Questionnaire/history: Onset? Vertigo? - Transient episodes (typically < 1 min.)? - Preceded by position change (eg lying down, turning over in bed, looking upwards, bending over)? - Asymptomatic between attacks? Nausea/vomiting? Light-headedness/imbalance (sometimes reported, may last longer than vertigo attack)? Hearing loss (not a feature of BPPV)? Tinnitus (not a feature of BPPV)? Past medical history? Current medication? Drug allergies? Examination: Ears? Nose? Throat? Blood pressure? Blood pressure (standing)? Pulse? Cor? NS? Dix- Hallpike manoeuvre? - Posterior semi-circular canal BPPV if positive with: - Provokes vertigo - Torsional (rotatory) upbeating nystagmus (upper pole of the eye beats towards the dependent ear with the vertical component towards the forehead when looking straight ahead): - Clockwise (left ear BPPV) - Anti-clockwise (right ear BPPV) - If negative, repeat in one week Management: Advised: - Most people recover over several weeks, even without treatment, but symptoms can last much longer and may recur - Simple repositioning manoeuvre can help alleviate their symptoms in most cases - To get out of bed slowly and to avoid tasks that involve looking upwards - Not to drive when they are dizzy, or if they might experience an episode of vertigo while driving - To inform their employer if their vertigo poses a risk in the workplace - Symptomatic drug treatment not usually helpful for people with BPPV - Options of watchful waiting to see whether symptoms settle without treatment and to treat, which may help the person's symptoms resolve more quickly - Suggested Brandt-Daroff exercises - Epley manoeuvre (ideally done at the first presentation) (Symptoms may improve shortly after treatment, but full recovery can take days to a couple of weeks) (If symptoms do not settle after 1 week and the diagnosis of BPPV is not in doubt, option to repeat) - Semont manoeuvre - To seek medical advice if symptoms deteriorate or have not subsided after 4 weeks Reference(s): NICE CKS: Benign paroxysmal positional vertigo Information for patient/carer(s): Patient: Benign Paroxysmal Positional Vertigo