Benign Positional Vertigo in Emergency Medicine Follow-up
- Author: Andrew K Chang, MD; Chief Editor: Robert E O'Connor, MD, MPH more...
Further Outpatient Care
Head exercise therapy (positional exercises of Brandt and Daroff) that promotes central accommodation may be helpful for BPV, although most patients have difficulty tolerating these maneuvers. The patient can perform the following therapy:
Sit on the edge of the bed near the middle, with legs hanging down.
Turn the head 45° to the right side. Quickly lie down on the left side, with the head still turned, and touch the bed with a portion of the head behind the ear.
Maintain this position and every subsequent position for about 30 seconds.
Sit up again.
Quickly lie down to the right side after turning head 45° toward the left side.
Sit up again.
Do 6-10 repetitions, 3 times per day.
If the patient becomes confused about the direction to turn his or her head, tell the patient his or her nose should always point toward the ceiling.
Further Inpatient Care
Patients with persistent vomiting or intractable vertigo may require admission for hydration and vestibular suppressant medication.
Surgical elimination of posterior canal function is restricted to rare cases of long-standing refractory benign positional vertigo (BPV).
Inpatient & Outpatient Medications
Meclizine is the most common outpatient medication. This medication is indicated for vertigo but should not be given for other categories of dizziness (near-syncope, dysequilibrium, or lightheadedness).
Avoid provocative movements and limit activities.
No complications (eg, neck injury, vertebral dissection) other than vomiting have been reported from the use of the Epley maneuver.
Benign positional vertigo (BPV) tends to resolve spontaneously after several days or weeks. An Italian researcher removed the otoliths from an animal, placed them in a Petri dish full of endolymph, and noted that the otoliths dissolved in approximately 100 hours.
Patients may experience recurrences months or years later (if the otoliths got out once, they can do it again).
Variants range from a single, short-lived episode to decades of vertigo with only short remissions.
A study by Kim et al assessed patients who were discharged home from the ED with a diagnosis of isolated dizziness or vertigo and determined that stroke occurs in less than 1 in 500 patients within the first month. Cerebrovascular risk factors should be considered for individual patients.
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