TL;DR: After BPPV treatment, follow your provider’s recovery instructions, avoid vigorous head shaking as advised, and don’t continue home maneuvers once symptoms have resolved unless instructed. BPPV can recur, and a new episode may require a different treatment.
After successful BPPV treatment, many patients have questions about what comes next. You may wonder which BPPV treatment precautions you should follow, when you can travel again, whether you should continue doing home maneuvers for BPPV, and how likely it is that the vertigo will return.
Although everyone’s BPPV treatment recovery may be different, these are five of the most common questions my patients ask about what to do after BPPV treatment.
1. What Precautions Should You Follow After BPPV Treatment?
The only precautions I universally recommend to all my patients after BPPV treatment are to take it easy for the rest of the day, get extra sleep that night, and clear their schedule the next day in case they have a hangover effect. It’s important to rest while your body heals from the vertigo and recovers from BPPV treatment.
For the next week, I advise all my patients to avoid vigorous head shaking, which includes jumping, jogging, and fast dancing.
I also advise my patients to wait at least one week before going to the hair salon, barber, or dentist.
Those are the only universal BPPV treatment precautions I use for all my patients. In some cases, I may add more individualized precautions based on the patient’s background, medical status, and vertigo history.
For more information about what to avoid after BPPV treatment, click here.
2. Should You Continue BPPV Home Maneuvers After Symptoms Resolve?
Not necessarily. Most home exercise protocols for BPPV self-treatment using particle-repositioning maneuvers have a specific endpoint included with the instructions.
You should always follow the individualized instructions from your vestibular healthcare provider.
For example, many home protocols I design instruct my patient to continue the maneuver for five to seven days and then schedule another appointment with me if the symptoms persist or recur.
Other protocols I design may instruct the patient to continue the maneuver once a day until they have three days in a row with no symptoms, then stop the program.
For my patients who are on the tail end of a vestibular treatment plan for BPPV, I may instruct them to do the home maneuver only if they still feel lingering symptoms, especially in bed at night or in the morning. I usually advise those patients to stop the home exercise program if they feel like the vertigo has completely cleared up.
At that point, BPPV is considered “resolved,” so they can return to life as usual after about a week has passed while following the precautions listed above.
Residual dizziness can last for a couple weeks. If needed, vestibular physical therapy can help with motion sensitivity and gaze stabilization after BPPV is resolved.
3. Is It Safe to Travel After BPPV Treatment?
If you are not sure whether it is safe for you to travel after vertigo treatment, talk to your primary care provider or your vestibular healthcare provider to receive individualized medical advice.
When my patients are planning to travel after BPPV treatment, I always suggest bringing enough motion sickness medication to take as directed throughout the trip if needed, just in case.
Some of my patients get prescription medication from their doctor, while other patients buy over-the-counter motion sickness medication.
Some of my patients also bring medications to use as needed for nausea, sinus congestion, allergies, anxiety, headaches, neck pain, and migraines while traveling.
Having the medication you might need can give you peace of mind while traveling, even if you never need to take it.
Talk to your doctor about which medications you might need to feel relaxed and comfortable when traveling after successful BPPV treatment.
BPPV can recur at any time, so it is good to be prepared while you are traveling.
4. How Likely Is BPPV to Come Back?
BPPV treatment has a high rate of success if you can work with a skilled vestibular provider. However, BPPV also has a fairly high rate of recurrence.
The exact statistic depends on which research study you are citing. In general, I usually tell my patients:
- There is about a 35% chance of BPPV recurrence within five years.
- For patients with migraines, there is about a 50% chance of BPPV recurrence within five years.
To reduce the risk of BPPV recurrence:
- Manage your stress proactively
- Stay hydrated daily
- Supplement with Vitamin D and calcium if your labs show deficiency, per your doctor’s recommendation
- Ensure good blood flow to your ears by actively managing medical conditions like high blood pressure, high cholesterol, and diabetes
- Take steps to manage allergies, sinus congestion, and inflammation
Keep in mind that most BPPV is considered “idiopathic.” This means that BPPV most often occurs with no known cause.
If BPPV recurs, then seek professional vestibular health care again for the recurrence at that time.
5. Should You Repeat the Same Maneuver if BPPV Returns?
No, not unless you have experienced the exact same type of BPPV multiple times. That type of pattern can only be established by working with a vestibular provider over time and discovering that you consistently need the same treatment.
Some patients have a “bad ear” that always gets BPPV, but most commonly BPPV is idiopathic, meaning it happens for no known cause and can occur in either ear.
If you ever feel symptoms of BPPV again, I suggest returning to your vestibular healthcare provider for a reassessment. That is always the best course of action to ensure that the treatment plan is exactly what you need for the new episode of BPPV.
The chance that you would need the exact same maneuvers as you did during a past episode of BPPV is low.
Research Review
According to a large research study, only 24% of patients who experienced a recurrence of vertigo had BPPV in the same canal and the same ear as during past episodes.* Therefore, the majority of patients needed a different treatment to fully resolve the BPPV recurrence.
That is why I do not recommend randomly trying old maneuvers that helped in the past. It is important for a professional to reassess your nystagmus, or involuntary eye movements, if you experience any recurrence of vertigo. This helps ensure that the treatment is correct.
A new onset of vertigo could also be caused by something different, such as vestibular neuritis due to inflammation or viral vertigo, so BPPV treatments may not help in that situation.
Consulting with a vestibular professional is always the best course of action for any recurrence of BPPV or other vertigo symptoms.
I do not recommend trying old maneuvers that helped before or randomly attempting maneuvers you found on YouTube. Too many things can go wrong if you are guessing how to perform BPPV self-treatment without professional assistance or supervision.
Learn More
Read: Should I Try to Treat Myself for Vertigo?
Read: BPPV Treatment Complications
What to Remember After BPPV Treatment
Successful BPPV treatment can bring tremendous relief, but it is normal to have questions about your recovery and the possibility of BPPV recurrence. Follow the specific instructions provided by your vestibular healthcare provider, give your body time to recover, and avoid continuing or restarting home maneuvers unless you have been instructed to do so.
If your vertigo returns, do not assume that it is the same type of BPPV or that it requires the same treatment. A vestibular professional can reassess your symptoms, determine what is causing them, and recommend the safest and most appropriate treatment plan.
Frequently Asked Questions
How long does it take to recover after BPPV treatment?
Many people experience significant improvement after successful BPPV treatment, although temporary dizziness or unsteadiness may persist for a couple weeks. Recovery varies, so follow your vestibular provider’s instructions and seek reassessment if symptoms continue.
Can BPPV return after successful treatment?
Yes. BPPV can recur weeks, months, or years after successful treatment. If vertigo returns, a vestibular healthcare provider can reassess which ear and semicircular canal are involved and determine the appropriate treatment.
Should I do the Epley maneuver every day to prevent BPPV?
Routine Epley maneuvers are not generally recommended as a way to prevent BPPV recurrence after symptoms have resolved. Follow your provider’s specific home exercise instructions and seek reassessment if symptoms return.
Disclaimer
This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
