What is the best initial treatment for Benign Positional Vertigo (BPV)?

From the Guidelines

The best initial treatment for Benign Positional Vertigo (BPV) is a canalith repositioning procedure, such as the Epley maneuver, which has a high success rate of 80-90% after one or two treatments. This non-invasive procedure can be performed by a healthcare provider or taught to patients for home use. The Epley maneuver involves a series of head movements that helps reposition the displaced calcium crystals in the inner ear.

• The procedure is based on the strongest and most recent evidence, including a 2017 clinical practice guideline update by the American Academy of Otolaryngology-Head and Neck Surgery 1.
• The guideline strongly recommends treating patients with posterior canal BPPV with a canalith repositioning procedure, such as the Epley maneuver.
• Alternative repositioning techniques include the Semont maneuver and the BBQ roll (for horizontal canal BPPV).
• Medications like meclizine or diazepam may provide temporary symptom relief but don't address the underlying cause and should not be used as first-line treatment, as recommended against by the guideline 1.
• BPPV occurs when calcium carbonate crystals (otoconia) become dislodged from their normal location in the utricle and move into the semicircular canals, causing inappropriate signals about head movement to be sent to the brain, resulting in vertigo.
• The Epley maneuver is a safe and effective treatment for BPPV, with a low risk of complications, and can be performed in a clinical setting or at home with proper instruction 1.

From the FDA Drug Label

MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).

The best initial treatment for Benign Positional Vertigo (BPV) is not explicitly stated in the provided drug label. Key points:

• The label indicates that meclizine hydrochloride tablets are used for the treatment of vertigo associated with diseases affecting the vestibular system in adults.
• However, it does not specifically address the treatment of BPV or provide guidance on the best initial treatment. 2

From the Research

Initial Treatment for Benign Positional Vertigo

The best initial treatment for Benign Positional Vertigo (BPV) is the Epley maneuver, also known as the canalith repositioning maneuver. This treatment has been shown to be highly effective in resolving vertigo symptoms and converting a positive Dix-Hallpike test to a negative test.

Efficacy of the Epley Maneuver

• The Epley maneuver has a high success rate, with studies showing that it can resolve vertigo symptoms in 93.4% of patients 3.
• A systematic review of 11 randomized controlled trials found that the Epley maneuver was significantly more effective than a sham maneuver or control in resolving vertigo symptoms and converting a positive Dix-Hallpike test to a negative test 4.
• The Epley maneuver is also safe, with few adverse effects reported, and is considered a cost-effective treatment option 5.

Comparison with Other Treatments

• The Epley maneuver has been compared to other particle repositioning maneuvers, such as the Semont and Gans maneuvers, and has been found to be equally effective 4.
• The Epley maneuver has also been compared to vestibular suppressant medications, such as meclizine, and has been found to be more effective in resolving vertigo symptoms 5.

Practical Application

• The Epley maneuver can be performed in a clinical setting, such as an emergency department or outpatient clinic, and does not require specialized equipment 5.
• The maneuver is typically performed by a healthcare professional, but can also be taught to patients to perform at home 6.
• The Epley maneuver is a simple and effective treatment option for BPV, and can be used as a first-line treatment for patients with this condition 7.