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Last updated: 30 March, 2020 15:59pm

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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

Management

  • 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.

Patient leaflets

A Patient Information Leaflet can be downloaded, here.

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

References

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