Benign paroxysmal positional vertigo, known as BPPV, is a frequent reason for feeling dizzy. It happens when tiny crystals shift inside the inner ear, messing up signals reaching the brain.
When someone has vertigo, they might feel like everything around them is moving or spinning.
Although BPPV can happen to anyone, it’s most common in individuals over 50. It also tends to affect more individuals assigned female at birth compared to those assigned male at birth.
Symptoms
Symptoms of benign paroxysmal positional vertigo can vary widely among individuals. They commonly include feelings of dizziness, vertigo, light-headedness, impaired balance, a sick feeling of stomach or vomiting, vision issues, and nystagmus—a condition marked by rapid, unintentional eye movements.
These symptoms differ in their severity and duration from person to person. For some individuals, even a slight modification in head position can trigger intense symptoms, whereas others may experience only mild effects from rapid or excessive head movements. While vertigo episodes typically resolve in less than 60 seconds, other signs such as dizziness or vision problems may persist for days or weeks.
Understanding these variations helps in managing and treating BPPV effectively, as symptoms can impact daily activities and quality of life differently for each person affected.
Causes
The inner ear serves crucial functions through its two main structures. Firstly, the cochlea changes sound vibrations into signals that nerves carry to the brain. Then, the brain understands these signals as sound. Secondly, the vestibular system, which includes the bony and membranous labyrinths along with the semicircular canals, provides information about body position and is vital for balance and coordination
Benign paroxysmal positional vertigo arises when tiny calcium carbonate crystals, normally found in the membranous labyrinth, migrate into single or multiples of the semicircular canals. As these crystals accumulate, they disrupt the normal fluid movement within the canals, leading to altered signals sent to the brain.
Head movements can trigger vertigo in individuals with BPPV because the solid crystals react to gravity. Specific movements or positions such as rotating the head, sleeping on one side, rolling over in bed, moving in bed, bending your head forward, or tilting your head backward can provoke vertigo episodes due to the displacement of these crystals.
Diagnosis
Diagnosing benign paroxysmal positional vertigo typically involves a thorough assessment by a healthcare provider, starting with a review of the individual’s signs and medical history. The healthcare provider will also conduct a physical examination, focusing on the ears to check for any signs that might suggest a different basic condition.
To confirm BPPV, several tests can be performed. One common test is the Dix-Hallpike test, where the individual lies on their back when the healthcare provider moves their head into specific positions. This test aims to provoke vertigo and observe quick eye movements known as nystagmus, which are indicative of BPPV
Another diagnostic tool is electronystagmography, which records eye movements in response to various stimuli like lights or head movements. This test helps assess the function of the vestibular system.
In some cases, an electroencephalogram may be used to check brain activity and eliminate other neurological conditions that could mimic BPPV symptoms.
If the diagnosis remains uncertain after these tests, an MRI scan may be recommended to provide detailed images of the inner ear and head structures, helping to identify any abnormalities that could contribute to the symptoms.
These diagnostic approaches enable healthcare providers to accurately identify BPPV and develop an appropriate treatment plan tailored to the individual’s needs
Treatment
Treatment options for benign paroxysmal positional vertigo focus on improving balance, reducing vertigo, and stabilizing vision.
Epley maneuver
One effective treatment is the Epley maneuver, where specific head movements help move calcium carbonate crystals out of the semicircular canals. This maneuver can be performed by a healthcare provider or learned for home use. It involves sitting on the end of a bed, turning the head to each side, lying back, and holding positions to reposition the crystals.
Repositioning maneuvers like the Epley maneuver have shown high success rates in studies, with many individuals experiencing relief from BPPV symptoms within a month. After treatment, it’s important to keep the head upright to prevent the crystals from returning to the canals.
Brandt-Daroff exercises
Brandt-Daroff exercises are another option, although they are less effective than the Epley maneuver. These exercises involve lying on each side for about 30 seconds to help redistribute the crystals and alleviate vertigo.
Betahistine
Medications like betahistine are sometimes prescribed to manage vertigo symptoms associated with BPPV. Studies have shown that betahistine can significantly reduce vertigo and related symptoms like nausea and faintness when used regularly.
Combining betahistine with repositioning maneuvers like the Epley maneuver may lead to quicker recovery and fewer episodes of BPPV recurrence compared to using either treatment alone.
Tips
Living with benign paroxysmal positional vertigo involves working closely with healthcare providers like physical therapists or audiologists to create a personalized medication plan. It typically includes medications, specific exercises, and strategies for managing vertigo episodes.
It’s essential to keep track of head movements and positions that trigger vertigo. Avoid sudden head movements, as these can exacerbate symptoms by disturbing the calcium crystals in the inner ear.
Maintaining an upright head position whenever possible can help prevent the crystals from repositioning incorrectly and triggering vertigo episodes.
When feeling vertigo or dizziness, moving the head gradually into a neutral position can alleviate symptoms. Sometimes, lying down on a bed or couch until symptoms subside can also be helpful.
When to consult a healthcare provider
It’s important to see a healthcare provider if you experience certain symptoms related to vertigo or after a head or neck injury.
If you have frequent or prolonged episodes of vertigo, along with a sick feeling of stomach and vomiting, fever, headaches, continuous fatigue, or neck pain, it’s advisable to get medical attention. These symptoms could indicate underlying issues that need evaluation and treatment.
In cases where there’s been a neck or head injury, immediate medical attention is crucial if you experience prolonged dizziness, vomiting, loss of consciousness, a sudden extreme headache, confusion, mood changes, or difficulty using your legs or arms. These symptoms could suggest a more serious condition that requires prompt evaluation and care from a healthcare professional.
Outlook
Benign paroxysmal positional vertigo is a frequent source of vertigo, occurring when calcium carbonate crystals shift to the semicircular canals from the membranous labyrinth in the ear.
While BPPV itself isn’t dangerous, it can significantly disrupt daily life and cause discomfort.
In many cases, BPPV resolves spontaneously as the body naturally retakes the calcium carbonate crystals. However, if signs persist, effective treatment alternatives are available.
Treatment for BPPV typically involves maneuvers aimed at repositioning or eliminating the vertigo-prompting crystals from the semicircular canals. People experiencing BPPV symptoms can discuss various treatment options with their healthcare provider to find the most suitable approach for their condition. Seeking medical advice ensures appropriate management and relief from symptoms, improving overall quality of life.
Summary
Benign paroxysmal positional vertigo (BPPV) is a common condition where calcium carbonate crystals disrupt the balance in the inner ear’s semicircular canals, causing vertigo. Treatment options include maneuvers like the Epley maneuver to reposition these crystals and medications like betahistine for symptom management.
Living with BPPV involves avoiding sudden head movements and keeping the head upright to prevent vertigo triggers. Patients should seek medical attention if they experience persistent or severe vertigo, nausea, headaches, or symptoms following a head injury. Although BPPV can resolve on its own, effective treatments can alleviate discomfort and improve daily functioning, ensuring a better quality of life.
