BPPV (Benign Paroxysmal Positional Vertigo) is a condition that leads to dizziness and vertigo. For an in-depth review of BPPV check out our webinar hosted by Lifemark vestibular therapists here. This is the third feature of a 3-part Q&A blog series on BPPV, check out part one on causes here, and part two on reoccurrence patterns here.
Q&A: Treatment options for BPPV
1. I see something called Brandt-Daroff exercises online/was given this by my doctor, will these work?
Brandt-Daroff exercises were treatment options recommended to manage BPPV prior to contemporary approaches and tailored repositioning maneuvers. These exercises involve reproducing your positional vertigo repeatedly for days/weeks in efforts to either; get the particles get back into the right place; break the particles down enough from all the movement and get reabsorbed; or allow the brain to become accustomed to the abnormal information from the offending ear. While Brandt-Daroff exercises do have decent efficacy with certain variants of BPPV, they are taxing and uncomfortable for people to do consistently. Current treatment options are specifically tailored to the type and variant of BPPV a person has and are therefore the treatment of choice.
2. Is it possible the treatment can make it worse?
There are no reported serious adverse events from treatment for BPPV. However, we do need to bring a person into a position that provokes the vertigo briefly for both assessment and treatment, which might be upsetting for those who have been rigorously avoiding any movements or positions that bring on symptoms. It is not uncommon for people to have nausea and rarely vomiting, and some may experience neck discomfort or headache. Sometimes canal conversions can occur where the crystals move into a different canal or turn into a different variant during treatment rather than clearing out. This would simply require a change in the treatment maneuver being used. The good news is that the vast majority of BPPV cases are put into remission in 1-3 treatments.
3. What exercises should you do after the treatment?
There are not necessarily any exercises required following treatment if you are completely symptom-free. Once the crystals are back in the correct chamber there is nothing more to do mechanically from a treatment standpoint. However, it is not uncommon for people to have some ongoing sensitivity to motion, balance deficits, and anxiety around returning to normal head movements/activities. Your vestibular therapist will evaluate for these things after ensuring you are no longer testing positive for BPPV and prescribe a tailor-made program of exercises to address any residual symptoms.
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