Fortnightly Review: Benign positional vertigo: recognition and treatment

BMJ 1995;311:489-491 (19 August)

Education and debate

Fortnightly Review: Benign positional vertigo: recognition and treatment

Thomas Lempert, neurologist,^a Michael A Gresty, scientist,^a Adolfo M Bronstein, neurologist ^a

^a Medical Research Council Human Movement and Balance Unit, Section of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG

Correspondence to: Dr Lempert.

Summary points

Benign positional vertigo is one of the commonest causes of dizziness
It is characterised by short attacks of rotational vertigo that are precipiated by head move-ments such as looking up, lying down, or turning over in bed
The diagnosis is confirmed by Hallpike positional testing which shows a characteristic torsional nystagmus when the head is reclined and turned to the affected side
Benign positional vertigo is probably caused by otoconial debris that is trapped in the posterior semicircular canal and starts to move when head position is changed quickly with respect to gravity. The concurrent flow of endolymph stimulates the hair cells of the affected canal, causing vertigo
The condition can be treated successfully in most patients by a simple manoeuvre of the head that clears the canal from debris
Repeated manoeuvres and self guided positional exercises will increase the success rate in those whose condition does not improve after one treatment session

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