Head-Shaking Maneuver Effective Initial Treatment for PC-benign paroxysmal positional vertigo: JAMA
Researchers have found in a new trial that the head-shaking maneuver was effective in treating posterior canal cupulolithiasis benign paroxysmal positional vertigo (PC-BPPV-cu). Based on these results, it can be recommended as an initial treatment option. Although head-shaking and mastoid oscillation maneuvers are established therapies for horizontal canal cupulolithiasis BPPV, until now there has been no proven method for PC-BPPV-cu. This study was conducted by Eun Hye and colleagues published in JAMA Network Open.
This randomized double-blind clinical trial was performed in six South Korean university hospitals between November 2019 and April 2023. There were 159 enrolled patients (67.9% female, mean age 65.4 ± 10.5 years). Inclusion criteria needed patients to have recurrent bouts of positional vertigo or dizziness, show positional nystagmus lasting more than one minute on the Dix-Hallpike maneuver, and lack any neurological condition. Excluded were patients with cervical spine pathology, multicanal BPPV, or cognitive impairment.
Patients were randomly assigned into three groups: head-shaking (53 patients, mean age 64.0 ± 11.2 years), mastoid oscillation (53 patients, mean age 66.5 ± 11.1 years), and control (53 patients, mean age 65.6 ± 9.2 years). One series of up to two trials of their allocated maneuver was performed on each patient, and therapeutic response was measured within 30 minutes and once more the next day.
Key Findings
• Among the 142 patients completing follow-up examination, the head-shaking maneuver had the best resolution rate of vertigo and nystagmus the following day.
• On intention-to-treat analysis, 37.7% (20/53) of patients in the head-shaking group showed resolution of symptoms, which was significantly higher than in the mastoid oscillation group (26.4%, 14/53) and the control group (13.2%, 7/53).
• Comparison in rates of resolution was significant statistically (χ2 = 8.40; OR = 2.86; 95% CI: 1.32-6.18; p= 0.004; α = 0.0167).
• Immediate response within 30 minutes of two tests of each technique was not significant between groups (11.3% for head-shaking group, 7.5% for mastoid oscillation group, and 3.8% for the control group; p= 0.34; α = 0.05).
This randomized controlled trial concludes that head-shaking maneuver as an efficient treatment strategy for PC-BPPV-cu. Results indicate that such a maneuver can be incorporated in clinical practice in order to advance patient outcomes. Long-term benefit exploration and development of optimal management strategies for subjects with PC-BPPV-cu require more studies.
Reference:
Oh EH, Choi J, Kim HS, et al. Treatment Maneuvers in Cupulolithiasis of the Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(3):e250972. doi:10.1001/jamanetworkopen.2025.0972
