Repositioning maneuvers for benign paroxysmal positional vertigo.

OPINION STATEMENT: There are few conditions in neurology that are diagnosed with such ease and certainty as benign paroxysmal positional vertigo (BPPV). Repositioning maneuvers are highly effective in treating BPPV, inexpensive, and easy to apply. Surgery has a very minor role in the management of BPPV, and although medications may transiently ameliorate symptoms, they do not treat the underlying process. There is good evidence to support treatment of posterior canal BPPV with Epley or Semont maneuvers and horizontal canal BPPV with Gufoni maneuvers or BBQ roll (also known as Lempert 360 roll or log roll); and weaker evidence for head hanging maneuvers in the least common anterior canal variant. Since the therapeutic efficacy amongst maneuvers for each canal is comparable, the choice of treatment is generally based on clinician preference, complexity of the maneuvers themselves, poor treatment response to specific maneuvers, and musculoskeletal considerations such as arthritic changes and range of motion of the cervical spine. Treating posterior canal BPPV with Epley or Semont manuevers is comparable as far as efficacy and the ease with which maneuvers are performed. For horizontal canal BPPV, the Gufoni maneuver is easier to perform compared to the BBQ roll, as it requires that the clinician only identify the side of weaker nystagmus (regardless of whether it's geotropic or apogeotropic) and not necessarily the side involved. Anterior canal BPPV is rare and generally short-lived, but there is weak evidence that deep head hanging and a variety of eponymous maneuvers may hasten recovery. The advantage of deep head hanging maneuvers is that they can be effectively performed without knowledge of the side involved.