Treatment for Positional Vertigo (BPPV)
comes in sudden, brief spells
triggered by certain head positions
false sense of rotational movement
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 Frenzel 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 get help with managing BPPV if you suspect you have it.
Doing it at home
While these maneuvers can be done at home (remember BPPV is a benign condition!), and many people can have success with doing so. It not recommended to try these maneuvers at home if you do not know which canal the crystal is in (there is more than just the Epley!) and have not been advised by a professional.
If someone told you to go home and do "The Epley Maneuver," just know that there is a RIGHT Epley and a LEFT Epley. Doing one side may put the crystal back where it suppose to go (hurray!), theeenn you roll on the other side and that may displace the crystal again ... and maybe put the otoconia into a different canal that the Epley Maneuver does not work on.
80-90% of BPPV cases involve the posterior canal which the Epley Maneuver is appropriate for. The angle of the head and the smooth roll during the maneuver all are important to ensure the otoconia travels through the canal to get back home with its friends in the Utricle.
If you are not seeing progress within 2-3 days of doing the maneuvers, seek attention from a specialist that knows how to properly diagnose your vertigo. It is important to know which canal the crystal is in, which maneuver is most appropriate for that type of positional vertigo and most importantly ensure that your diagnosis is truly positional vertigo (BPPV). Also, it is not always a "crystal" out of place causing vertigo or imbalance.
Some practitioners have fun tools like Frenzel Goggles to be able to evaluate eye movement (nystagmus) that coincides with the type of BPPV. They will also be able to evaluate if there are any other underlying inner ear or brain conditions that could be the cause of your vertigo.
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 some 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 need it, but long-term use is not recommended for a positional vertigo (BPPV) condition.
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.
Contact us with any questions or for more information: