BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)
What is
BPPV? Benign paroxysmal
positional vertigo is generally thought to be due to some
debris within one of the semi-circular canals of the inner
ear. The flow of fluid within that canal is hindered, and
consequently the inner ear sends erroneous information to
the brain regarding one's position and movement. BPPV causes
about 50% of all dizziness in older people, but can occur in
children. What are the
symptoms? Symptoms include dizziness
or vertigo, lightheadedness, imbalance, and nausea.
Activities that bring on symptoms will vary, but symptoms
are almost always brought on by a change of position of the
head. Getting out of bed or rolling over in bed may produce
symptoms. Because people with BPPV often feel dizzy and
unsteady when they tip their heads back to look up,
sometimes BPPV is called "top shelf vertigo." Women with
BPPV may find that the use of shampoo bowls in beauty
parlors brings on symptoms. An intermittent pattern is
common. BPPV may be present for a few weeks, then stop, and
come back again. How is it
diagnosed? The diagnosis is often
made based on the history and physical examination.
Sometimes further testing is required.
How is BPPV
treated?
BPPV often subsides or disappears within 2 months of onset, though can last much longer. Though it is not life-threatening, one has to be rather careful in their activities. Otherwise, one can certainly just wait it out.
If you decide to wait it out, certain modifications in your daily activities may be helpful. Try using two or more pillows at night. Avoid sleeping on the "bad" side. In the morning, get up slowly and sit on the edge of the bed for a minute. Avoid bending down to pick up things. Avoid extending the head, such as to get something out of a high cabinet. Be careful when putting your head back at the dentist's office, at the beauty parlor, or when washing your hair.
Symptoms tend to wax and wane. Motion sickness medications are sometimes helpful in controlling the nausea associated with BPPV but are otherwise rarely beneficial.
HOME TREATMENT OF BPPV
These exercises succeed in 95% of cases. The response rate at one week is about 25%. These exercises are performed in three sets per day for two weeks. In each set, one performs the maneuver as shown five times.
1 repetition = maneuver
done to each side in turn (takes 2 minutes) Start sitting upright
(position 1). Then move into the side-lying position
(position 2), with the head angled upward about halfway. An
easy way to remember this is to imagine someone standing
about 6 feet in front of you, and just keep looking at their
head at all times. Stay in the side-lying position for 30
seconds, or until the dizziness subsides if this is longer,
then go back to the sitting position (position 3). Stay
there for 30 seconds, and then go to the opposite side
(position 4) and follow the same routine. These exercises should be
performed for two weeks, three times per day, or for three
weeks, twice per day. This adds up to 52 sets in total. In
most persons, complete relief from symptoms is obtained
after 30 sets, or about 10 days. In approximately 30 percent
of patients, BPPV will recur within one year. If BPPV
recurs, you may wish to add one 10-minute exercise to your
daily routine. When performing these
exercises, if you experience neurological symptoms (i.e.
weakness, numbness, visual changes other than vertigo), do
not proceed with the exercises. Consult your physician.
Adapted from Timothy Hain, MD
(http://www.dizziness-and-balance.com/disorders/bppv/bppv.html)