• Clinical Practice Guideline


    Benign Paroxysmal Positional Vertigo

    (Affirmation of Value, November 2016)

    The guideline, Benign Paroxysmal Positional Vertigo (BPPV), was updated by the  American Academy of Otolaryngology—Head and Neck Surgery and categorized as Affirmation of Value by 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 a canalith repositioning procedure (CRP). Post-procedural postural restrictions should not be recommended after repositioning procedure is performed. 
    • BPPV should not be routinely treated with vestibular suppressant medications such as antihistamines or benzodiazepines.
    • Patients with persistent symptoms should be evaluated for unresolved BPPV or underlying peripheral vestibular or CNS disorders.
    • Patients should be educated regarding the impact of BPPV on their safety, the potential for recurrence, and the importance of follow-up.

    See the full recommendation for further details, including specifics about the Dix-Hallpike maneuver and a treatment algorithm. 

    More About Practice Guidelines

    These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for 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 recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.