Benign Paroxysmal Positional Vertigo – Information for GPs
Exclude red flag symptoms
- Cerebellar signs should be excluded: DDK, past-pointing, limb/trunk/gait ataxia, dysarthria –refer stroke pathway or neurology as relevant
- Syncope – not a feature of BPPV
- History - a good history of rotational vertigo on position change lasting for seconds to minutes
- Examination - fatiguable nystagmus may be detected (to the affected side) routinely or upon Hallpike-Dix testing. To view a demonstration, please click here
- Treatment – depends on severity; sometimes reassurance for mild cases suffices
Cannolith repositioning – Epley’s manoeuvre can be performed in surgery, but warn patient they may not be able to drive afterwards. To view a demonstration, please click here.
Brandt Daroff self-help exercises, please click here.
Use of vestibular sedatives (e.g. Prochlorperazine) should be reserved for severe cases and for short duration of use only e.g. 3-5 days, as delays recovery.
Refractory cases or if diagnostic uncertainty: refer to the Balance Clinic.
Information to include in the referral letter
- History; must include duration of vertigo (seconds, hours, days), triggers, associated symptoms e.g. hearing loss, tinnitus, nausea and vomiting
- Examination; include auroscope findings, postural BPs, neuro examination findings
- Treatment to date; include details of impact of Epley’s manoeuvre, Brandt Daroff exercises, any therapy trials
- Past medical/surgical history
- Drug history
- BMI (must be below 35)
- Smoking cessation