Executive summary
- BPPV causes brief vertigo triggered by head position changes (rolling in bed, looking up).
- Diagnosis: typical history + positional nystagmus on Dix–Hallpike (if safe).
- Treatment: particle repositioning manoeuvre (e.g. Epley) — can be done in primary care.
Red flags (think central cause)
- Focal neurological deficits, new severe headache, persistent ataxia, vertical nystagmus, continuous non-positional vertigo, or high stroke risk.
- If uncertain, escalate urgently (stroke pathway).
Management and follow-up
- Epley manoeuvre; consider Brandt–Daroff exercises if manoeuvres not possible.
- Falls/driving advice while symptomatic; review if symptoms change or persist despite manoeuvres.
- Refer if atypical, recurrent with significant impact, or not improving (vestibular physio/ENT/neurology per local pathway).
Frequently asked questions
Do vestibular suppressants help?
They can reduce nausea but do not treat BPPV; manoeuvres are first-line.
Can it recur?
Yes. Recurrence is common; early manoeuvre/exercise advice helps.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.