If you’ve ever sat up quickly or rolled over in bed abruptly and felt like the room was spinning or whirling around you when you’re actually still, you may have experienced a condition called benign paroxysmal positional vertigo (BPPV) without knowing what it was. This vestibular disorder—one that affects the inner ear—is one of the most common causes of vertigo, and it can make people feel very dizzy, unsteady, sweaty, even nauseous. Individual bouts tend to be brief—usually lasting 15 to 60 seconds at a time—but they can recur with certain head movements, make it difficult to function, and increase the risk of falling.
“The term ‘benign’ is the first part of the phrase—it does not feel benign when you experience it,” says Dr. Nedim Durakovic, an associate professor of otolaryngology and neurotology at the Washington University School of Medicine in St. Louis. Before the condition was well understood, “people thought that patients were having strokes when they had vertigo, [but] this is not the stroke form of vertigo.”
Here’s what to know about BPPV.
What causes BPPV?
With BPPV, tiny calcium carbonate crystals—called otoconia—that usually sit on hair cells in the inner ear get dislodged from where they belong and travel into one of the three semicircular canals of the inner ear. A change in head position, such as while rolling over in bed or tipping your head back in the shower, is what usually triggers BPPV symptoms.
It’s natural for these crystals to be in the ear. “They are part of your normal anatomy for your balance function,” says Dr. Gail Ishiyama, a professor in the departments of neurology and head and neck surgery and director of the Vestibular Clinical Laboratory at the UCLA School of Medicine. With BPPV, “they’re just in the wrong place, and that can cause vertigo.”
BPPV affects twice as many women as men, and it’s particularly common between the ages of 40 and 70. It can happen anytime, but head trauma or dental procedures involving drilling are two of the more common triggers, Ishiyama says.
People who have Menière’s disease (a chronic inner ear disorder), diabetes, hypertension, high cholesterol, hypothyroidism, migraine, anemia, osteoporosis, or peripheral neuropathy are particularly susceptible to BPPV, research has found. And research increasingly suggests that low vitamin D levels are a risk factor for BPPV.
How is BPPV diagnosed?
Getting the right diagnosis for BPPV isn’t always straightforward. “One of my frustrations with patients who experience this is they’ll go to the ER or they’ll get an MRI scan or a head CT scan—this whole [expensive] workup—when somebody just needed to lay them down and look at their eyes,” says Durakovic.
That, he says, is the easiest way to diagnose BPPV. Using something called the Dix-Hallpike maneuver, a health care provider will have the patient move between a seated and supine position and move their head in different directions while the provider examines their eyes. If the person’s eyes rapidly, repetitively, and involuntarily move up and down or in a twisting motion, these are signs of nystagmus, a condition involving sudden eye movements. Nystagmus often accompanies vertigo caused by BPPV, and if it does, the diagnosis is clear. If the patient doesn’t exhibit nystagmus, other diagnostic maneuvers may be used to trigger telltale symptoms.
What’s the treatment for BPPV?
The first-line treatment for BPPV uses a different maneuver called the Epley maneuver, which involves a series of specific head and body movements to remove the wayward crystals from the semicircular canal in order to relieve symptoms of vertigo. Sometimes the maneuver needs to be repeated several times, notes Durakovic. But research has found that it does the trick in more than 80% of people with BPPV.
There are other repositioning maneuvers, too, depending on which of the semi-circular canals is affected. “The positional maneuvers move the crystals along the pathway out of the canal and back to where they belong,” explains Dr. Cameron Wick, an associate professor of otolaryngology and neurotology at the Case Western Reserve University School of Medicine. If the maneuvers don’t provide immediate relief, people are advised to do them one to two times per day while they’re symptomatic, according to Wick.
In the instances when repositioning maneuvers don’t effectively relieve BPPV, the condition may resolve on its own over time. Other treatment options may include vestibular rehabilitation therapy—which is designed to treat dizziness, vertigo, and balance disorders—or surgery, which involves inserting a plug to block the part of the inner ear that crystals are flowing into.
Sometimes doctors prescribe vestibular suppressant medications, such as benzodiazepines or antihistamines, to calm the vertigo associated with BPPV. But Durakovic and Wick advise against these because they don’t address the underlying cause; they simply mask the symptoms temporarily. What’s more, these drugs are linked with an increased risk of falls when they’re used to treat dizziness.
Even when BPPV is successfully treated, recurrences occur in about 20% of people who’ve experienced it. “If you take vitamin D supplements, you’re less likely to get a recurrence of BPPV,” says Ishiyama. Staying hydrated and doing regular aerobic exercise can help, too, she says.
If, despite these measures, you find yourself experiencing recurrences of unexplained vertigo, it’s a good idea to see a neurotologist, an otolaryngologist, or a vestibular therapist to make sure that you are getting the right diagnosis.
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