I have BPPV. Which side do I treat first? Can I treat both sides?

We are often asked which side to treat with BPPV. This answer is relatively simple. The Dix-Hallpike maneuver is the standard test for BPPV. Basically what happens is that you lie down fast on your back and turn your head to one side (ideally looking up a bit too). After about 30 seconds have passed you will either be dizzy or have no reaction. In this example if you are on your left and you get dizzy on that side then you have left sided BPPV. The same is true vice-versa. Obviously you treat the side on which you have BPPV. However about 10% of people have BPPV on both sides or it is not clear on which side they have BPPV because they didn’t get dizzy during the test but do other times.

The answer to the question about treating both sides is a bit more complicated. If you have BPPV on both sides or are not sure which side you have BPPV then you can indeed treat both sides. People often ask if you can “undo” the Epley maneuver by treating the left side immediately after treating the right side. No you can’t. However, you can cause yourself to be more nauseous and may even throw up. Even worse you run the risk of converting posterior BPPV to horizontal BPPV. What is that you ask,… Well usually people have Posterior canal BPPV meaning the crystals are in the back most balance canal. When you do the treatment maneuver the crystals come out of this canal and float back into the vestibule of the vestibular apparatus (the balance organ). If you get a lot of these crystals floating around in there and then start rolling around again they can float into another balance canal – the horizontal canal. This is actually a much worse feeling BPPV. Luckily it is easily treating by a log roll (something you might accidentally do in bed) so it usually doesn’t last very long.

So in summary we suggest getting a proper diagnosis for BPPV – and treating the appropriate side. If you are unsure on which side you have BPPV or have it on both sides we suggest treating one side for one week then treating the other side for the next week. This avoids confusion as to the diagnosis and also avoids nausea and conversion to Horizontal BPPV.

8 Responses

  1. Clearwater Clinical
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    Thanks for sharing. Good tip re “eyes closed” if no one is watching. Often times with dizziness you can visually suppress vertigo (meaning eyes open can help you fixate your eyes. However, BPPV is not one of those so it really doesn’t matter eyes open or closed. Whichever you find most comfortable.

  2. Pati Young
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    Well, 10 days later. Still wobbly, but Bonine helping. No throwing up. Meant to mention in my other post that I have found that I don’t need to have my eyes open if no one is witnessing me do the mameuver. I can tell when the nystagmus hits. Keeping my eyes shut prevents me from throwing up most times especially after the initial bout.

    This bout continues to be confusing. Usually I have my BPPV on the left side but I’m clearly more dizzy when I turn to the right.

    Last time took 3 weeks to recover. Looks like this time heading for same.

  3. Clearwater Clinical
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    Thanks for the great comment. Some people are very sensitive to the Epley maneuver and do indeed throw up when this is attempted. Most find this gets less intense over time. It sounds like you are able to do your own Epley at home – great. Once you have a correct diagnosis of BPPV and have successfully treated it before your suggestion of taking some medication to dull the symptoms while you do the maneuver is a good one. You may find that weekly ‘preventative’ Epley maneuvers are effective at avoiding “big” episodes of BPPV. This is not well discussed in the medical literature but I have found it effective. Do one maneuver a week and see if you have any more recurrences – let me know. As a note – during a ‘preventative’ maneuver you will not likely experience dizziness as your BPPV has not reached a critical point. The idea here is to prevent that from happening at all. As always you should discuss any treatment plans with your own physician before initiating them. Good luck.

  4. Chimpati
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    I am 60 and have had BPPV for too many years. Each time I get it, there is a learning curve. Glad to find this web site; happy to compare notes with other sufferers. I am a strong proponent of the Epley and Halpike Dix: both self taught and re-trained in vestibular PT. The simpler maneuver seems to be enough to correct things for me most times. More recently, I seem to have vertigo on the right in the 1st lying back position and then on the left when I sit up. This is confusing. However, most importantly for me has been to learn that taking Bonine (over the counter anti-nausea meds & therefore easier to keep down once I get nauseous) ASAP before I do any maneuvers. This prevents me from throwing up. Further, my PCP prescribed dissolving Zophran for the very intense beginning of my BPPV. This helps knock me out and protects me from throwing up. I use it for sleep the 1st couple of nights. Now I just need to remember to carry the Bonine with me and take it when I feel the BPPV coming on which I usually do for a few days before, Then maybe I wouldn’t be so afraid to do the maneuvers earlier on. Never too old to learn new ways to cope….

  5. Clearwater Clinical
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    You are exactly correct. First and third position are the right places to have vertigo. If you have it in the 4th position (sitting up) it usually means you didn’t do it quite right. Looking toward the floor is the most gravity sensitive position as the crystals are falling out of the canal into the vestibule.

  6. Clearwater Clinical
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    If you don’t do the maneuver correctly it will fail. Some studies show success of maneuvers as low as 5% in inexperienced hands. Yes usually you have a “reverse” spin if the crystals fall back during the maneuver.

  7. Jill
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    Oh, I should also mention that when I did the second epley, I had what felt like two vertigo spins in the third position (like I spun then it stopped for a split second then started again before stopping after 10 seconds or so). I’m so worried I screwed something up and moved the crystals back or just irritated the canal even more (I had the epley done by a pt a few years ago and had no more vertigo on the second epley. I’m worried though because on this most recent episode of doing the epley again I’ve had less vertigo in first position and only spun for a few seconds (I know this is a good thing), but I had more vertigo in the third position than I did the first time I did the epley, worried I’ve done something.

  8. Jill
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    I did the epley at home since I have bppv in my left ear. Each time I’ve done it I’ve only gotten spinning vertigo in the first and third position:ex. go back get vertigo, 2nd position no vertigo, 3rd position on side with head turned to floor vertigo, 4th position sitting up no vertigo. Is this normal? From what I’ve read aren’t you supposed to get vertigo in each position, especially the last one when you sit up? The worst vertigo seems to be in the third position for me (on my side with my head turned at an angle towards the floor). I noticed the second time I did it (2 days after the first), I had less vertigo in the first position, but more during the third position. Any input?

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