It’s All in Your Head: Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a brief, intense sensation of spinning that usually occurs when getting out of bed or turning your head too quickly.

Also referred to simply as “positional vertigo,” benign paroxysmal positional vertigo (BPPV) is a common form of balance disturbance that originates in the inner ear. Imagine waking up in the morning: you open your eyes and start to roll out of bed, but then you’re stopped by a sudden sensation that the room is spinning. You have to hold the furniture and walls just to get out of bed and take a few steps. After you stand in one position for a few minutes, the feeling passes. Although frightening, it is most often harmless. This is one of the most common types of dizziness that we see and treat in our office.

The impact of BPPV can range from being a mild annoyance to a highly debilitating condition that can affect function, safety and present a fall risk. The condition will sometimes spontaneously resolve over days or weeks.

BPPV is actually a mechanical problem in the inner ear when some of the otoconia (little grains of calcium carbonate that are like sand) that are normally embedded in the gel of the utricle – the part of your inner ear that senses changes in gravity – become dislodged and migrate into one or more of the three fluid filled semicircular canals where they are not supposed to be. When the crystals get caught in these canals, particular head positions can cause a feeling of dizziness.

Treatment for the vertigo is dependent on which ear and which canal the otoconia are stuck in, but in general, by watching our patient’s eye movements when we evaluate where the dizziness is coming from, we can tell which treatment is going to be successful. The most common of the treatment methods is called the Epley maneuver. Following the treatment, the dizziness will typically be gone, if not immediately, within 24 hours.

Not all dizziness is from BPPV, but typically if there are no other ear symptoms like ringing in the ears, changes in hearing or other symptoms that suggest a stroke or more serious problem, BPPV should be suspected. Many primary care doctors, physical therapists or chiropractors know how to perform the testing and perform and explain the treatment maneuvers. My office will be happy to see you or a family member to help get rid of this condition.