• Nalaka de Silva

Benign Positional Vertigo

Updated: Jun 16, 2019

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.



Benign Positional vertigo usually is vertigo that lasts few seconds to a few minutes. Its is recurrent but not prolonged. It is caused by 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 Epley to the affected Semi Circular Canal. For simplicity best 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





Step1

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




Step 2

Keep the head turned to Right and gently lie down. Head MUST end up hanging down over the edge. This also could be done 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/ head HANGING down, slowly rotate the head towards the good ear (rotate towards 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 head still rotated and HANGING maximally towards the good ear (L) slowly roll entire body on to the "good side" shoulder (towards 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 patients 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.






Left side is done by doing the same movements in the opposite direction





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