Most patients do not demand perfection. Not cure. Not even relief, no matter what the TV commercials promise or how badly they wish them to be true. Patients want someone who listens longer and lets them express themselves in their own words? Someone who cares about the outcome—their personal outcome—and not just the “clinical course”? What they all desire is a plan that connects them to another human being—their doctor—which is a kind of relief all its own.
Benign paroxysmal positional vertigo (BPPV) is the likely cause in patients reporting brief recurrent attacks of dizziness triggered by changes in head position. It is important to recognize this cause because it can be readily treated at the bedside and because identification of the key features is the most effective way to exclude a central nervous system cause of positional dizziness. Important points about BPPV are that; a) the dizziness episodes last < 1 minute – Sometimes nausea or a mild light headedness can persist longer than 1 minute, but any patient reporting positional dizziness lasting longer than 1 minute should be carefully scrutinized for other potential causes. b) patients are normal in between episodes The Epley manoeuvre, a curative bedside manoeuvre, can then be used to reposition the debris in the semicircular cannals that is responsible for BPPV.