Does BPPV Treatment Hurt?
Many people ask me if BPPV treatment hurts.
The answer is that BPPV treatment may cause some temporary discomfort.
During or after BPPV treatment, some patients also complain of mild to moderate pain in their head or neck.
Informed Consent: Risks and Benefits of Care
Signing an agreement to participate in care, called an “Informed Consent,” is an important step before starting BPPV treatment.
All healthcare providers must inform patients of the risks and benefits of medical care.
The treatment is beneficial to resolve BPPV, but there are inherent risks involved in medical care. Most people I meet with vertigo decide that it is worth the risk.
Risks of BPPV Treatment
Before I begin BPPV treatment with a new patient, I always educate them on the following discomfort they can experience during BPPV Treatment:
- Dizziness
- Spinning feeling (vertigo)
- Pressure in the head
- Neck pain
- Headache
- Stress
- Anxiety
- Possibly a feeling of panic, if they are prone to panic attacks
- Nausea or vomiting, if that has been part of their original symptoms
- Headache or neck pain the next day, which can last for a few days
- Full body muscle soreness the next day that can last for a few days, especially if they have been inactive due to vertigo and they have gotten out of shape with weak muscles
- The patient might feel worse afterwards for a few hours if they have BPPV in both the right and left ears, since we can only treat one side per day. Treating BPPV one side can aggravate BPPV on the opposite side. A second treatment is needed to address the second side, if both ears are involved.
Prior Symptoms may be Temporarily Magnified during BPPV treatment
Almost everyone who gets BPPV treatment feels dizzy, has vertigo, or experiences a spinning feeling.
Dizziness is the most common source of discomfort during BPPV treatment. Unfortunately, that is a necessary part of the care to resolve BPPV.
Before we begin, I instruct my patients on how to manage symptoms of dizziness or vertigo during our treatment.
If they have been anxious or stressed, that may feel temporarily worse during the treatment. People who are prone to panic attacks might feel panicky.
If nausea or vomiting has been part of their BPPV symptoms, that may occur during or after the treatment.
Basically, I educate my patients that whatever they have been experiencing may be magnified during the treatment.
We take special precautions to manage any of these symptoms, if they arise during treatment.
Hopefully the treatment will resolve the root cause of their discomfort. That is the goal!
Pressure in the Head is a Common Complaint
Because the patient’s head typically is tilted downwards during BPPV treatment, many people feel pressure in their head.
Their forehead, sinuses, face, and top of the head might feel pressure from the blood rushing to their head while their head is down.
During BPPV treatment sometimes people say “I feel pressure in my head.”
I encourage them to hang in there by saying, “I know and I am sorry, but please bare with me. We will be done in a minute or two.”
Establish a Safe Word to Stop BPPV Treatment if needed
Before we start the BPPV treatment, we always establish that they can say “Stop” at any time and I will sit them up right away.
During my sessions, this “safe word” stops the BPPV treatment immediately.
I encourage people to try to get through it in order to get the benefits of resolving the BPPV symptoms.
Neck Pain is Possible
Sometimes people do complain of neck pain during or after the treatment.
BPPV treatment may require about 20-30 degrees of extension to the neck and about 45 degrees of rotation of the neck. For some people, this neck position can cause their neck to hurt during or after the treatment.
I am very aware of this problem, so I try my best to support their head and neck with my hands throughout the whole treatment to minimize neck pain.
For people with healthy, strong, and flexible necks, this is not usually a problem.
People with a history of neck pain, neck injury, or poor posture are more likely to complain of neck pain during or after treatment.
Typically I will recommend using a soft ice pack on their neck for 15-20 minutes to reduce any neck pain after BPPV treatment.
I will sometimes do a gentle, manual massage for the muscles of the neck during or after the BPPV treatment.
Some People get a Headache
Sometimes people complain of a headache, migraine, or neck pain the next day after BPPV treatment.
If someone has a migraine or a headache when we start BPPV treatment, their head may feel worse afterwards.
If they need actual follow up care for their neck pain, I can do that at the next visit or I can send them to somebody else who specializes in orthopedics, but that is pretty rare.
Muscle Soreness may occur in People who are Sedentary
I have treated some older adults in their 70’s, 80’s, or 90’s who have been bed-bound for years due to vertigo.
Their muscles are so out of shape that they can feel full body muscle soreness for a few days after the BPPV treatment. Our treatment session might be the most that they have moved around in years!
I treated one lovely woman in her 90’s who had been in bed for about five years with vertigo, only walking to and from the bathroom. As usual, I rolled her all around on her bed to resolve her BPPV.
The next day when I called to check on her, she said, “I am so happy that I am not dizzy anymore, but I am really sore all over!”
I encouraged her to gradually increase her activity level to build back her muscle strength now that she was vertigo-free.
Many People Feel Better Afterwards
I treated a young lady at San Diego State University (SDSU) while I was there guest lecturing in the Doctorate of Physical Therapy (DPT) Program on the subject of BPPV.
She was a DPT student who had vertigo for a couple years. I gave her a BPPV treatment in front of her classmates to demonstrate the life-changing benefits of Vestibular Rehab.
In one treatment, her vertigo was resolved! She felt fine afterwards – so fine that she drove up to Sacramento on the same day to go visit her family.
She had not been able to drive alone by herself for hours to see her family for awhile due to her vertigo problems, but right after the treatment she could.
Some people will bounce back really quickly, while for other people it may take them a day or two to bounce back and feel better.
Patients who are neurologically more sensitive may take a bit longer to bounce back.
Extra Rest and Good Sleep is Important
Most people need to rest or take a nap after BPPV treatment. I recommend that they plan to take it easy for the rest of the day and go to bed early.
Extra rest and a good night’s sleep can help their brain “reboot” after the neurological stress of BPPV.
I often recommend a few extra hours of sleep during the night after treatment to maximize recovery.
My after-care instructions include not to visit the hairdresser or dentist for at least 48 hours afterwards to allow the crystals to settle.
My Patients say “It’s worth it!”
Overall, any discomfort that comes as a result of the treatment is worth the risk, according to my patients in comparison to the symptoms of BPPV.
As someone who has suffered with more than 17 episodes of BPPV myself so far, I would have to agree!
Disclaimer
This blog is provided for informational 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.
Hi Dr. Bell,
I am so glad to find your blog here which is very informative.
Two months ago in March, I had my 3rd onset of BPPV. I did home epley maneuver (EM) as usual as told by my ENT before which successfully clear everything, including balance, for my first two onset 3 years ago. This time, EM stops the spinning on site, but since then, I have off-balance and floating sensation. This feeling never happened before for my first two onset of vertigo 3 years ago with home EM.
I went to my ENT in May who, and with my family member around, noticed eyes lateral movements, and the ENT performed EM for me in the clinic. I was told to continue doing home EM for a few weeks, and if situation does not improve, go to PT. After 3 days home EM, I still feel off balance. I cannot stand the off balance feeling anymore. Eventually, I decided to go to a vestibular physiotherapist who did a thorough assessment as I was found ear crystals on my left (80% most likely) with the infrared goggles and noticed light lateral eye movements. Barbecue Roll maneuver instead of the EM was performed on site as EM is for posterior canal and does not work for my case. I was also told to do brisk walking once daily and test it out with BBQ roll 2 days after. I sleep on a double pillow and lie flat when I go to bed.
Since the PT treatment for a week, I am still feeling off (walking with head leaning forward as if a force pushing you, and rocking slightly side to side) and never have my full balance 100% back as in the past. The PT treatment does not make much difference. I was told by the PT before therapy that I should have everything cleared within 5 days.
I am frustrated and sad about what’s happening – ENT did EM in the clinic, which I found out later that it works only for patients with crystals dropped to the posterior canal, while the rest have to use other maneuvers. My case has been delayed proper treatment due to inaccurate diagnosis to start off at the ENT.
I read lots of information on ‘residual dizziness’. Now, I am concerned and worry whether my balance will be resumed 100% and have my life back as before. Are there cases that floating sensation and balance will not be 100% resume from your experience?
Also, is there a critical time that BPPV has to be treated? If there is a delay in treatment, will the residual dizziness and balance be less likely be cleared? Please advise.
Thanks so much!
Hi RR,
BPPV can be treated anytime that you can find a skilled provider to assess and treat you.
I don’t really buy into the “residual dizziness” discussion. I keep digging until all root causes are identified and dealt with…
For example, the neck is a commonly overlooked cause of “residual dizziness” after Epley maneuvers.
Also, symptomatic BPPV is commonly missed.
I hope that information helps!
I wrote this blog about Frustrations with dealing with vertigo.
This blog has home remedies that may help.
The delay in care you have faced and potential misdiagnosis you mentioned are sadly all too common for people with dizziness and vertigo.
You are not alone! Hang in there and speak up regarding your concerns to your providers. You must advocate for yourself as you go along.
Best wishes,
Kim Bell, DPT
Hi Doctor,
I was detected with BPPV two weeks back. After the detection, I have been having neck pain and headache issues. My neck keeps hurting whenever I rotate it or look sideways along with a mild headache most of the time. My neck starts hurting more as soon as I lie down on my pillow and also feel some pressure on the back of my head. Can you please help me out as to where can I go to get them treated? My doctor has recommended me to go get physical therapy too. Please help.
Hi Prutha,
You can seek a vestibular physical therapist for BPPV Treatment.
You can use this article to find two online directories.
You may also want to get some additional physical therapy from someone else who specializes in orthopedic manual physical therapy for cervicogenic dizziness.
In this blog and this blog, I share about dizziness from the neck.
If you prefer chiropractic care for your neck, you can find a specialty upper cervical chiropractor.
Upper cervical care for the neck causing dizziness is an advanced skill in both physical therapy and chiropractic care.
Best wishes!
Hi Dr Bell,
I started getting BPPV 5 days ago and was able to perform the Epley maneuver successfully. The last 3 nights I’ve been getting headaches when I sleep at night. It’s that normal? Thank you so much for your dedication to BPPV patients.
Hi AC,
I’m glad to hear the Epley maneuver was successful!
I definitely suggest notifying your doctor about the headaches, since they are new and persistent. Your doctor may have suggestions or referrals for you.
Sometimes the Epley maneuver can flare up or aggravate old or existing upper cervical issues, which can cause daily headaches.
After I do Epleys on myself a few days in a row for BPPV treatment, I usually have to get my neck adjusted.
I have written a few articles on upper cervical issues.
For more details on upper cervical problems, you can search the term “upper cervical” on this website and also my other website at BetterBalanceInLife.com.
I hope that helps!