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Benign Paroxysmal Positional Vertigo (BPPV) Treatment

RIGHT: Epley maneuver for self-treatment of benign positional vertigo

Treatment of Right Sided BPPV (Epley maneuver)
  1. Lie back quickly with shoulders on the pillow and head reclined onto the bed. Wait for 30 seconds.
  2. Turn your head 90° to the left (without raising it) and wait again for 30 seconds.
  3. Turn your body and head another 90° to the left and wait for another 30 seconds.
  4. Sit up on the left side.
  5. Start sitting on a bed and turn your head 45° to the right. Place a pillow behind you so that on lying back it will be under your shoulders.

LEFT: Epley maneuver for self-treatment of benign positional vertigo

Treatment of Left Sided BPPV (Epley maneuver)
  1. Start sitting on a bed and turn your head 45° to the left. Place a pillow behind you so that on lying back it will be under your shoulders.
  2. Lie back quickly with shoulders on the pillow and head reclined onto the bed. Wait for 30 seconds.
  3. Turn your head 90° to the right (without raising it) and wait again for 30 seconds.
  4. Turn your body and head another 90° to the right and wait for another 30 seconds.
  5. Sit up on the right side.

Post treatment care

This maneuver should be carried out three times a day. Repeat this daily until you are free from positional vertigo for 24 hours.

Wait for 10 minutes after the maneuver is performed doing activities. This is to avoid “quick spins,” or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don’t drive immediately after performing the procedure.

Sleep semi-recumbent for the next night. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eye drops are required, try to put them in without tilting the head back. Shampoo only under the shower. Some authors suggest that no special sleeping positions are necessary (Cohen, 2004; Massoud and Ireland, 1996). We, as do others, think that there is some value (Cakir et al, 2006)

Sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch.

For at least one week, avoid provoking head positions that might bring BPPV on again.

  • Use two pillows when you sleep.
  • Avoid sleeping on the “bad” side.
  • Don’t turn your head far up or far down.
  • Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist’s office, and while undergoing minor surgery.
  • Try to stay as upright as possible.
  • Exercises for low-back pain should be stopped for a week.
  • No “sit-ups” should be done for at least one week and no “crawl” swimming. (Breast stroke is OK.)
  • Also avoid far head- forward positions such as might occur in certain exercises (i.e. touching the toes).
  • Wait to start doing BPPV exercises (Brandt-Daroff) for 2 days following the Epley or Semont maneuver, unless specifically instructed otherwise by your doctor.

At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can’t fall or hurt yourself. Let your doctor know how you did.

Links

Dr. Hain’s BPPV Info
Vestibular Disorders Association
Geriatric Depression Scale
Berg Balance Scale (PDF)
Dizziness Handicap Inventory (PDF)

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