Repositioning maneuvers A number of maneuvers have been found to be effective including: the Epley maneuver, the Semont maneuver, and to a lesser degree Brandt–Daroff exercises. Both the Epley and the Semont maneuvers are equally effective. Epley maneuver The Epley maneuver employs gravity to move the calcium crystal build-up that causes the condition. This maneuver can be performed during a clinic visit by health professionals, or taught to people to perform at home, or both. Postural restriction after the Epley maneuver increases its effect somewhat. When practiced at home, the Epley maneuver is more effective than the Semont maneuver. The most effective repositioning treatment for posterior canal<unk>  is the therapist-performed Epley combined with home-practiced Epley maneuvers. Devices such as the DizzyFIX can help users conduct the Epley maneuver at home, and are available for the treatment of<unk> . The Epley maneuver does not address the presence of the particles (otoconia); rather it changes their location. The maneuver aims to move these particles from some locations in the inner ear that cause symptoms such as<unk> , and reposition them to where they do not cause these problems. Semont maneuver The Semont maneuver has a cure rate of 90.3%. It is performed as follows: #The person is seated on a treatment table with their legs hanging off the side of the table. The therapist then turns the person's head 45 degrees toward the unaffected side. #The therapist then quickly tilts the person so they are lying on the affected side. The head position is maintained, so their head is turned up 45 degrees. This position is maintained for 3 minutes. The purpose is to allow the debris to move to the apex of the semicircular duct. #The person is then quickly moved so they are lying on the unaffected side with their head in the same position (now facing downward 45 degrees). This position is also held for 3 minutes. The purpose of this position is to allow the debris to move toward the exit of the semicircular duct. #Finally, the person is slowly brought back to an upright seated position. The debris should then fall into the utricle of the canal and the symptoms of<unk>  should decrease or end completely. Some people will only need one treatment, but others may need multiple treatments, depending on the severity of their<unk> . In the Semont maneuver, as with the Epley maneuver, people are able to achieve canalith repositioning by themselves. Brandt–Daroff exercises The Brandt–Daroff exercises may be prescribed by the clinician as a home treatment method, usually in conjunction with particle-repositioning maneuvers or in lieu of the particle-repositioning maneuver. The exercise is a form of habituation exercise, designed to allow the person to become accustomed to the position that causes the<unk>  symptoms. The Brandt–Daroff exercises are performed in a similar fashion to the Semont maneuver; however, as the person rolls onto the unaffected side, the head is rotated toward the affected side. The exercise is typically performed 3 times a day with 5–10 repetitions each time, until symptoms of<unk>  have resolved for at least 2 days. Roll maneuver For the lateral (horizontal) canal, a separate maneuver has been used for productive results. It is unusual for the lateral canal to respond to the canalith repositioning procedure used for the posterior canal<unk> . Treatment is therefore geared toward moving the canalith from the lateral canal into the vestibule. The roll maneuver or its variations are used, and involve rolling the person 360 degrees in a series of steps to reposition the particles. This maneuver is generally performed by a trained clinician who begins seated at the head of the examination table with the person supine There are four stages, each a minute apart, and at the third position the horizontal canal is oriented in a vertical position with the person's neck flexed and on forearm and elbows. When all four stages are completed, the head roll test is repeated, and if negative, treatment ceases. Medications Medical treatment with anti-vertigo medications may be considered in acute, severe exacerbation of<unk> , but in most cases are not indicated. These primarily include drugs of the antihistamine and anticholinergic class, such as meclizine and hyoscine butylbromide (scopolamine), respectively. The medical management of vestibular syndromes has become increasingly popular over the last decade, and numerous novel drug therapies (including existing drugs with new indications) have emerged for the treatment of<unk> /dizziness syndromes. These drugs vary considerably in their mechanisms of action, with many of them being receptor- or ion channel-specific. Among them are betahistine or dexamethasone/gentamicin for the treatment of Ménière's disease, carbamazepine/oxcarbazepine for the treatment of paroxysmal dysarthria and ataxia in multiple sclerosis, metoprolol/topiramate or valproic acid/tricyclic antidepressant for the treatment of vestibular migraine, and 4-aminopyridine for the treatment of episodic ataxia type 2 and both downbeat and upbeat nystagmus. These drug therapies offer symptomatic treatment, and do not affect the disease process or resolution rate. Medications may be used to suppress symptoms during the positioning maneuvers if the person's symptoms are severe and intolerable. More dose-specific studies are required, however, in order to determine the most effective drug(s) for both acute symptom relief and long-term remission of the condition. Surgery Surgical treatments, such as a semi-circular canal occlusion, exist for severe and persistent cases that fail vestibular rehabilitation (including particle repositioning and habituation therapy). As they carry the same risks as any neurosurgical procedure, they are reserved as last resorts.
Benign paroxysmal positional vertigo
Stroke
Migraine-associated vertigo
Ménière's disease
Benign paroxysmal vertigo of childhood
Labyrinthitis
Alternobaric vertigo
Flicker vertigo