What can you do if you have BPPV?

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If benign paroxysmal positional vertigo (BPPV) is hard to cope with or doesn’t go away on its own, a simple treatment can be done. The treatment consists of doing certain head and body movements in a specific order. The aim is to make the problems in the organ of balance go away.

In about half of all people who have BPPV, the symptoms go away after only 1 to 3 months. So treatment isn't always needed.

If the dizzy spells don’t go away on their own or are very difficult for the person to cope with, repositioning maneuvers can help. They are a common treatment for benign paroxysmal positional vertigo.

How do repositioning maneuvers work?

To do a repositioning maneuver, the doctor shows you how to get into various sitting and lying positions while holding your head at certain angles.

In BPPV, the vertigo is caused by loose deposits (crystals or “ear rocks”) in the organ of balance (vestibular system) inside our ear. The aim of following a certain order of head and body movements is to move the loose crystals to a position where they no longer cause dizzy spells.

The vestibular system has three semicircular canals in it. The Epley maneuver and the Semont maneuver are two very simple and effective repositioning procedures for the treatment of BPPV that is caused by crystals in the posterior semicircular canal. The exercises are usually repeated several times under the supervision of a doctor. There are also slightly different versions that you can do on your own at home as well.

This treatment doesn't have many side effects. But the movements can lead to nausea or vomiting, similar to during an episode of vertigo. Repositioning maneuvers aren’t suitable for some people – for instance, those who can’t move the neck region of their spine freely.

What does a repositioning maneuver involve?

The Epley maneuver is done in the following way (the person in this example has loose crystals in their left ear):

  1. Sit upright.
  2. Tilt your head back slightly and move it about 45° to the left.
  3. Lie on your back, keeping your head turned to the left. Wait for about 30 seconds.
  4. Now turn your head to the right by 90°, keeping it tilted back slightly. Wait for about 30 seconds.
  5. Now turn your whole body to the right. Your head moves with your body until you are almost facing the floor. Wait for about 30 seconds.
  6. Sit upright again.

After having this treatment, you can move or lie down normally again.

Illustration: Sequence of movements in the Epley maneuver for the treatment of BPPV caused by deposits in the left ear – as described in the article

Sequence of movements in the Epley maneuver for the treatment of BPPV caused by deposits in the left ear

In most cases the symptoms are caused by loose crystals in the posterior semicircular canal. The crystals only rarely develop in either of the other two semicircular canals of the vestibular system. If they do, other repositioning maneuvers can be done that are a little different to the Epley and Semont maneuvers. One example is the Gufoni maneuver.

Are there other treatment options?

If the Epley or Semont maneuvers don't help, aren't possible or the patient doesn’t want to do them, certain exercises can be done. Your doctor can show you how to do them in his or her practice, and then you can do them at home on your own.

Other treatments, such as anti-nausea medication, are only needed in rare cases.

If the symptoms are very severe and don’t go away, surgery on the vestibular system (the organ of balance) may be considered. This involves destroying either the nerve fibers in the affected semicircular canal, or the semicircular canal itself. The sensory hair cells can then no longer pass information on to the brain. As a result, the loose crystals don't cause dizziness any more, but the organ of balance in that ear is permanently affected by the surgery.

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.

Cromwell C, Tyler J, Nobbs R, Hockaday A, Donnelly S, Clendaniel R. The Necessity for Post-Maneuver Restrictions in the Treatment of Benign Paroxysmal Positional Vertigo: An Updated Meta-Analysis of the Literature. Otol Neurotol 2018; 39(6): 671-679.

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).

Fu W, Han J, Chang N, Wei D, Bai Y, Wang Y et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx 2019 [Epub ahead of print].

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

Mattle H, Mumenthaler M. Neurologie. Stuttgart: Thieme; 2013.

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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