From the Guidelines
Benign Paroxysmal Positional Vertigo (BPPV) is primarily treated with specific repositioning maneuvers, such as the Epley maneuver, which has a high success rate of around 80% with only 1-3 treatments 1. The Epley maneuver involves a series of head position changes that should be performed by a healthcare provider initially, though patients can learn to do it at home after proper instruction.
- For posterior canal BPPV (most common type), the Epley maneuver involves:
- Sitting upright
- Turning the head 45 degrees toward the affected ear
- Quickly lying back with the head hanging slightly off the edge of the bed
- Turning the head 90 degrees to the opposite side
- Rolling onto that side while turning the head another 90 degrees
- Finally returning to a sitting position This should be repeated three times daily until symptoms resolve for 24 hours. The Semont and Brandt-Daroff exercises are alternative techniques that may be recommended. Medications like meclizine or diazepam may temporarily relieve vertigo symptoms but don't treat the underlying cause, and are not routinely recommended for treatment of BPPV, other than for the short-term management of autonomic symptoms, such as nausea or vomiting, in a severely symptomatic patient 1. Most BPPV cases resolve within one week of proper treatment, though recurrence is common (about 15-30% within one year) 1. These repositioning maneuvers work by using gravity to guide the displaced calcium carbonate crystals from the semicircular canals back to the utricle where they belong, thus stopping the inappropriate triggering of vertigo when the head changes position. The Epley maneuver is the most effective treatment for BPPV, and clinicians should treat, or refer posterior canal BPPV patients with a canalith repositioning procedure, as recommended by the clinical practice guideline 1.
From the Research
Treatment Options for Benign Paroxysmal Positional Vertigo (BPPV)
- The primary evidence-based treatment strategy for BPPV is physical therapy through maneuvers, including the Epley, Semont, and Gufoni's maneuvers 2.
- These maneuvers are level 1 evidence treatment for evidence-based medicine, with comparable efficacy, and the choice of maneuver depends on the clinician's preferences, failure of the previous maneuver, or movement restrictions of the patient 2.
- The Epley manoeuvre is a safe and effective treatment for posterior canal BPPV, with a significant reduction in vertigo symptoms and conversion of a positive Dix-Hallpike test to a negative test 3, 4.
- Studies have shown that the Epley manoeuvre is effective in treating BPPV, with complete resolution of vertigo symptoms in 56% of patients, compared to 21% in the control group 3.
- The treatment may require repeated sessions, with 37.69% of cases becoming asymptomatic after the first session, and 61.52% requiring repeated sessions 5.
Efficacy of Epley Maneuver
- The Epley maneuver has been shown to be effective in treating BPPV, with a high success rate and low recurrence rate 3, 4, 6.
- The maneuver is easy to perform and can be done in a hospital or clinical setting, with proper training and commitment from healthcare professionals 5.
- The Epley maneuver is also cost-effective and can provide short-term and long-term control of symptoms of unilateral posterior SCC 5.
Considerations for Treatment
- Patients with BPPV may require repeated sessions of the Epley maneuver, and it is essential to counsel them on the importance of follow-up 5.
- The treatment may not be effective in all cases, and some patients may experience partial response or no response to the maneuver 5.
- Further research is needed to identify the optimum maneuvers for variants of BPPV, whose diagnosis and treatment are still a matter of debate 2.