Benign paroxysmal positional vertigo is the commonest cause of vertigo and is usually curable in the room. Brief spinning vertigo triggered by lying down, rolling over or looking up points to it.
A Dix-Hallpike test that reproduces vertigo with torsional upbeating nystagmus confirms posterior canal BPPV, and an Epley manoeuvre treats it immediately. Scans and vestibular sedatives are not needed for typical cases.
- Perform a Dix-Hallpike on each side for positional vertigo.
- Treat posterior canal BPPV with an Epley manoeuvre at the same visit.
- Avoid prolonged vestibular suppressants, which slow compensation.
- Refer atypical nystagmus, neurological signs or failure after repeated manoeuvres.
Why it matters
BPPV is often treated with sedatives and scans when a two-minute manoeuvre would cure it.
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