This handout is for benign paroxysmal positional vertigo (with acute-vertigo triage). Your care team identified this based on: recurrent brief (<1 min) vertigo spells triggered by rolling over in bed / lying down / looking up — classic positional bppv history (bárány society criteria, von brevern 2017; aao-hns bppv cpg 2017).
Other reasons your team may use this plan: acute continuous spontaneous vertigo with nystagmus + nausea + head-motion intolerance + gait unsteadiness lasting hours-days (acute vestibular syndrome — apply hints, not positional testing first) (kattah stroke 2009; newman-toker neurol clin 2015 titrate); positional or continuous vertigo plus any of the 4 d's (diplopia, dysarthria, dysphagia, dysmetria), severe gait/truncal ataxia, or other focal neuro signs — central-vertigo / posterior-circulation-stroke entry (kattah stroke 2009; aao-hns bppv cpg 2017); recurrent or repositioning-refractory positional vertigo (≥2 prior bppv episodes, or persistent after ≥1 canalith repositioning maneuver) — recurrent/secondary-bppv entry (hilton cochrane 2014 — ~36% recurrence; aao-hns bppv cpg 2017).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| epley_canalith_repositioning_posterior_canal | — | — | — | AAO-HNS BPPV CPG 2017 strong recommendation — treat posterior-canal BPPV with a canalith repositioning procedure (Epley). Hilton Cochrane 2014 (PMID 25485940): vertigo resolution OR 4.42 (95% CI 2.62-7.44; 21%→56%), Dix-Hallpike conversion OR 9.62 (95% CI 6.0-15.42). NO post-procedure postural restriction (AAO-HNS strong rec against). |
| semont_liberatory_maneuver_posterior_canal | — | — | — | Hilton Cochrane 2014 — Semont equivalent to Epley for posterior-canal BPPV; side-lying technique preferred when neck extension/rotation is limited (cervical spondylosis, vascular) |
| bbq_roll_or_gufoni_maneuver_horizontal_canal | — | — | — | AAO-HNS BPPV CPG 2017 / Bárány 2017 — horizontal-canal BPPV treated with BBQ-roll (Lempert) or Gufoni; canalolithiasis (geotropic) vs cupulolithiasis (apogeotropic) determines direction |
| observation_with_followup_option | — | — | — | AAO-HNS BPPV CPG 2017 option — observation with follow-up is acceptable initial management (BPPV may remit spontaneously over weeks) when repositioning is declined/not feasible; reassess at ~1 month |
Plan: BPPV — canalith repositioning (definitive, non-pharm) + strictly short-term symptomatic suppressant
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
AAO-HNS recommendation: reassess within ~1 month to document resolution vs persistence. Persistent/recurrent BPPV → evaluate (or refer) for unresolved BPPV vs underlying peripheral/central disorder; pursue secondary-BPPV substrate (head trauma, post-vestibular-neuritis, osteoporosis / low vitamin D — supplementation reduces recurrence). Educate on recurrence (~36% over time — Hilton Cochrane 2014), safety/fall impact, and self-administered home maneuvers (self-Epley) for recurrence. Elderly recurrent BPPV with falls → route to geriatrics.falls.core.v1 for the multifactorial programme.
Guideline: AAO-HNS Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) — Bhattacharyya et al, Otolaryngol Head Neck Surg 2017 (PMID 28248609) + Bárány Society BPPV diagnostic criteria — von Brevern et al 2015/2017 (PMID 29056234) + HINTS (Kattah Stroke 2009 PMID 19762709; Newman-Toker Acad Emerg Med 2013 PMID 24127701) + TiTrATE (Newman-Toker & Edlow Neurol Clin 2015 PMID 26231273) + Cochrane Epley (Hilton & Pinder 2014 PMID 25485940). Reconciled 2026-05-17 — WebSearch confirms the 2017 AAO-HNS update remains current (no 2018-2026 replacement).