Self-treatment of Benign Positional Vertigo

Wait for 10 minutes after the maneuver is performed before going home. This is to avoid "quick spins," or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don't drive yourself home.

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 below). 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)

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). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley or Semont maneuver, unless specifically instructed otherwise by your health care provider.

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.

Give Patient Home Epley Maneuver to perform three times a day. Repeat this daily until free from positional vertigo for 24 hours.

Following the maneuvers instruct the patient: Wait 10 minutes before leaving the office, Avoid sudden head movement, Have another person drive you home.

HOME Left EPLEY MANEUVER

Typically 3 cycles are performed just prior to going to sleep. Best to do them at night rather than in the morning or midday. If they become dizzy following the exercises, then it can resolve while one is sleeping. The mirror image of this procedure is used for the right ear. Repeated every night for a week. The head is turned to the side of vertigo/nystagmus during the Dix/Hallpike Test.

Recommended Websites

Timothy C. Hain, MD
http://www.dizziness-and-balance.com/disorders/bppv/bppv.html (Pg modified 11-21-09)

Dix-Hallpike Test
http://www.neurology.org/content/vol70/issue22/images/data/2067/DC2/Video_1.wmv

To see a movie of BPPV
nystagmus, a 13 meg download - (http://www.dizziness-and-balance.com/disorders/bppv/movies/bppv.avi)

Epley maneuver
http://www.dizziness-and-balance.com/disorders/bppv/bppv.html
We offer a home treatment DVD that illustrates the home Epley exercises.

Vestibular Disorders Association
(VEDA) http://www.vestibular.org/.

Brandt Daroff exercise VIEW MOVIE AT
http://www.neurology.org/content/vol70/issue22/images/data/2067/DC2/Video_8.wmv.

Mayo Clinic Staff Original Article: http://www.mayoclinic.com/health/vertigo/DS00534

Outcome Tools

The Berg Balance Scale
http://www.aahf.info/pdf/Berg_Balance_Scale.pdf

Dizziness Handicap Inventory
http://web.missouri.edu/~proste/tool/vest/Dizziness-Handicap-Inventory.pdf

Geriatric Depression Scale
http://www.stanford.edu/~yesavage/GDS.html

Documents