What is the best treatment for benign positional vertigo?

From the Guidelines

The Epley maneuver is the most effective treatment for benign positional vertigo, with a success rate of up to 90% in resolving vertigo symptoms after 1-3 treatments, as supported by the 2017 clinical practice guideline update 1.

Key Points

• The Epley maneuver is a series of head movements that helps reposition the displaced calcium crystals in the inner ear, using gravity to guide these crystals back to their proper location.
• The procedure can be performed by a healthcare provider or taught to patients for home use, and involves a series of specific head position changes, as illustrated in Figure 3 and described in Table 10 1.
• The Epley maneuver has been shown to be more effective than other treatments, such as the Brandt-Daroff exercises, 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.
• The maneuver is most commonly performed in the outpatient setting, and patients should be informed that nausea, occasional vomiting, and/or a sense of falling may arise during the procedure, and may be offered antiemetic prophylaxis 30 to 60 minutes prior to the Epley maneuver 1.

Treatment Outcomes

• Studies have consistently shown that the Epley maneuver is effective in resolving vertigo symptoms, with success rates ranging from 80% to 100% after 1-3 treatments, as reported in Table 12 1.
• A randomized controlled trial found that the Epley maneuver was more effective than the Brandt-Daroff exercises in resolving vertigo symptoms, with 80.5% of patients in the Epley group experiencing negative Dix-Hallpike results at 1 week, compared to 25% in the Brandt-Daroff group 1.
• Another study found that the Epley maneuver was effective in reducing perceived disability, as assessed by the Dizziness Handicap Inventory, with significant improvements in symptoms and quality of life reported by patients 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 treatment for benign positional vertigo is not explicitly stated in the label, but meclizine is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.

• The recommended dosage is 25 mg to 100 mg daily, in divided doses.
• Meclizine hydrochloride tablets should be swallowed whole. 2

From the Research

Treatment Options for Benign Positional Vertigo

The treatment for benign positional vertigo (BPV) can vary depending on the severity and cause of the condition. Some common treatment options include:

• Epley's maneuver: a series of physical movements that help to relocate the calcium particles in the inner ear [ 3, 4 ]
• Modified canalith repositioning maneuver (CRP): a variation of Epley's maneuver 5
• Modified liberatory maneuver (LM): another type of physical maneuver used to treat BPV 5
• Brandt and Daroff's exercise: a series of exercises that can help to improve balance and reduce vertigo symptoms 5
• Vertigo habituation exercises: a type of exercise that can help to reduce vertigo symptoms by habituating the body to the movements that trigger vertigo 5

Effectiveness of Treatment Options

Studies have shown that Epley's maneuver is an effective treatment for BPV, with a significant reduction in vertigo symptoms 3, 4. The modified canalith repositioning maneuver and modified liberatory maneuver have also been shown to be effective 5. Brandt and Daroff's exercise and vertigo habituation exercises may also be beneficial, but the evidence is less clear 5.

Considerations for Patients with Cervical Spine Problems

For patients with cervical spine problems, Epley's maneuver may be contraindicated due to the risk of exacerbating the condition 6. In such cases, a new particle repositioning maneuver may be a safer and more effective alternative 6.

Key Findings

• Epley's maneuver is a safe and effective treatment for posterior canal BPV 4
• The modified canalith repositioning maneuver and modified liberatory maneuver are also effective treatments 5
• Patients with cervical spine problems may require alternative treatment options 6
• The recurrence rate of BPV after treatment is relatively high, at around 36% 4