Home Remedies for Benign Paroxysmal Positional Vertigo (BPPV)

What is Benign Paroxysmal Positional Vertigo (BPPV) and is it serious?

BPPV is a type of vertigo caused by small crystals of calcium moving in your inner ear (semicircular canals). These small crystals moving out of place can cause you to feel dizziness and like the world is spinning around you. As the name suggests, it is considered a benign condition caused by positional changes with your head.

Other common BPPV symptoms include:

• A loss of balance
• Nausea
• Vomiting

Symptoms can be intermittent lasting for sometimes up to a minute. Typically these symptoms are aggravated by a change in head position causing the crystals to move triggering an eye movement known as a “nystagmus”. A nystagmus is when your eyes rapidly move uncontrollably.

This condition is typically associated with aging or a head injury but sometimes can onset without any particular cause. BPPV is one of the most common diagnoses causing dizziness among the general population.

Who is affected by BPPV?

BPPV most commonly affects those over the age of 50 and typically affects women more so than men. However, younger individuals can experience BPPV as well but typically have a preceding head trauma. Head trauma is also the most common cause of bilateral BPPV.¹

What causes BPPV?

BPPV can be broken down into two different causes: canalithiasis or cupulolithiasis. Some patients may suffer from both of these at the same time but that is less common.

Canalithiasis

This term refers to the free-floating particles of endolymph debris that move through the semicircular canal fluids. This is seen as the most common cause of BPPV and tends to affect the posterior semicircular canal most often. This is due to the posterior canal being the most gravity-dependent part of the inner ear.² These small endolymph debris move when the head is repositioned causing vertigo. Patients with posterior canal canalithiasis will typically present with a geotropic nystagmus that fatigues with repetitive provocation. However, canalithiasis in the anterior and lateral canals will present with a different vector of nystagmus.

Cupulolithiasis

In cupulolithiasis, the particles adhere to the cupula in one of the canals. This is seen as less common than canalithiasis (less than 5%) and typically affects the lateral canals.² Nystagmus and dizziness are very intense and persistent when the cupula is in a non-horizontal position. Patients with cupulolithiasis can present with an apogeotropic nystagmus with no latency.

Primary

Primary or Idiopathic BPPV accounts for the majority of cases (50% – 70%).² Patients will be diagnosed with primary or idiopathic BPPV when it is found in isolation and without a preceding trauma.

Secondary

Secondary represents about 30% – 50% of BPPV and is most commonly associated with a preceding head trauma.1,2 It can also be in conjunction with Ménière’s disease, vestibular migraines and labyrinthitis.

How is BPPV diagnosed?

A typical doctor’s office visit will begin with a history of how the dizziness began and what the dizziness feels like. A trained practitioner will perform a Dix-Hallpike test on you. A more thorough and potentially more seasoned practitioner will use frenzel or video frenzel goggles to aid in a more accurate diagnosis.

Imaging is not suggested in diagnosing BPPV, because it does not show any movement of the crystals through the semicircular canals. Testing through the Dix-Hallpike or Roll tests cause the crystals to move triggering an eye movement called a “nystagmus”. They may perform the Epley maneuver there if they diagnose you with BPPV.

If they find out you do not have BPPV, they may do further testing including a videonystagmography (VNG) test, Posturography test, and possibly bloodwork.

We recommend you seek out a professional before trying these at-home maneuvers as you may have a different type of vertigo or have contraindications. We’ve ordered these from most commonly used/effective to least used/effective.

At Home Maneuvers for BPPV

Epley Maneuver

The Epley maneuver is the most common at-home treatment for BPPV and is seen as the most effective of the at-home maneuvers. You will need a bed and a pillow to do this maneuver.

Do the following for BPPV with your LEFT ear:

1. Start by sitting on a bed with a pillow placed behind you. Position the pillow so that when you lay down it is under your shoulders. Turn your head 45° to the affected side (in this case the left).
2. Lie back quickly with your shoulders on the pillow and your head extended on the bed. Do this for 30 seconds.
3. Turn your head to the right 90° without raising it. Do this for another 30 seconds.
4. Turn your whole body and head another 90° to the right into the bed. Do this for another 30 seconds.
5. Sit up and keep your head straight.

Do the following for BPPV with your RIGHT ear:

1. Start by sitting on a bed with a pillow placed behind you. Position the pillow so that when you lay down it is under your shoulders. Turn your head 45° to the right.
2. Lie back quickly with your shoulders on the pillow and your head extended on the bed. Do this for 30 seconds.
3. Turn your head to the left 90° without raising it. Do this for another 30 seconds.
4. Turn your whole body and head another 90° to the left into the bed. Do this for another 30 seconds.
5. Sit up and keep your head straight.

You may do this up to 3x a day or as suggested by your healthcare provider. Stop once symptoms subside for at least 24 hours. Your healthcare provider may suggest you sleep with your upper body propped up following the epley maneuver.

Half-Somersault Maneuver

Another option for an at-home treatment of BPPV is the Half-somersault maneuver, also known as the Foster maneuver. Each position should be held for at least 15 seconds but should be held until any dizziness has subsided.

Do the following for BPPV with your LEFT ear:

1. Start in a kneeling position with your hands on the ground. Quickly extend your head backwards. Hold this for 15 seconds or until the dizziness has subsided.
2. Then half somersault forward tucking your chin towards your knees. Hold this for 15 seconds or until the dizziness has subsided.
3. Next turn the head 45° to the left, facing your left elbow. Hold this for 15 seconds or until the dizziness has subsided.
4. While keeping your head turned 45° to the left, push up fully extending your arms to raise your head keeping it level with your shoulders. Hold this for 15 seconds or until the dizziness has subsided.
5. While keeping your head turned 45° to the left, extend your head backwards. Hold this for 15 seconds or until the dizziness has subsided.

Do the following for BPPV with your RIGHT ear:

1. Start in a kneeling position with your hands on the ground. Quickly extend your head backwards. Hold this for 15 seconds or until the dizziness has subsided.
2. Then half somersault forward tucking your chin towards your knees. Hold this for 15 seconds or until the dizziness has subsided.
3. Next turn the head 45° to the right, facing your right elbow. Hold this for 15 seconds or until the dizziness has subsided.
4. While keeping your head turned 45° to the right, push up fully extending your arms to raise your head keeping it level with your shoulders. Hold this for 15 seconds or until the dizziness has subsided.
5. While keeping your head turned 45° to the right, extend your head backwards. Hold this for 15 seconds or until the dizziness has subsided.

Do this a few times a day with at least a 15 minute rest period in between.

Semont Maneuver

The Semont maneuver is very similar to the Epley maneuver but has been seen as being not as effective due to it being difficult to reproduce at-home (Radke et al, 2004).

Do the following for BPPV with your LEFT ear:

1. While sitting on the edge of the bed, turn your head 45° to the right.
2. Quickly lie down on the left side of your body. Do this for 30 seconds.
3. While keeping your head turned 45° to the right, quickly flip over to the right side of your body keeping your head looking down towards the ground. Do this for 30 seconds.
4. Slowly sit up and keep your head forward for 2 minutes.

Do the following for BPPV with your RIGHT ear:

1. While sitting on the edge of the bed, turn your head 45° to the left.
2. Quickly lie down on the right side of your body. Do this for 30 seconds.
3. While keeping your head turned 45° to the left, quickly flip over to the left side of your body keeping your head looking down towards the ground. Do this for 30 seconds.
4. Slowly sit up and keep your head forward for 2 minutes.

You may do this up to 3x a day or as suggested by your healthcare provider. Stop once symptoms subside for at least 24 hours.

Brandt-Daroff Exercise

Brandt-Daroff exercises were the first at-home exercise for treating BPPV. However, it’s use has declined in recent years as the Epley maneuver has been seen as more effective (Radke et al, 1999). Many see it as being ineffective due to the nature of the movement possibly causing the crystals to move to the wrong place in the semicircular canal. Exercise caution when using this exercise and stop if neck pain, weakness, numbness, headaches, or visual changes occur.

Do the following for this exercise:

1. Start by sitting in an upright position.
2. Lie on your left side with your head turned to the right. Do this for 30 seconds or until the dizziness subsides.
3. Sit back up for 30 seconds.
4. Lie down on your right side with your head turned to the left. Do this for 30 seconds or until the dizziness subsides.
5. Repeat this process 5 times.

This exercise is recommended to be done for 2 weeks, 3x per day, or for 3 weeks, 2x per day.

What to expect afterwards

Once your symptoms go away you do not need to keep doing these maneuvers. Usually we suggest people sleep propped up the night of to avoid your neck extending backwards.

You should only need to do the maneuver a few times for your symptoms to decrease. If your symptoms persist, please follow up with your healthcare provider as you may have a different condition causing your vertigo.

Why am I still experiencing symptoms?

Many people may experience a recurrence of BPPV symptoms within a year or two of the initial treatment. Studies ranged from 14% to 29% recurrence rates within a few years of BPPV. Some studies relate that recurrent BPPV may be due to secondary causes. Misdiagnosis is also very common with BPPV for a multitude of reasons. One being the fact that it can occur with other inner ear diseases. Another being that depending on the physician you see, you may get a different diagnosis. In a systematic review done by Parker et al they had found that if you went to an ENT you were more likely to be diagnosed with BPPV, whereas if you were in an emergency room you may be diagnosed with other vestibular disorders.3 In our clinical experience we see some central vestibular disorders being misdiagnosed as BPPV as well. Vertigo can be caused by many different mechanisms so it’s important to get the right diagnosis first.

Are you experiencing dizziness?

Comment below if you currently have issues with dizziness or have in the past. If you have any home remedies that have worked for you that are not listed above we would love to hear about them!

If you have any questions about BPPV, these maneuvers or other conditions, please feel free to contact us.

References

1. Haripriya, G R et al. “Incidence and Treatment Outcomes of Post Traumatic BPPV in Traumatic Brain Injury Patients.” Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India vol. 70,3 (2018): 337-341. doi:10.1007/s12070-018-1329-0
2. Parnes, Lorne S et al. “Diagnosis and management of benign paroxysmal positional vertigo (BPPV).” CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne vol. 169,7 (2003): 681-93.
3. Parker, I G et al. “A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo.” Otology & Neurotology vol. 40, 1 (2019): 6-15.