You can read my older post about Benign Paroxysmal Positional Vertigo (B.P.P.V.)
Important–If diagnosis of BPPV is established Epley maneuver is first line of treatment.
Benign Paroxysmal Positional Vertigo and other non specific peripheral vestibular disorders where etiology is unknown can be managed by following protocol–
- Reassurance (Wait and watch) with home care
- Vestibular Rehabilitation Exercises (physical therapy)
- Medicines (pharmacotherapy)
Reassurance and Home care Benign Paroxysmal Positional Vertigo
Peron with acute vertigo is anxious and afraid of stroke or tumor. Most of the patients develop emotional reaction to vertigo which may result in aggravation of the symptoms. These patients need strong reassurance.
As BPPV is not intrinsically life threatening and symptoms usually reduce in a week’s time and disappear in about 4-6 weeks thus patient should be explained about the benign and self limiting nature of the disorder.
Nature has marvelous capacity for compensation of imbalance which can be accelerated by certain exercises.
Self Home care while waiting for nature’s compensation of imbalance
- Take proper bed rest
- Avoid sudden jerky head movements and body position changes.
- Avoid sleeping on the “bad” side.
- Get up slowly and sit on the bed for a minute before getting out of the bed.
- Avoid bending down and extending the head
- Avoid driving, working at heights or with machinery during acute attack of vertigo.
- Cawthorne Cooksey exercises (see details below)
- Positional exercises of Brandt and Daroff (see details below)
- Home Epley Maneuver (See detail below)
Cawthorne Cooksey exercises
Positional exercises of Brandt and Daroff
- Sit on the edge of the bed near the middle, with legs hanging down. (position 1)
- Turn head 45° to right side.
- Quickly lie down on left side, with head still turned (angled upwards), and touch the bed with portion of the head behind the ear. (Position 2)
- Maintain this position and every subsequent position for about 30 seconds or till the dizziness disappears.
- Sit up again. (Position 3) stay for 30 seconds
- Quickly lie down to right side after turning head 45° toward the left side. (Position 4)
- Sit up again.
- Do 6-10 repetitions, 3 times per day for 2 weeks
The Brandt-Daroff Exercises are a home method of treating BPPV, usually used when the side of BPPV is unclear. They succeed in 95% of cases but may take longer than the other maneuvers. In approximately 30 percent of patients, BPPV will recur within one year.
Caution–When performing the Brandt-Daroff maneuver, person should immediately visit his physician if he feels weakness, numbness or visual changes.
HOME EPLEY MANEUVER Home Epley Left
The Epley and/or Semont maneuvers as described in my previous post can be done at home every night for a week.
The method (for the left side) is performed as shown on the figure. One stays in each of the lying down positions for 30 seconds, and in the sitting upright position (top) for 1 minute. Thus, once cycle takes 2 1/2 minutes. Typically 3 cycles are performed.
Caution– Before doing home Epley maneuver diagnosis of BPPV should be confirmed, and one should know the affected or “bad” side. It is safer to have the first Epley performed in a doctor’s clinic which can be followed at home.