Benign Positional Vertigo

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Benign positional vertigo usually is vertigo that lasts a few seconds to a few minutes. It is recurrent but not prolonged. It is caused by the movement of an otolith, hence precipitated by turning in bed or sitting up or down.

Vertigo is best treated by a single correct application of the Epley maneuver to the affected semicircular canal. For simplicity, it is best to test the posterior canal, which is the most commonly affected canal. Please see the following video, which explains the pathophysiology and principles of treatment of posterior canal BPPV.

Instructions for your GP

Eg Right side

Step 1

Begin treatment with the patient sitting upright in the middle of the bed. Turn the head towards the right (ear causing vertigo symptoms) approximately 45 degrees.

Step 2

Keep the head turned to the right and gently lie down. The head MUST end up hanging down over the edge. This can also be done by placing a pillow under the shoulders to extend the neck. Maintain this position for one minute. This position will likely provoke either transient dizziness or vertigo.

Step 3

While still lying flat with the head HANGING down, slowly rotate the head towards the good ear (rotate towards the left) as far as possible or approximately 90 degrees. Maintain this position for one minute. This position may again provoke either transient dizziness or vertigo.

Step 4

With the head still rotated and HANGING maximally towards the good ear (left), slowly roll the entire body onto the "good side" shoulder (towards the left). Keep the head and neck fixed as much as possible. If done properly, the patient should be able to stare down at the floor. Maintain this position for one minute.

Step 5

Finally, to complete the Epley maneuver, return to a sitting position with the patient's head up but flexed forward approximately 45 degrees. Maintain this position for one minute.

Step 6

Most reference sources state that the Epley maneuver should take five minutes to complete. Three complete cycles need to be performed in some cases.

The left side is done by performing the same movements in the opposite direction.