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BPPV Patient Handout

last modified on: Mon, 09/11/2023 - 11:41

see also: VertigoCawthorne Head Exercises

You may have a disorder called BPPV (Benign Paroxysmal Positional Vertigo). This causes dizziness as a result of particles (calcium crystals) floating in the semicircular canal of your ear. BPPV is the most common vestibular disorder and is the cause of around 50% of dizziness in older populations (Fife et al. 2008).

Benign: NOT malignant or life threatening

Paroxysmal: sudden

Positional: symptoms occur with changes in the position of your head or body

Vertigo: dizziness where you feel like you are spinning/moving or the things around you are moving

Today, the doctor or therapist has moved your head and body in a technique that helps the crystals float out of the semicircular canal back into the utricle, where they belong, so they will no longer cause dizziness.

In order to make this technique more successful, it helps if you:

1. Immediately after the treatment maneuver is performed, it is helpful if you sit very still without moving your head for about 10 minutes.

2. Do not bend over, lie back, move your head up or down, or tilt your head to either side for the rest of the day.

3. Sleep propped upright (about a 45 degree angle) when you sleep tonight. Sleep in a recliner chair or with extra pillows.

4. Avoid jarring activities the rest of the day. No exercise which requires head movement the rest of the day.


Cawthorne's Head Exercises

These exercises are to be carried out for 15 minutes twice a day, increasing to 30 minutes.

  1. Eye Exercises:
    1. Look up, then down - at first slowly, then quickly - 20 times
    2. Look from one side to the other - at first slowly, then quickly - 20 times
    3. Focus on finger at arm's length moving one foot closer and back again - 20 times
  2. Head Exercises:
    1. Bend head forward then backward with eyes open - slowly, later quickly - 20 times
    2. Turn head from one side to other side - slowly, then quickly - 20 times
    3. As dizziness decreases these exercises should be done with eyes closed.
  3. Sitting:
    1. While sitting shrug shoulders - 20 times
    2. Turn shoulders to right, then to left - 20 times
    3. Bend forward and pick up objects from ground and sit up - 20 times
  4. Standing:
    1. Change from sitting to standing and back again - 20 times with eyes open
    2. Repeat with eyes closed
    3. Throw a small rubber ball from hand to hand above eye level.
    4. Throw ball from hand to hand under one knee
  5. Moving About:
    1. Walk across room with eyes open, then closed - 10 times
    2. Walk up and down a slope with eyes open, then closed - 10 times
    3. Walk up and down steps with eyes open, then closed - 10 times
    4. Any game involving stooping or turning is good

Note: The earlier and more regularly these exercises are practiced, the faster and more likely complete the recovery.

Image above with permission from C mamais, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons


Dix MR.  The rationale and technique of head exercises in the treatment of vertigo. Acta Otorhinolaryngol Belg. 1979;3(3):370-84.

Herdman SJ. Canalith repositioning maneuver. Otolaryngol Head Neck Surg. 1994;111(5):691-692.

Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70(22):2067-2074. doi:10.1212/01.wnl.0000313378.77444.ac