Manage BPPV (Benign Paroxysmal Positional Vertigo) with effective first-line treatments like the Epley Maneuver, a non-invasive technique to reposition displaced otoconia, offering up to 90% success. Consider supervised maneuvers or Vestibular Rehabilitation Therapy (VRT) for recurrent or persistent symptoms. Medications like meclizine or diazepam are reserved for severe cases to alleviate nausea or anxiety.
January 9, 2025

BPPV (Benign Paroxysmal Positional Vertigo)

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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BPPV is caused by displaced calcium carbonate crystals (otoconia) within the inner ear. This displacement disrupts normal vestibular function and leads to dizziness or vertigo with changes in head position.

First-line recommendations:

  • Canalith Repositioning Maneuvers (Epley Maneuver): These are non-invasive techniques that reposition the displaced otoconia back to their proper location in the inner ear. Up to 80–90% success rate. Performed as needed until symptoms resolve. Epley Maneuver self-tutorial. 

Physical therapy:

  • Supervised Repositioning Maneuvers: Since doing the maneuver properly can be highly uncomfortable, supervision of a healthcare provider or trained physical therapist may be necessary.

  • Vestibular Rehabilitation Therapy (VRT): Exercises focused on improving balance and compensating for inner ear dysfunction. Recommended for patients with recurrent BPPV or persistent symptoms.

Prescription medications:

Medications are generally not recommended for BPPV but may be used in severe cases to manage symptoms such as nausea or anxiety. Examples include:

  • Meclizine (antihistamine): Orally as needed for vertigo.

  • Diazepam (benzodiazepine): Orally as needed for severe symptoms (prescription required).

Citation:

Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017; 156(3_suppl): p.S1-S47. doi: 10.1177/0194599816689667

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