How to prevent Benign Paroxysmal Positional Vertigo (BPPV)?

From the Guidelines

To prevent Benign Paroxysmal Positional Vertigo (BPPV), focus on reducing risk factors and maintaining good head positioning, as recommended by the most recent clinical practice guideline update in 2017 1.

Key Prevention Strategies

• Avoid sleeping completely flat by using an extra pillow to elevate your head slightly at night
• Perform gentle head movements throughout the day and be cautious with sudden or extreme head positions, especially looking up or bending down quickly
• If you've had BPPV before, your doctor might teach you modified Epley maneuvers to perform at home as preventative maintenance
• Stay well-hydrated and maintain adequate vitamin D levels, as deficiencies may contribute to BPPV recurrence
• Regular physical activity that includes balance exercises can help strengthen your vestibular system
• When getting out of bed, move slowly and sit on the edge for a moment before standing
• During episodes, avoid triggers like quick head movements, and consider sleeping on the unaffected side if you know which ear has the problem

Understanding BPPV

BPPV occurs when calcium carbonate crystals in your inner ear become dislodged and move into the semicircular canals, disrupting your normal balance signals. These preventative measures aim to minimize crystal displacement and help maintain proper inner ear function. According to the guideline update, patient education is crucial in managing BPPV, and clinicians should educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up 1.

Importance of Follow-up

Regular follow-up with a healthcare provider is essential to monitor the progression of BPPV and adjust treatment plans as needed. The guideline update recommends that clinicians reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms 1. By prioritizing prevention and follow-up, individuals can reduce their risk of developing BPPV and minimize its impact on their quality of life.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The FDA drug label does not answer the question.

From the Research

Prevention of Benign Paroxysmal Positional Vertigo (BPPV)

To prevent BPPV, several strategies can be employed:

• Sleep habit modification: Changing sleep-position habits may help prevent recurrent BPPV, as suggested by a study published in 2023 2. The study found that patients who modified their sleep habits had a lower recurrence rate of BPPV.
• Vestibular rehabilitation: A 2018 study found that vestibular rehabilitation exercises, including habituation and otolith exercises, can reduce the recurrence rate of BPPV in patients with otolith dysfunction 3.
• Avoiding certain head positions: Patients with BPPV should avoid certain head positions that can trigger vertigo, such as lying on the affected side or making sudden head movements.
• Treatment of underlying conditions: Treating underlying conditions, such as otolith dysfunction, can also help prevent BPPV recurrence 3.

Risk Factors for BPPV Recurrence

Certain factors can increase the risk of BPPV recurrence, including:

• Otolith dysfunction: A 2018 study found that otolith dysfunction can increase the recurrence rate of BPPV 3.
• Utricular dysfunction: The same study found that utricular dysfunction is more likely to lead to BPPV recurrence than saccular dysfunction 3.
• Sleep position: A 2023 study found that sleeping on the affected side can increase the risk of BPPV recurrence 2.
• A 2012 study also found a correlation between the head-lying side during sleep and the affected side by BPPV, which may provide additional clues about the pathophysiology of BPPV 4.

Additional Considerations

Other factors that may contribute to BPPV include:

• Trauma: A 1993 case report described BPPV following an otherwise uneventful neurosurgical procedure 5.
• Viral labyrinthitis: This is another common cause of BPPV, although it is not directly related to prevention strategies.
• Efficient management of BPPV in emergency departments can also reduce resource utilization, ED length of stay, and use of ineffective medications, as discussed in a 2023 review article 6.