Can benign paroxysmal positional vertigo (BPPV) return? If so, what can I do?

A new episode of BPPV can develop after successful treatment. On average, the rate of recurrence (new episode) is 15-50%.

However, it may be possible to treat recurrent BPPV at home by performing a series of movements when an episode occurs. Patients will receive information on ways to handle recurrences on their own, or they can work with an audiologist or physical therapist to develop a plan.

In general, if you wake up with positional vertigo, try the following steps:

  • Slowly move into the good-ear-down position and wait for a minute.
  • Next, slowly move into a face-down position and slide to the foot of the bed.
  • Keep your head down until you reach the end of the bed and are kneeling or standing on the floor.
  • Slowly bring your head backward into an upright position. (Hold on to the bed at all times.)

Another method is to sit toward the foot of the bed, leaving enough room to lay back with your head resting comfortably at the end of the bed, slightly extended. Be careful not to overextend your neck, as this may aggravate existing neck problems. If your symptoms are severe, you may need assistance to complete the maneuver.

Without treatment, the symptoms of BPPV may persist. However, with time (usually within 6 weeks), the otoconia dissolve on their own. Until then, the number and severity of episodes may be reduced simply by paying careful attention to head position. In addition, anti-motion sickness drugs can control nausea.

However, before drugs are taken, it is usually best to try the particle repositioning procedure first. It is a very safe and rapid way to relieve symptoms and reduce the chance for falls. Medications should not be taken for a long period of time.

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