How should I manage a patient with recurrent episodes of benign paroxysmal positional vertigo (BPPV)?

Management of a patient with recurrent benign paroxysmal positional vertigo (BPPV) should primarily involve repeated canalith repositioning maneuvers, such as the Epley maneuver, which are effective in resolving symptoms and can be safely performed in primary care or outpatient settings ¹ (Bhattacharyya et al., 2008). Patients should be educated about the benign nature of BPPV and the possibility of recurrence, with advice to return for further treatment if symptoms recur ¹. In cases of frequent recurrences, referral to a specialist for further assessment is recommended to exclude other vestibular disorders or central causes ¹. Additionally, vestibular rehabilitation exercises may be considered to reduce symptom severity and improve balance, especially in older patients at risk of falls ¹ (Bhattacharyya et al., 2008). Medication is generally not recommended for BPPV as it does not address the underlying cause and may delay recovery ¹.

Overall, the integrated approach emphasizes prompt diagnosis, use of repositioning maneuvers, patient education, and specialist referral for atypical or refractory cases, aligning UK guideline recommendations with evidence from clinical practice guidelines in the literature ¹ (Bhattacharyya et al., 2008).