Are repositioning maneuvers effective in benign paroxysmal positional vertigo (BPPV)?

Photo of a woman with vertigo standing up
PantherMedia / Tatiana Gladskikh

Can having someone move you around into different positions really get rid of vertigo? A group of researchers wanted to find out just that, so they analyzed studies on repositioning maneuvers. What they concluded: Yes, this treatment approach helps.

The Epley and Semont maneuvers are sequences of movements that involve turning your head and changing the position of your torso. They are used in the treatment of benign paroxysmal positional vertigo (BPPV). The aim is to get rid of vertigo caused by tiny crystals in the organ of balance. The maneuvers are thought to cause the loose crystals to stay in one place, where they no longer trigger episodes of vertigo and can be broken down by the body.

Research on effectiveness

Researchers from the – an international network of researchers – analyzed eleven studies on the Epley maneuver. Nearly 750 adults who had BPPV took part in these studies.

The results show that the Epley maneuver is very likely to get rid of this type of vertigo. After up to four weeks, a comparison of the two groups showed the following:

  • The BPPV symptoms had gone away in 20 out of 100 people who didn’t use the maneuver,
  • compared to 52 out of 100 people who did use the Epley maneuver.

This means that the Epley maneuver prevented further episodes of vertigo in an additional 32 out of 100 people.

Studies comparing the Epley maneuver with the Semont maneuver found that the two approaches are equally effective.

Because the repositioning maneuvers didn’t cause any serious complications in the studies, researchers assume that they are safe. Typical side effects include vertigo or nausea because the maneuvers sometimes lead to episodes of vertigo themselves.

Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 2017; 156(3_suppl): S1-S47.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Akuter Schwindel in der Hausarztpraxis (S3-Leitlinie). AWMF-Registernr.: 053-018. July 12, 2019. (DEGAM-Leitlinien; Volume 17).

Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev 2014; (12): CD003162.

Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78(7): 710-715.

Zhang X, Qian X, Lu L, Chen J, Liu J, Lin C et al. Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis. Acta Otolaryngol 2017; 137(1): 63-70.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 9, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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