Benign paroxysmal positional vertigo: Early diagnosis and treatment by physical maneuver in the emergency department

Benign paroxysmal positional vertigo is the most common form of vertigo seen in emergency departments. Typically these patients complain of the room spinning associated with certain head movements, nausea and vomiting. This condition can be diagnosed by taking a good history and performing a Dix-Hallpike manoeuvre. BPPV can be successfully treated by physical manoeuvres such as Epley, modified Epley, Semont et al. This condition does not require any investigation. Most ED physicians would normally treat BPPV sufferers with medications such as antihistamines and benzodiazepines, without offering any physical manoeuvre. Herein, we present five cases of benign paroxysmal positional vertigo that were diagnosed with Dix-Hallpike manoeuvre and successfully treated by modified Epley manoeuvre by an emergency physician. Early diagnosis and treatment by modified Epley manoeuvre may prevent unnecessary investigations such as blood tests, CT scans and a prolonged stay in the hospital. It is a useful manoeuvre that usually works within an hour and should be more widely utilized in emergency departments. There are no significant complications associated with this treatment.