Chiropractic Management of Benign Paroxysmal Positional Vertigo Using the Epley Maneuver: A Case Series
SOURCE: J Manipulative Physiol Ther. 2013 (Feb); 36 (2): 119–126 ~ FULL TEXT
Sandy S. Sajko, MSc, Kent Stuber, MSc, DC, Tim N. Welsh, PhD
Maple Grove Chiropractic Clinic,
OBJECTIVE: The purpose of this case series is to describe the management of benign paroxysmal positional vertigo in a chiropractic clinical setting.
CLINICAL FEATURES: Eight patients (4 women, 4 men) with symptoms of persistent benign paroxysmal positional vertigo presented for chiropractic care. The outcome measures included self-reported resolution of vertigo, a Short Form 12 Health Survey, Measure Yourself Medical Outcome Profile, and the Dix-Hallpike maneuver. Outcome measures were assessed at initial assessment, 6 days, 30 days, and 3 months postintervention.
INTERVENTION AND OUTCOME: The patients underwent one or more canalith repositioning procedures (Epley maneuver). Scores in each of the categories decreased from the initial to 6-day assessment and then again at the 30-day assessment. The effects of the treatment on the Short Form 12 scores showed changes between the initial assessment and 30 days posttreatment.
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CONCLUSION: The patients in this case series demonstrated reduction in symptoms with chiropractic management.
Key Indexing Terms: Vertigo, Chiropractic, Benign Paroxysmal Positional Vertigo, BPPV, Dizziness, Nystagmus, Labyrinth Diseases, Head Movement
Benign paroxysmal positional vertigo (BPPV) is characterized by a brief recurrent episode of vertigo and nystagmus brought on by changes in head position with associated symptoms, which may or may not include nausea, balance difficulties, and light-headedness. [1-3] This condition is the most common cause of recurrent vertigo,  as between 17% and 42% of patients with vertigo have BPPV.  It is more common in women than men. [4, 5] The lifetime prevalence of BPPV is 2.4% overall, 3.2% for women and 1.6% for men, whereas the 1-year prevalence has been reported as 1.6% or 131.6 per 100000 people. [3, 4]
The incidence of BPPV has been reported at a rate of 95.8 per 100000 people annually or 0.6% annually. [3, 4] Benign paroxysmal positional vertigo is more common in older individuals; the peak decades of onset are between the fifth and seventh, with the sixth decade as the most common; the average age of onset has generally been reported to be between 49 and 57 years. [1, 3-6] The 1-year prevalence of BPPV in those older than 60 years is 7 times higher than in the 18- to 39-year age group.  To date, several factors have been associated with an increased risk for developing BPPV including being female, advanced age, osteoporosis, endolymphatic hydrops, and head trauma.  Benign paroxysmal positional vertigo is considered idiopathic in more than 80% of cases; however, approximately 10% to 17% of cases are posttraumatic. [5, 8]