Positional vertigo, characterized by brief episodes of dizziness triggered by specific head movements or changes in position, is a common and often overlooked condition. While it can sometimes resolve on its own, proper diagnosis and treatment are crucial for managing symptoms and preventing recurrence.
Have you ever felt like you’re on a wild, dizzying ride first thing in the morning, a common symptom of Benign Paroxysmal Positional Vertigo (BPPV)?
That’s the reality for many people who suffer from this affection.
It’s like being on a carousel that’s spinning out of control, and it can happen to anyone, at any age.
In fact, BPPV affects an estimated 2.4% of the population at some point in their lives, making it a surprisingly common and often overlooked health issue.
Contents
- 1 What is benign positional vertigo?
- 2 Inner ear disorders
- 3 Who is affected by BPPV?
- 4 Benign paroxysmal positional vertigo symptoms
- 5 BPPV diagnosis
- 6 Ear crystals and dizziness
- 7 Why does the treatment not relieve my positional vertigo?
- 8 How can you be certain that you’re experiencing positional vertigo?
- 9 Benign positional vertigo exercises
- 10 Long-term management strategies
- 11 Complications of untreated BPPV
- 12 How to make dizziness go away?
- 13 Frequently asked questions about positional vertigo
What is benign positional vertigo?
Benign Paroxysmal Positional Vertigo (BPPV) is the most prevalent form of vertigo, affecting millions worldwide.
This condition can make you feel as if you’re on a spinning carousel, a hallmark of Benign Paroxysmal Positional Vertigo, even when you’re standing still.
The sensation is triggered by specific head movements, often leaving you disoriented and unable to walk straight.
Despite its intensity, BPPV is considered benign, meaning it isn’t life-threatening.
However, it can be highly disruptive to daily life due to its sudden onset and short-lived nature.
This type of vertigo is also known as “positional vertigo” because it tends to occur after certain head movements or changes in position.
It’s important to note that vertigo typically gives the sensation of movement even when you’re not in motion.
Inner ear disorders
The inner ear is a complex structure responsible for both hearing and balance.
It consists of the cochlea, which is involved in hearing, and the vestibular system, which maintains balance.
The vestibular system comprises three semicircular canals, the utricle, and the saccule.
These structures are filled with a fluid called endolymph and are lined with tiny hair cells that detect movement.
In BPPV, tiny crystals known as otoconia, which are made of calcium carbonate, become dislodged from the utricle and migrate into the semicircular canals where they don’t belong, causing the characteristic symptoms of vertigo.
When the head moves, these displaced crystals stimulate the hair cells in the semicircular canals, sending incorrect signals to the brain about the body’s position and movement.
This mismatch between what the brain expects and what the inner ear is signaling results in the sensation of dizziness or vertigo.
Who is affected by BPPV?
BPPV is the most common cause of vertigo, affecting millions of people worldwide, particularly those aged 70 and older.
It is estimated that 50% of individuals aged 70 and older will experience this disorder at some point in their lives.
Risk factors associated with BPPV
While BPPV can affect anyone, certain risk factors, such as a history of head trauma, inner ear infections, or certain medical conditions, may increase the likelihood of developing the condition.
– History of head trauma: Head trauma such as a concussion or injury to the head can increase the risk of developing BPPV.
This is because the crystals in the inner ear responsible for BPPV can become dislodged or damaged due to the impact, leading to the condition.
– Inner ear infections: Inner ear infections, particularly those affecting the vestibular system, can also contribute to the onset of BPPV.
Infections can cause inflammation and swelling in the inner ear, disrupting the normal function of the vestibular system and leading to vertigo.
– Certain medical conditions: Meniere’s disease or vestibular neuritis may predispose individuals to BPPV.
Meniere’s disease, for example, is characterized by fluid buildup in the inner ear, which can affect the balance and lead to vertigo.
Vestibular neuritis, on the other hand, is an inflammation of the vestibular nerve, which can also disrupt balance and cause vertigo.
It’s important to note that while these factors can increase the likelihood of developing BPPV, they do not guarantee its occurrence.
Understanding the risk factors associated with BPPV can provide valuable insights into the symptoms experienced by individuals affected by this condition.
Benign paroxysmal positional vertigo symptoms
Symptoms of BPPV, including brief episodes of dizziness, lasting from seconds to minutes, can be triggered by specific head movements or changes in position.
These episodes may be accompanied by nausea and can even trigger vomiting.
Additionally, individuals may experience a feeling of imbalance and weakness in the legs, prompting them to sit down quickly.
Symptoms of BPPV can be triggered by specific head movements or changes in position, such as:
– Leaning forward
– Getting up from a seated or lying position
– Hanging upside down
– Moving the head
– Changing position
– Lowering the head
It’s important to note that BPPV does not typically cause hearing loss.
If you experience both vertigo and hearing loss, it’s advisable to consult a doctor promptly to determine the underlying cause.
BPPV diagnosis
Diagnosing BPPV typically involves manipulating the head and body to provoke the characteristic symptoms, such as nystagmus, an involuntary rhythmic oscillation of one or both eyes.
This can include specific movements and changes in position designed to trigger vertigo.
Additionally, an eye examination may be conducted to look for nystagmus, an involuntary rhythmic oscillation of one or both eyes that often accompanies BPPV.
The presence of nystagmus can help confirm the diagnosis and guide further testing and treatment.
Ear crystals and dizziness
Once BPPV is diagnosed, treatment can commence, typically with canalith repositioning maneuvers, such as the Epley maneuver, aimed at relocating the displaced crystals back into the utricle.
When executed correctly, these maneuvers can yield excellent results.
It’s worth noting that there are several repositioning techniques available for BPPV, each suited to different individuals depending on the specific canal involved.
It’s advisable to undertake these maneuvers under the guidance of a healthcare professional, who can determine the most suitable technique for your unique case and ensure it is performed accurately.
Why does the treatment not relieve my positional vertigo?
If you’ve tried various treatments for BPPV without experiencing any improvement, there could be several reasons for this, including the speed of the maneuver, canal error, or misdiagnosis.
1. The maneuver is too fast
The repositioning maneuver is designed to move the crystals in the semicircular canals slowly.
If the waiting time between manipulations is insufficient, the crystals may become stuck in the center of the canals, leading to a lack of improvement in symptoms.
The maneuver should be performed in two stages, with a time-lapse of 30 seconds to one minute between the two stages.
2. Canal error
There are three canals in each inner ear, and crystals can be found in any of the six canals.
Each canal requires a specific maneuver, so it’s possible that the affected canal has not been addressed.
3. Misdiagnosis
If you continue to experience vertigo despite undergoing the maneuvers, it may be time to question the diagnosis of BPPV.
While the success rate of treatment for BPPV is high (97% according to some researchers), if you don’t see improvement after three sessions, it’s important to consider other potential causes of vertigo.
To be sure you have positional vertigo, look for specific signs such as dizziness lasting between 30 and 60 seconds, balance issues lasting from one to two hours or even several days after a dizzy spell, and accompanying symptoms such as a floating sensation, headache, and nausea.
If you experience these symptoms, consult a physician for further evaluation and treatment.
How can you be certain that you’re experiencing positional vertigo?
There’s a subtle difference between feeling dizzy and having a dizzy spell, but specific criteria can help you identify positional vertigo.
Movements such as waking up, getting out of bed, washing your hair, bending down while showering, or gardening can indicate BPPV.
In this case, dizziness typically lasts between 30 and 60 seconds.
If your dizzy spells persist for more than a minute, there may be another underlying cause.
Additionally, after a dizzy episode, you might experience balance issues that can last from one to two hours, or even several days.
Other symptoms may include a floating sensation, headache, and nausea.
These are all significant signs of positional vertigo.
If you experience these symptoms, it’s crucial to consult your physician for a proper diagnosis and to begin treatment as soon as possible.
Benign positional vertigo exercises
Repositioning maneuvers remain the best treatment for positional vertigo.
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The Epley maneuver
When the Epley maneuver is applied to treat the posterior canal, the head is turned 45° while lying on the back.
A cushion positioned in the back up to the shoulders allows the head to be placed back at an inclination of 20 to 30° with the shoulders.
Of course, you prefer the side that seems to trigger vertigo.
If you have BPPV, nystagmus, or involuntary eye twitching, occurs in this position.
Hold for about 60 seconds before turning your head to the opposite side for the same duration.
You then move on by standing sideways, the head placed at 45° from the horizontal.
You hold this position for 60 seconds and then proceed in the same way on the other side.
What happens during the Epley maneuver?
During the Epley maneuver, the goal is to move the dislodged crystals (otoconia) from the semicircular canals back into the utricle, where they belong.
This process is crucial for alleviating the symptoms of BPPV.
As the maneuver progresses, each change of position allows the crystals to gradually settle near the opening of the canal.
This repositioning typically takes between 30 and 60 seconds.
It’s essential to allow enough time for the crystals to stabilize in their new position before moving on to the next step.
If you change position too quickly before the crystals have settled, they may return to their original location, and the maneuver will be ineffective.
Therefore, patience and precision are key to the success of the Epley maneuver.
Additionally, the tilt of the head during the maneuver is critical.
The head should be tilted at a specific angle to ensure that the crystals move in the desired direction.
However, it’s important to perform the maneuver at the correct speed.
If the maneuver is executed too slowly, the crystals may not move as intended, rendering the maneuver ineffective.
Overall, the Epley maneuver is a delicate process that requires careful attention to detail and proper technique to achieve the desired results.
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Semont maneuver
The Semont maneuver is another repositioning technique used to treat BPPV, particularly when the posterior canal is involved.
It involves a series of specific movements designed to move the dislodged crystals (otoconia) out of the semicircular canal.
To perform the Semont maneuver:
- Sit on the edge of your bed and turn your head 45° to the side that triggers vertigo.
- Quickly drop onto your side, maintaining the head tilt.
- Lie down in this position for a minute.
- Quickly get up and adopt the same position on the opposite side, maintaining the head tilt.
- Lie down in this position for a minute.
- Finally, stand up and sit on the edge of the bed again for about ten minutes.
It’s important to ensure that your head orientation remains consistent throughout the maneuver.
Practice this exercise once a day until your dizziness subsides.
Long-term management strategies
For individuals who experience recurrent episodes of vertigo, adopting long-term management strategies, such as lifestyle modifications, vestibular rehabilitation therapy, or medications, is crucial.
Lifestyle modifications, such as avoiding sudden head movements or positions that trigger vertigo, maintaining a balanced diet, staying hydrated, and engaging in regular exercise, can significantly reduce the frequency and severity of symptoms.
Additionally, vestibular rehabilitation therapy (VRT), a specialized form of physical therapy focusing on balance and coordination exercises, can be highly effective.
VRT targets specific movements and activities that trigger vertigo, helping individuals adapt to their symptoms and improve overall balance and coordination.
In some cases, medications may be prescribed to alleviate vertigo and associated symptoms.
Commonly prescribed anti-vertigo drugs, such as meclizine or diazepam, can help reduce the severity and frequency of vertigo attacks.
Other medications, such as anti-nausea drugs, may also be recommended to manage symptoms like nausea and vomiting that often accompany vertigo.
It’s essential for individuals to work closely with their healthcare provider to determine the most appropriate management plan based on their specific needs and medical history.
Regular follow-up appointments with a healthcare provider can help monitor the effectiveness of the treatment plan and make any necessary adjustments to ensure optimal symptom management.
Complications of untreated BPPV
If benign paroxysmal positional vertigo (BPPV) is left untreated, it can lead to several potential complications, such as falls or injuries resulting from dizziness or vertigo, as well as the impact of chronic dizziness on quality of life.
One of the most significant risks is an increased likelihood of falls or injuries resulting from dizziness or vertigo.
Individuals with untreated BPPV may experience sudden episodes of vertigo, causing them to lose their balance and potentially fall, especially when performing activities that require coordination or rapid movements.
These falls can result in injuries such as fractures, sprains, or head trauma, which can further exacerbate the condition and lead to additional health complications.
Moreover, the impact of chronic dizziness on quality of life cannot be overstated.
Individuals with untreated BPPV may experience persistent feelings of dizziness or vertigo, which can significantly impair their ability to perform daily activities, work, or engage in social interactions.
Chronic dizziness can also lead to feelings of anxiety, depression, or social isolation, further affecting an individual’s overall well-being and mental health.
It’s essential to seek prompt medical attention and follow through with appropriate treatment to prevent these potential complications and improve your quality of life.
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How to make dizziness go away?
Benign paroxysmal positional vertigo (BPPV) is a common and often overlooked cause of vertigo, affecting millions worldwide, particularly those aged 70 and older.
It is characterized by brief episodes of dizziness triggered by specific head movements or changes in position.
While BPPV is not life-threatening, it can significantly impact daily life due to its sudden onset and short-lived nature.
Treatment typically involves repositioning maneuvers, such as the Epley and Semont maneuvers, which aim to move the dislodged crystals back into the utricle, alleviating symptoms.
However, it’s important to note that these maneuvers should be performed under the guidance of a healthcare professional to ensure their effectiveness and safety.
If you suspect you have BPPV, consult your physician for a proper diagnosis and treatment plan tailored to your individual needs.
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Frequently asked questions about positional vertigo
Can positional vertigo go away on its own?
Positional vertigo can sometimes resolve on its own, especially if it is caused by benign paroxysmal positional vertigo (BPPV). BPPV is often treated with repositioning maneuvers, which can help the displaced crystals in the inner ear return to their proper position. However, if positional vertigo is caused by another underlying condition, it may not go away on its own and may require medical treatment.
Why does positional vertigo keep returning?
Positional vertigo can recur if the underlying cause is not addressed. For example, if the vertigo is caused by BPPV, the displaced crystals in the inner ear may become dislodged again, leading to a recurrence of symptoms. It is important to identify and treat the underlying cause of positional vertigo to prevent it from returning.
What should you avoid with positional vertigo?
To help manage positional vertigo, it is important to avoid sudden head movements or changes in position that can trigger vertigo. This may include avoiding rapid head turns, bending over quickly, or looking up for extended periods of time. It is also important to avoid activities that worsen symptoms, such as driving or operating heavy machinery.
Which herbs help with positional vertigo?
Some herbs that may help with positional vertigo include ginger, ginkgo biloba, and peppermint. These herbs have been traditionally used to help manage symptoms of vertigo and may help reduce dizziness and nausea. However, it is important to talk to a healthcare provider before using any herbal remedies, as they may interact with other medications or conditions.
Which vitamins help with positional vertigo?
Some vitamins that may help with positional vertigo include vitamin D, vitamin B6, and vitamin B12. These vitamins are important for maintaining proper balance and may help reduce symptoms of vertigo. However, it is important to talk to a healthcare provider before taking any supplements, as they may interact with other medications or conditions.
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