Benign Paroxysmal Positional Vertigo, also known commonly as BPPV, is a type of vertigo that is triggered by certain sudden changes in the position of the head. These sudden movements or changes in the position of the head might include tipping the head in one direction, or getting up suddenly, or moving the head from one side to the other. Some BPPV patients might experience symptoms & episodes when they do something as simple as rolling over in the bed.
What are the symptoms of BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is a type of vertigo triggered by changes in the position of the head, from sudden tipping to moving the head in a different direction too quickly. BPPV leads to sudden vertigo, with patients often feeling as if the room is spinning or moving around them. This moving or spinning sensation can be mild or severe depending on the exact health of the individual.
BPPV may also be accompanied by other symptoms. Some of these include:
- Headache, ranging from mild to severe & migraine intensity
- A general sense of being unbalanced, disoriented, or woozy
- Motion sickness
What causes BPPV?
Our middle ear consists of tiny calcium crystals called otoconia. These calcium crystals are motion-sensitive, which means they have the ability to detect motion & changes in the head’s position relative to gravity. When in the middle ear, these crystals don’t usually cause any problems with changes in the head’s position. However, when they get accidentally dislodged inside the inner ear, they cause problems with the way the vestibular system perceives balance & the head’s position relative to gravity.
This is why, a person with BPPV on moving their head, feels as if their surroundings or they themselves, are moving or spinning out of control. As the calcium crystals loosen up & keep getting deposited in the semicircular canals of the inner ear, they stimulate the ‘cilia’, which are tiny hair on the surface of the inner ear responsible for carrying balance information from the inner ear to the brain, into thinking there is movement even when there is not.
This misfire in the inner ear is what causes the sudden spinning sensations, dizziness, nausea, motion sickness, & vomiting among people who suffer from BPPV. When in this state, movements like tipping the head over, rolling over in bed, or moving your head from side to side, can bring on BPPV symptoms in people.
In most cases, BPPV only affects one of the ears. Although in some rare cases, BPPV may affect both ears.
Is BPPV dangerous?
As is in its name, Benign paroxysmal positional vertigo is often not dangerous, & is not something to worry about. However, the constant fear of falling down, losing your balance while performing activities that require sharp focus & concentration like driving, hiking, etc. can cause people to become anxious & unduly fearful. This can cause them to suffer from depression & anxiety in situations where they feel they can lose their balance & fall down.
So, even if BPPV is not dangerous, it can significantly affect a person’s abilities to maintain a healthy, meaningful social life & perform various activities.
Diagnosis of BPPV: The Dix-Hallpike Maneuver
Your doctor can easily diagnose BPPV based on a detailed medical history, the onset & triggers of your symptoms, their intensity, & their duration. Once they have determined that you suffer from BPPV, your doctor can also tell you which of your ears is affected by BPPV. They can do this by performing a simple maneuver called the Dix-Hallpike maneuver. You can perform this maneuver yourself at home too, to figure out which of your ears is affected by BPPV.
Here’s how to perform the Dix-Hallpike maneuver:
- Sit on the bed/exam table such that when you lie down, your head hangs over the edge of the bed/table slightly.
- Turn your head to the right & quickly lie on your back.
- Wait about a minute.
- If you feel dizzy after this, it means that your right ear is the one affected by BPPV.
- If you don’t feel dizzy, sit up and wait about a minute.
- Turn your head to the left side & quickly lie back.
- Wait about a minute.
- If you feel dizzy after this, it means that your left ear is the affected one.
Benign paroxysmal positional vertigo treatment:
In most cases, BPPV goes away on its own. However, if you still get BPPV symptoms even after 6 weeks from the onset of BPPV, then your doctor might prescribe you some BPPV treatments. Your BPPV treatment may include BPPV exercises like the canalith repositioning maneuver, certain medications to reduce dizziness & nausea, along with some home remedies for vertigo. One of the most common & popular exercises prescribed for BPPV patients is called the canalith repositioning maneuver, which is also widely known as the Epley Maneuver. It is highly effective in BPPV treatment, with a success rate of up to 90% in some cases.
The Epley Maneuver is an easy-to-perform BPPV exercise that you can perform by yourself at your home. A trained specialist can also do it on you in their office.
To perform the Epley Maneuver at home, follow the instructions below:
- Begin by sitting up on a bed or table. Turn your head towards the affected ear about 45 degrees.
- With your head still turned towards the affected ear, lie down quickly on the bed/table such that your head hangs slightly over the edge of the bed/table.
- Wait a minute or so in this position to let any dizziness pass.
- Roll onto your side & turn your head in the same direction, another 90 degrees. Your nose should now be facing the floor. Wait for about a minute in this position.
- While keeping your chin tucked in toward your shoulder, sit up in the direction of your body.
- Wait for about 15 minutes before you resume your daily activities.
Perform this exercise in a set of 3 repetitions each time, about thrice a week for best results.
What if my BPPV returns?
On average, about 15-50% of BPPV patients experience a recurring episode of BPPV, even after successful remission. However, performing the Epley Exercises & other BPPV exercises can easily give you relief from your symptoms. Your doctor will likely give you a specific plan to prevent any recurring episodes from happening, along with instructions to follow if another episode does happen.
The next time you experience BPPV symptoms, try the steps given below:
- Move into the good-ear-face-down position slowly and wait for about a minute.
- Then move into a face-down position slowly while sliding to the edge of the bed.
- Keeping your head downwards, reach the end of the bed and either kneel or stand on the floor.
- Bring your head back into an upright position slowly. Perform all the steps while holding on to the bed.
There’s another thing you can try to relieve dizziness the next time you experience an episode of BPPV. Sit toward the foot of the bed, while leaving enough space to lay back comfortably with your head resting at the end of the bed, in a slightly extended position. Take care to not overextend your neck, as this may cause certain neck problems or worsen already existing neck issues. People with severe BPPV might require assistance to perform this maneuver.
It’s possible that BPPV symptoms may persist, especially if you don’t seek treatment. However, most cases of BPPV usually resolve within about 6 weeks, as that is the amount of time after which the loose calcium crystals get absorbed by the utricle inside your ear. If it doesn’t, you can always fall back on the Epley Maneuver, other BPPV Vertigo exercises, & BPPV treatment medications & procedures.