Though many people are given medication for BPPV, there is no evidence to support its use in treatment of this condition In extremely rare circumstances, surgical options are considered. However, fortunately, in the vast majority of cases, BPPV can be corrected mechanically. Once your healthcare provider knows which canal(s) the crystals are in, and whether it is canalithiasis or cupulolithiasis, then they can take you through the appropriate treatment maneuver. The maneuvers make use of gravity to guide the crystals back to the chamber where they are supposed to be via a very specific series of head movements called Canalith Repositioning Maneuvers. In the case of cupulolithiasis, they would utilize rapid head movement in the plane of the affected canal to try to dislodge the ‘hung-up’ crystals first, called a Liberatory Maneuver, and then guide them out as described above.

One maneuver that is used for the most common location and type of BPPV is called the Epley maneuver. However, that will not work for all presentations of BPPV. Often people have tried the Epley maneuver themselves or had it performed on them without success. Later assessment reveals that it is actually a different maneuver that should have been used, or that it is not BPPV at all. This is why caution should be used with self-treatment or with being treated by someone who is not fully trained in identifying the many different variants of BPPV and respective treatment maneuvers. Additionally, before testing or treating for BPPV, the healthcare provider should perform a careful neurological scan, evaluation of the neck, and other safety-related investigations to determine if certain elements of the procedure need to be modified or avoided. This is another strong reason for caution with self-treatment or treatment by a minimally trained healthcare provider.