10 Things You Should Know About Positional Vertigo

Posted by Kerrie Denner

Is benign paroxysmal positional vertigo (BPPV)  a rare and exotic disease? No, on most clinic days, I see at least one person with BPPV, and often, I see several. For some, BPPV is a minor annoyance. For others, it’s a nightmare of dizziness, loss of balance, nausea, and inability to work or participate in family activities.

BPPV is a disorder causing brief, sometimes terrifying sensations of movement -- of the environment or the patient -- when in fact, there is no movement.

BPPV occurs, when one or more motion sensing, calcium-based crystals called otoconia break down and dislodge from the inner ear utricle. Otoconia begin as normal elements giving weight to the utricle, helping it sense acceleration and/or gravity.

When otoconia break down, the resultant debris floats freely, in the fluid of the inner ear -- think “snow in a snow globe.” Then, debris may float into one of the inner ear’s rotation sensors, known as semicircular canals. These canals are fluid filled tubes sensing fluid flow with the slightest head movements. Using the analogy of snow in a snow globe, if you have snow floating in a semicircular canal, head movements may produce violent sensations of spinning. This can happen when lying down, getting out of bed, turning in bed, or looking up.

So, with that preamble, here are 10 things you should know about positional vertigo:

1. If you woke up with vertigo, it is likely you have BPPV.

2. If you have vertigo that comes on when you lie down, it is likely you have BPPV.

3. If you have had more than 2 episodes of severe vertigo, there’s a strong possibility you have BPPV, though your doctor should also think about other inner ear diseases, as well as migraine and stroke.

4. If you have BPPV in both ears, it will almost certainly throw off your balance.

5. If you have a past history of migraine and develop BPPV, you may notice an increase in headaches or light sensitivity. These symptoms will likely decrease after the BPPV has been successfully treated.

6. After BPPV has been treated, it’s a good idea for the doctor to ensure that dizziness, imbalance and related symptoms resolve-- if not, there is more work to be done.

7. If your vertigo makes you nauseated, and you do not have any vestibular tests planned, you may want to ask your doctor if it would be all right to take a medication for vertigo, 30 minutes before your appointment. This can make BPPV treatment much more comfortable.

8. Curing a bout of BPPV can require persistence. Doctors always talk about the “easy” cases, miraculously cured on the first visit. However, I have seen patients who needed treatment on 10 different days in one month to finally clear the symptoms.

9. Another version of Rule 8: if you’ve “had BPPV for a year” or more, it’s likely you haven’t been treated enough.

10. In some cases, BPPV follows a previous inner ear infection that has damaged the inner ear and/or vestibular nerve. If this is the case, and if you still have symptoms after successful treatment of BPPV, the best treatment may be vestibular physical therapy, intended to train the ear and brain to work well together. -- Gregory T. Whitman, M.D. (Otoneurology)

Disclaimer: If you are dizzy, you should see a physician. I consider new vertigo an emergency, until proven otherwise. Though BPPV is often initially diagnosed as possible stroke, it is also true that stroke and other serious conditions may be initially diagnosed as BPPV. Judgment and medical expertise are needed to get the diagnosis right. Dr. Whitman specializes in otoneurology and dizziness disorders.

Source: Massachusetts Eye and Ear blog


Accessed 6/9/2014


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