Clinical Practice Guideline

Vertigo

Benign Paroxysmal Positional Vertigo

(Endorsed, February 2010)

The guideline, Benign Paroxysmal Positional Vertigo (BPPV), was developed by the American Academy of Otolaryngology—Head and Neck Surgery and endorsed by the American Academy of Family Physicians.

Key Recommendations

  • Posterior semicircular canal BPPV should be diagnosed when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver.
  • If the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, a supine roll test should be performed to assess for lateral semicircular canal BPPV.
  • BPPV should be differentiated from other causes of imbalance, dizziness, and vertigo.
  • Patients with BPPV should be questioned for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support and increased risk for falling.
  • Radiographic imaging and/or vestibular testing should not be used in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing.
  • Patients with posterior canal BPPV should be treated with particle repositioning maneuver (PRM).
  • Initial therapy may include vestibular rehabilitation or observation with the assurance of follow up. Patients should be reassessed within one month to confirm symptom resolution.
  • BPPV should not be routinely treated with vestibular suppressant medications such as antihistamines or benzodiazepines.
  • Patients with BPPV who are initial treatment failures should be evaluated for persistent BPPV or underlying peripheral vestibular or CNS disroders.
  • Patients should be counseled regarding the impact of BPPV on their safety, the potential for recurrence, and the importance of follow-up.

Read the full recommendation for more details.


These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.