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:

  1. Dizziness
  2. Spinning feeling (vertigo)
  3. Pressure in the head
  4. Neck pain
  5. Headache
  6. Stress
  7. Anxiety
  8. Possibly a feeling of panic, if they are prone to panic attacks
  9. Nausea or vomiting, if that has been part of their original symptoms
  10. Headache or neck pain the next day, which can last for a few days
  11. 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
  12. 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!


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.

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