Tackle Vertigo Head On!
Vertigo is a common problem that I see in primary care. A lot of times patients tell me that they feel ‘dizzy,’ so the first thing I have to do is figure out if a patient is feeling generally off balance or lightheaded, vs true vertigo. Vertigo is a room-spinning sensation, as if you are on an amusement park ride and can’t get off. The most common presentation of vertigo I see is the type that happens on and off. This is called BPPV - Benign Paroxysmal Positional Vertigo. Let me break that down a little.
Benign in medicine refers to something that is not harmful. Mostly this is contrasted with malignant ( = badness), though benign conditions in medicine are generally not ‘pleasant and kind,’ which is the lay definition of benign. Paroxysmal means it happens on and off as a sudden attack. Positional is in this diagnosis because these on and off sudden attacks are typically related to the position of the body, or in this case, usually a change in position.
BPPV classically presents with a sudden onset of a room-spinning sensation triggered by a position change such as standing up, rolling over, or turning the head. The room-spinning sensation goes away on its own within seconds to minutes. It is generally a very uncomfortable and scary experience, and can increase a person’s risk of falling. So the symptom itself is not necessarily benign, but the underlying cause is not something alarming or harmful.
In our ear canals, we have calcium crystals sitting within fluid. These crystals shift with head movement, bending little hair cells that report the movement back to the brain. When you turn your head, the crystals move and then stop, sending that signal to the brain. At the same time, your eyes move and then stop, sending a matching signal, and all is well. With BPPV, these crystals are either not where they should be, or there is some other debris within the ear canal also stimulating those hair cells with extra messages that don’t align with the message your vision receives, resulting in the room-spinning sensation.
Luckily there is a fairly simple and low risk treatment for BPPV, called Epley maneuvers. By doing a simple repositioning exercise at home, three times a day, the majority of patients with BPPV will improve within a few days to a week! Some resistant cases need to work with a vestibular physical therapist rather than doing self-treatment. A lot of people will experience recurrent episodes of BPPV, but still should improve with starting up the Epley manevuer again. There are some studies that suggest taking a Vitamin D supplement can reduce recurrence rates by almost half (see my youtube video on soaking up some Vitamin D!).
There are many other reasons you might feel dizzy, so if you think you have BPPV but you aren’t getting better with Epley maneuvers, make sure you reach out to your doctor to talk it over!
