed) or diazepam (2-5mg every 8 hours as needed) for short-term symptom relief during severe episodes, as noted in the guideline update 1. These medications should be used briefly (3-5 days maximum) as they can delay central compensation, as recommended by the guideline 1. Patients should avoid sudden head movements, sleep with the head slightly elevated, and rise slowly from lying positions. Most BPPV cases resolve within weeks with proper treatment, though recurrence occurs in about 30% of patients, as reported in the studies 1. The effectiveness of repositioning maneuvers stems from their ability to use gravity to move the displaced otoconia (calcium carbonate crystals) out of the semicircular canals where they inappropriately trigger vertigo symptoms during certain head movements.

Some key points to consider in the treatment of BPPV include:

• The use of canalith repositioning procedures (CRPs) as initial therapy for patients with posterior canal BPPV, as strongly recommended by the guideline update 1.
• The option to offer vestibular rehabilitation in the treatment of BPPV, as noted in the guideline update 1.
• The importance of patient education and counseling regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up, as recommended by the guideline update 1.
• The need to reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms, as recommended by the guideline update 1.

Overall, the treatment of BPPV should be individualized and based on the specific needs and circumstances of each patient, with a focus on using evidence-based treatments to improve outcomes and reduce the risk of recurrence, as supported by the studies 1.

From the Research

Treatment for Vertigo

The treatment for vertigo, specifically benign paroxysmal positional vertigo (BPPV), involves several approaches.

• The Epley manoeuvre, also known as the canalith repositioning procedure, is a widely recommended treatment for BPPV 2, 3, 4.
• This manoeuvre involves a series of specific head and body movements that help to relocate the calcium particles (otoconia) in the inner ear, which are thought to cause the vertigo symptoms.
• The Epley manoeuvre has been shown to be effective in resolving vertigo symptoms in patients with posterior canal BPPV, with a significant improvement in symptoms compared to sham manoeuvres or control treatments 2, 4.
• Other treatment options for BPPV include the Semont manoeuvre, Brandt-Daroff exercises, and Gans manoeuvre, although the Epley manoeuvre is generally considered to be the most effective 2.
• In some cases, vestibular suppressant medications such as meclizine may be prescribed to help manage vertigo symptoms, although these medications are not recommended as a first-line treatment for BPPV 3, 5.

Diagnosis and Treatment Approach

• The diagnosis of BPPV typically involves a physical examination, including the Dix-Hallpike test, which can help to identify the presence of vertigo symptoms and determine the affected ear 3, 6.
• The treatment approach for BPPV usually involves a combination of the Epley manoeuvre and vestibular rehabilitation exercises, which can help to improve balance and reduce vertigo symptoms 3, 5.
• In some cases, patients may require additional treatment, such as medication or further evaluation, if their symptoms persist or worsen over time 5.

Effectiveness and Safety

• The Epley manoeuvre has been shown to be a safe and effective treatment for BPPV, with a low risk of adverse effects 2, 4.
• The manoeuvre is generally well-tolerated, although some patients may experience mild side effects, such as nausea or dizziness, during the procedure 2.
• The effectiveness of the Epley manoeuvre can vary depending on the individual patient and the severity of their symptoms, although it is generally considered to be a highly effective treatment for BPPV 2, 4.