What are the ways to prevent Benign Paroxysmal Positional Vertigo (BPPV)?

From the Guidelines

To prevent Benign Paroxysmal Positional Vertigo (BPPV), it is crucial to focus on minimizing head trauma and maintaining good head positioning during sleep, as well as being cautious during activities that involve rapid head movements or position changes. This approach is supported by the clinical practice guideline for BPPV, which emphasizes the importance of patient education and counseling on the risk of falls and recurrence of BPPV 1.

Key Preventive Measures

• Sleep with your head slightly elevated using an extra pillow to reduce the likelihood of otoconia becoming dislodged and entering the semicircular canals.
• Avoid sleeping on the side where you experience vertigo symptoms to minimize the risk of triggering BPPV.
• Be cautious during activities that involve rapid head movements or position changes, such as getting in or out of bed, to reduce the risk of head trauma and otoconia dislodgement.
• Regular physical activity may help maintain overall balance system health, although the evidence for this is not as strong as for other preventive measures 1.
• For those with recurrent BPPV, learning self-administered Epley maneuvers from a healthcare provider can help quickly address symptoms when they appear, as suggested by the clinical practice guideline 1.

Importance of Patient Education and Counseling

Patient education and counseling are critical components of BPPV management, as they can help patients understand the risks and benefits of different treatment options and make informed decisions about their care 1. Counseling on the risk of falls and recurrence of BPPV can also help patients take steps to minimize these risks and improve their overall quality of life.

Reducing Recurrence Risk

While these strategies may reduce the risk of BPPV recurrence, it is essential to note that BPPV can still happen spontaneously, and knowing how to manage symptoms is equally important. Patients with recurrent BPPV should be counseled on the importance of follow-up and the potential need for further treatment or evaluation if symptoms persist or recur 1.

From the Research

Prevention and Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

• The Epley manoeuvre, also known as the canalith repositioning procedure, is a safe and effective treatment for posterior canal BPPV, as shown in studies 2, 3, 4, 5.
• The Semont manoeuvre is also effective in treating posterior canal BPPV, with comparable outcomes to the Epley manoeuvre 2, 5.
• The Gufoni manoeuvre is easier to perform than the BBQ roll for horizontal canal BPPV, as it only requires identifying the side of weaker nystagmus 2.
• Deep head hanging manoeuvres may be effective in treating anterior canal BPPV, although the evidence is weaker 2.
• The Epley manoeuvre has been shown to be superior to Brandt-Daroff exercises in treating posterior canal BPPV 5.
• Repositioning manoeuvres, such as the Epley and Semont manoeuvres, are highly effective in treating BPPV, with a high success rate and low risk of adverse effects 2, 3, 4, 5.
• Surgery has a minor role in the management of BPPV, and medications may only transiently ameliorate symptoms without treating the underlying process 2.
• The canalith repositioning procedure has been shown to be effective in treating BPPV, with a high success rate and low risk of adverse effects 6.

Methods of Prevention

• While there are various treatment options available for BPPV, there is limited evidence on methods of prevention.
• However, it is suggested that repositioning manoeuvres, such as the Epley manoeuvre, can be used to prevent recurrent episodes of BPPV 5.