Harvard Women's Health Watch

In the journals: Head maneuvers work best for common vertigo

In the journals

Head maneuvers work best for common vertigo

As anyone who's experienced it can tell you, vertigo is not your average dizzy spell. It's a false sense of motion — a feeling of tilting, spinning, or swaying when you're not actually moving. Some people feel as though they are twirling in space (subjective vertigo), others as though the world is turning around them (objective vertigo). Either way, it's often accompanied by nausea, vomiting, and sweating, and sometimes by uncontrolled eye movements called nystagmus. Though symptoms eventually subside, vertigo can be extremely distressing while it lasts.

Benign paroxysmal positional vertigo (BPPV), the most common form, occurs mainly in people ages 60 and over, and more often in women than in men. As its name implies, BPPV is triggered by certain changes in position, particularly head position — such as when turning in bed or tilting the head backward to look up. The most common treatment is physical therapy using various head and body maneuvers; after therapy, patients are sometimes told to restrict their activities for a few days. In another treatment, called habituation, patients adopt a vertigo-triggering position twice a day for several weeks and try to teach the brain not to set off the vertigo response. Other treatments include motion sickness medications, home exercises, and — in a few cases — surgery.

Until recently, it's been unclear which of these treatments works best. Now, a review of evidence by the American Academy of Neurology (AAN) has found that the most effective therapy is also the easiest and quickest. Called the Epley maneuver — also known as the canalith repositioning procedure — it consists of clinician-guided head movements that are safe for people of all ages and can be performed in a few minutes. The findings were published in the form of treatment guidelines in the May 27, 2008, issue of the journal Neurology.

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