Treatment for Positional Vertigo (BPPV)
Benign
Paroxysmal
Positional
Vertigo
non-life threatening
comes in sudden, brief spells
triggered by certain head positions
false sense of rotational movement
1000s of otoconia "crystals" live in the Utricle of the inner ear. When they get displaced into the Semicircular Canal, it causes disruption of the natural fluid and causes vertigo.
What causes
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a mechanical problem in the inner ear. It occurs when some of the calcium carbonate crystals, “otoconia” that are normally embedded in gel in the Utricle become dislodged and migrate into one or more of the 6 fluid-filled Semicircular Canals, where they are not supposed to be.
When enough of these particles accumulate in one of the canals or get knocked off the bed of gel (like with falling down or whiplash), the otoconia interfere with the normal fluid movement that these canals use to sense head motion. This sends a false signal to the brain that you are moving. Your eyes follow the signal of the otolith when it moves in the canal and it causes nystagmus (abnormal eye movements) – which is what causes the room to feel like it is spinning, when you are not actually moving.
Certain positions such as lying down, looking up and turning over in bed may cause symptoms of vertigo. This should stop within 30-60 seconds. This type of vertigo rarely affects hearing. It can be scary and other symptoms may occur (nausea, imbalance, anxiety, etc.).
How to Diagnose BPPV?
Professionals can determine which canal the otoconia is in based on these eye movements using Infrared Goggles (to view nystagmus patterns) with certain testing positions. You do not have to have these special goggles but it makes diagnosing BPPV more accurate. Once you know which canal the otoconia (“crystal”) is in, you can be most effective with the treatment options.
There are maneuvers to reposition the otoconia back to the Utricle. Seeking an evaluation from a Vestibular Specialist may be necessary if vertigo symptoms persist or the maneuvers are not successful in completely resolving vertigo symptoms. There is good prognosis for this condition. Contact us to find a specialist near you.
Try it at home
Please see videos in our VIDEO VAULT
There are 6 Semicircular Canals: 3 on left side, 3 on right side
The two Epley Maneuvers manage 4/6 canals.
There is a RIGHT and LEFT Epley Maneuver
* Based on their location in the inner ear, the Epley Maneuver is the often most common maneuver used to treat vertigo. Make sure you are treating the proper side and you would use the "Dix Hallpike" left and right test to confirm which side to treat.
The Gufoni Maneuver is used treat the other 2/6 canals called the Horizontal Canals. You would use the "Supine Head Roll" test to confirm which side to treat, left or right.
START:
If you do not already know which canal the otoconia is in, there are 3 testing positions that may help to determine this:
Left Dix Hallpike
Tests 2/6 canals
Tests the Left Posterior and Right Anterior canals. The maneuver to treat BPPV would be "Left Epley"
Right Dix Hallpike
Tests 2/6 canals
Tests the Right Posterior and Left Anterior canals. The maneuver to treat BPPV would be "Right Epley"
Supine Head Roll
Tests 2/6 canals
Tests the left and right horizontal canals. The maneuver to treat BPPV would be "Gufoni Maneuver"
Whichever testing position creates the MOST vertigo symptoms is the side/canal the crystal is most likely in.
The home maneuvers are safe. It may be helpful to have someone at home with you while you go through the movements. It is normal to feel some vertigo at first but vertigo/symptoms should subside with repeat maneuvers. Remember this is benign but it can be scary. Breathe!
Perform the same maneuver 2-3 x day until vertigo stops
If you lie back in the testing position (or first position of the maneuver) and there is no vertigo, you can stop the maneuvers as the otolith has returned back to its home!
AFTER THE MANEUVERS
Wait a few minutes after the maneuver to let things settle. Sometimes people feel relief rather quickly, sometimes they may feel "wonky" while the inner ear recalibrates. It is possible to feel better after one maneuver, however sometimes people need to do it daily for up to 7 days.
Everyone is different on how quickly their body responds after these techniques. You can also just "wait it out" as BPPV can spontaneously resolve itself, but that may take a few days to weeks. Be sure to drink water and get good nutrition, get rest and allow your brain to recover. Listen to your body.
If there is no change in your symptoms or symptoms get worse with the maneuvers, consult your medical provider or a Vestibular Specialist.
Medication will not fix/cure BPPV. Getting the otoconia back to the Utricle with maneuvers is the most effective management. Prescription or over the counter drugs such as Meclizine (Antivert, Bonine, D-Vert, Dramamine) only help with secondary symptoms such as nausea, vomiting and motion sickness. Talk with your doctor about options.
This type of medication reduces the excitability of neurons in the Vestibular/Balance system. There are potential side effects and can lead to reports of "foggy headedness," "imbalance," "cognitive limitations" and "fatigue," as it suppresses brain control centers. It may be necessary to take for a 1-3 days directly after the sudden onset of vertigo or take it if you really really need it, but long-term use is not recommended.
If symptoms continue more than 1 week, contact a specialized provider. You do not have to live with vertigo. Getting specialized care early on after your vertigo onset will have better long-term outcomes.
NOTE
When performing the tests and maneuvers, vertigo symptoms should last less than 1 minute, usually less than 30 seconds if related to BPPV or "positional vertigo". This is the amount of time it takes for the otoconia to fall into a dependent position in the canal. If vertigo symptoms last longer that one minute, or these testing positions do not elicit vertigo symptoms at all … you may not have BPPV. Consult with Vestibular Specialist or your medical provider.
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