The awful feeling of motion when you’re perfectly still – vertigo. Not to be confused with dizziness (the feeling of being lightheaded, woozy, or unbalanced). Vertigo can happen for a number of reasons in a number of different situations – at sea, in bed, an adverse reaction to medication, too much to drink. People often feel nauseous, off-balance and describe involuntary eye movements. Most episodes of vertigo occur spontaneously and can be triggered by something as benign as rolling over in bed (a very common description by clients).
What causes vertigo?
We are going to address one specific cause of vertigo – Benign Paroxysmal Positional Vertigo or BPPV. BPPV is the most common cause of vertigo or the false sensation of movement.
Benign – it is not life-threatening
Paroxysmal – it comes in sudden, brief spells
Positional – it gets triggered by certain head positions or movements
Vertigo – a false sense of rotational movement
Who is affected?
It is most often occurs spontaneously between the ages of 50 and 70. In younger individuals, it is usually due to head trauma as a result of a fall or motor vehicle accident.
What causes BPPV?
BPPV is due to small particles being dislodged in the inner ear and floating free – this can happen spontaneously or due to the above-mentioned head trauma. The inner ear is a complex labyrinth of compartments and canals that contain fluid called endolymph. The inner ear canals sense movement of the head through the movement of the fluid and help you balance your head and focus your eyes on moving objects. When the small ear stones or otoconia become dislodged they move through the fluid causing the sensation of movement at rest. The vestibular system has input from the eyes – this is why BPPV causes involuntary jerking of the eyes called nystagmus.
Should I seek help if I have these symptoms?
Yes. Most episodes of vertigo are benign, however, it is important to rule out other causes of vertigo or dizziness like other neurological disorders, stroke, inner ear infection. It is also important to know that BPPV will not give you constant vertigo or dizziness that isn’t affected by movement. Vertigo due to BPPV is triggered by certain movements and once you stop moving, after a short period the vertigo will stop.
Your family doctor or ER physician may be able to assess and treat vertigo due to BPPV, however, they usually refer on to someone that specializes in the assessment and treatment of vestibular problems. This can be a physiotherapist trained in VRT (Vestibular Rehabilitation Therapy), neurologist or Ear Nose and Throat specialist.
What is the treatment for BPPV?
Once the diagnosis of vertigo due to BPPV is made, the treatment of choice depending on the canal that is affected is the Canalith Repositioning Procedure or Epley maneuver. This usually follows the maneuver to make the diagnosis – the Dix Hallpike Maneuver.
How many treatments do I need?
It is impossible to say how many treatments will be needed, however, it usually only takes a few treatments using the repositioning maneuver for the symptoms to subside on a more permanent basis. Once you have had BPPV, there is always a greater chance that the ear stones will become dislodged causing symptoms again. However, many clients never have a recurrence after treatment is finished. Should your symptoms recur you should seek the guidance of a health care professional trained in vestibular disorders for another assessment.
For more information regarding the assessment and treatment of vertigo as a result of BPPV contact one of our physiotherapist trained in vestibular rehabilitation at 416 621-2506 or read more about our vestibular rehabilitation services.
1. Vestibular Disorders Association. www.vestibular.org
2. Bhattacharyya N et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 139(5 Suppl 4):S47-81, 2008.