Benign paroxysmal positional vertigo (BPPV) usually causes intense, brief episodes of dizziness or vertigo associated with moving the head, often when rolling in bed or getting up in the morning. Some people may also feel nauseous between episodes of vertigo.


A 41 year old woman (FP) woken suddenly in middle of night with severe true rotational vertigo with associated nausea and vomiting. Initial episode occurred 18 month’s ago. Has been able to manage daily activities cautiously, particularly any activities involving neck extension eg putting clothes on clothes line, which can momentarily reproduce her dizzy symptoms. FP unable to roll on to left side in bed and admits that has become so terrified of reproducing the vertiginous episodes if she rolls over, that has spent the last 18 months sitting upright in a long sitting supported position to sleep, to avoid positional triggers. With the severity of her symptoms, FP admits she has become isolated, avoiding social outings to prevent reoccurrences, as she now notices her neck is stiff and sore, and moving her head quickly can bring on mild symptoms.


With testing for BPPV, Dix-Hallpike Test to the left was positive and indicative of posterior canal BPPV.


FP was treated with a left Canalith Repositioning Manoeuvre, and gentle mobilisation to the upper cervical joints and musculature, in sitting.


FP returned five days later for a review of her BPPV symptoms and reported no further dizziness when looking up, and had been able to sleep on two pillows. Dix-Hallpike Test supported her resolution of symptoms and further manual treatment for cervicogenic stiffness and pain, occurred at our session. FP was encouraged to return to automatic activity without caution and sleep on one pillow as was normal for her. A follow-up phone call one week later found FP to have remained symptom free. FP was discharged from our care.

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