Simple Home Remedy for Vertigo Works
July 12, 2004 -- If the word " vertigo" conjures images of the Alfred Hitchcock thriller, it's a good bet you don't have it. For those who do, the severity of the dizziness that is the main symptom of this condition can range from simply annoying to life altering.

While the causes of the most common type of vertigo are complex, the treatment can be simple. So simple, in fact, that new research suggests patients can have as much success treating their condition at home as in a doctor's office.

The study found that 95% of patients with benign paroxysmal positional vertigo had no further episodes of dizziness a week after beginning a simple and well-tolerated physical therapy regimen at home. Known as the Epley procedure, the maneuver is the most widely used treatment for this type of vertigo in the U.S., but it is typically performed by a physician or physical therapist in a medical setting.

"At-home treatment is really a much more effective method of managing these symptoms," vertigo expert Timothy C. Hain, MD, tells WebMD. "For patients who know they have this type of vertigo, I don't see any downside to trying it."

Top-Shelf Vertigo
Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, especially among older people. One study showed that roughly one in 10 people over the age of 75 had the condition, which is caused by small stones or crystals of calcium carbonate in the inner ear. These stones stimulate the nerves of the inner ear, causing dizziness.

The condition is also known as top-shelf vertigo because changes in head position such as looking up and down cause dizziness. Getting out of bed or rolling over in
bed are common triggers.

Different head movement exercises have been used for decades to dislodge the crystals. Earlier at-home maneuvers were much less effective than those now commonly performed in a doctor's office.

In this study, published in the July issue of the journal Neurology, researcher Andrea Radtke, MD, and colleagues assessed the effectiveness of two of the newer maneuvers when performed at home without medical supervision.

Both of the maneuvers involved head and body movements performed while sitting on a bed. The maneuvers were done once in a doctor's office, and patients were then told to perform the exercise three times a day at home until they had no symptoms of vertigo for at least 24 hours.

Within a week, 95% of the patients who performed the modified Epley procedure had complete resolution of their symptoms, compared with 58% of patients who performed the other procedure.

How to Do It
Patients start by sitting on a bed and placing a pillow behind them so that it will be under their shoulders when they lie back. Then,

1. Turn your head 45 degrees to the left, if the vertigo is in the left ear, or to the right if it is in the right ear.

2. Lie back quickly with shoulders on the pillow, neck extended, and head resting on the bed. In this position, the affected ear is underneath. Wait for 30 seconds.

3. Turn your head 90 degrees to the right (without raising it), and wait again for 30 seconds.

4. Turn your body and head another 90 degrees to the right, and wait for another 30 seconds.

5. Sit up on the right side.

The maneuver should be performed three times a day and repeated daily until there are no signs of vertigo for at least 24 hours.

Routine Management
Radtke and colleagues recommend the maneuver for patients who do not get relief after a first treatment by a doctor or therapist, and for those who have a recurrence of their vertigo. Roughly a third of patients have such recurrences within a year of treatment and half have recurrences within five years.

"It is still important for people who don't know why they are dizzy to see a doctor," University of Pittsburgh neurology and otolaryngology professor Joseph M. Furman, MD, PhD, tells WebMD. "But at-home treatment is certainly something that patients who have been treated before could try, either preventatively to avoid a recurrence or when they have recurrences."

Furman and Hain co-wrote an editorial accompanying the new study in which they concluded that at-home treatment is likely to become part of the routine management of BPPV.

"I encourage my patients to try it," Furman says. "If it works, great. If it doesn't then they should come to see me."
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