Benign paroxysmal positional vertigo (BPPV), facilitated by Associate Professor Jane Smith

Paper: Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008675. DOI: 10.1002/14651858.CD008675.pub2.

To read the full paper, click on CD008675

Fact sheet: Vertigo_benign_paroxysmal_positional_vertigo

In summary

Re: benign paroxysmal positional vertigo (BPPV) 

Epley exercise done once fixes about 80% of cases of BPPV.

Adding postural restrictions has a small additional effect with number needed to treat of 10

Mostly this was by sleeping upright (not lying flat for 1-2 days after) and also sometimes additional restriction of neck movements e.g. wearing a neck collar (for 1-5 days after)

If BPPV is left sided start with head turned 45 degrees to left, patient lies down with back flat plus head (also bent down 30 degrees below horizontal) wait 1-3mins,  then turn head slowly to the right side (also bent down 30 degrees below horizontal) wait another 1-3 minutes, then turn patient onto right side with head still turned 45 degrees.

Dix Hallpike is to diagnose BPPV and Epley to treat

Left sided BPPV is “vertigo/nystagmus” triggered by turning head to left and right sided is “vertigo/nystagmus” triggered by turning head to right.

Epley works, and patients  can be taught  with the assistance of a choice of you tube videos, patient hand outs, diagrams, and Dizzy Fix hat.

Reverse this if right sided.


Click on the links below:

Epley for Dizziness:

The Dix Hillpike test for BPPV:

Epley’s manoeuvre: