From the Guidelines
The primary treatment for Benign Paroxysmal Positional Vertigo (BPPV) is a series of head maneuvers called canalith repositioning procedures, with the Epley maneuver being the most common, as it has been shown to be highly effective in resolving BPPV symptoms with a success rate of around 80% with only 1-3 treatments 1.
Key Points to Consider
- The Epley maneuver involves moving the head through specific positions to relocate displaced calcium crystals from the semicircular canals back to the utricle where they belong, and it can be performed by a healthcare provider or taught to patients for home treatment 1.
- Other effective repositioning techniques include the Semont maneuver and the BBQ roll (for horizontal canal BPPV) 1.
- 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 as needed) for short-term symptom management during severe episodes, although they should be used briefly as they can delay central compensation 1.
- Most BPPV cases resolve with one or two repositioning treatments, though some patients may require repeated maneuvers, and vestibular rehabilitation exercises may be recommended for residual symptoms 1.
Important Considerations for Treatment
- Patients with persistent symptoms after initial treatment of BPPV should be reevaluated to identify treatment failures, promote the timely diagnosis and management of underlying peripheral or CNS disorders, and reduce the risk of secondary complications related to unresolved or unidentified disease 1.
- Repeat canalith repositioning maneuvers can be performed as a preferred treatment for persistent BPPV, with a success rate of 90% to 98% when additional repositioning maneuvers are subsequently performed 1.
From the Research
Treatment Options for BPPV
The treatment for Benign Paroxysmal Positional Vertigo (BPPV) includes various approaches, with the primary goal of relieving vertigo symptoms. The main treatment options are:
- Canalith repositioning maneuvers, such as the Epley maneuver 2
- Surgical therapy, including singular neurectomy and posterior semicircular canal occlusion, for intractable cases 3, 4
- Rehabilitative exercises and physical maneuvers
Efficacy of the Epley Maneuver
The Epley maneuver has been shown to be an effective treatment for posterior canal BPPV, with a high success rate:
- A study found that the Epley maneuver resulted in complete resolution of symptoms in 90.7% of patients after the initial treatment, and 96% after a second treatment 5
- Another study concluded that the Epley maneuver is a safe and effective treatment for posterior canal BPPV, although the evidence is based on a limited number of small randomized controlled trials 2
Postmaneuver Patient Restrictions
Research suggests that postmaneuver patient restrictions may not be necessary:
- A study found that postmaneuver restrictions do not improve treatment efficacy, and that patients can resume normal activities without restrictions 6
Surgical Therapy
Surgical therapy may be considered for intractable BPPV cases: