Management of a patient with recurrent benign paroxysmal positional vertigo (BPPV) should primarily involve repeated canalith repositioning maneuvers, such as the Epley maneuver, which are effective in resolving symptoms and can be safely performed in primary care or outpatient settings NICE NG127 Bhattacharyya et al. 2008. Patients should be educated about the benign nature of BPPV and the possibility of recurrence, with advice to return for further treatment if symptoms recur NICE NG127. In cases of frequent recurrences, referral to a specialist for further assessment is recommended to exclude other vestibular disorders or central causes NICE NG127. Additionally, vestibular rehabilitation exercises may be considered to reduce symptom severity and improve balance, especially in older patients at risk of falls NICE NG127 Bhattacharyya et al. 2008. Medication is generally not recommended for BPPV as it does not address the underlying cause and may delay recovery NICE NG127.
Overall, the integrated approach emphasizes prompt diagnosis, use of repositioning maneuvers, patient education, and specialist referral for atypical or refractory cases, aligning UK guideline recommendations with evidence from clinical practice guidelines in the literature NICE NG127 Bhattacharyya et al. 2008.