Vertigo can be one of the most unpleasant and debilitating conditions to experience, particularly because it often comes on so suddenly and intensely.
However, it’s a condition I enjoy treating as the most common form of vertigo (benign paroxysmal positional vertigo, or BPPV) can be quite easily treated in most cases.
However, there are a couple of things we need to determine first.
- Are you actually experiencing vertigo or is it another form of dizziness?
- If you are experiencing vertigo, what is causing it?
1. Are you actually experiencing vertigo or is it another form of dizziness?
Vertigo is considered a sensation of whirling and loss of balance. Often it feels like the room is spinning.
This must be distinguished from other forms of dizziness such as light-headedness, fogginess or unsteadiness, however this can be difficult.
Other forms of dizziness that must be excluded include:
- Vertebrobasilar insufficiency (VBI)
- Cervicogenic dizziness/cervical vertigo
- Vestibulocochlear neuralgia/neuritis
- Orthostatic hypotension
2. If you are experiencing vertigo, what is causing it?
After screening and excluding other forms of dizziness, the cause of the vertigo symptoms must be determined. 75% of vertigo is due to a peripheral cause rather than a central cause.
- Meniere’s disease
- Post traumatic vertigo
- Cervical vertigo (cervicogenic dizziness)
So what is BBPV?
The most common cause of vertigo is BPPV affecting an estimated 107 per 100,000 per year and a lifetime prevalence of 2.4%.
The vestibular system includes the inner ear, which is made up of 3 canals containing semi-circular fluid and calcium carbonate crystals (otoconia) to detect movement.
For example, when we look up, movement of fluid within the posterior canal sends a message to our brain that our head is moving and about what position our head is in space.
Over time or following an acute injury, the crystals in the inner ear can become dislodged and accumulate at the bottom of the canal.
Movement of the head such as rolling then causes excessive stimulation of the vestibular system as these free particles move resulting in the sensation of spinning (vertigo).
What BPPV actually stands for is:
- Benign – it is not life-threatening
- Paroxysmal – it comes in sudden, brief spells
- Positional – it gets triggered by certain head positions or movements
- Vertigo – a false sense of rotational movement
Typical symptoms of BPPV are?
- Sudden severe vertigo
- Can be triggered by rolling out of bed, getting out of bed, looking up
- Loss of balance
So, how can physiotherapy help?
Once we’ve excluded any other conditions causing your dizziness and identified the problem as BPPV it can be quite easily treated.
A simple manoeuvre called the Epley manoeuvre can be performed under assistance to re-position the particle in inner ear, back where it belongs.
We will often repeat this manoeuvre 2-3 times in the first session.
You’ll often notice a rapid improvement by the end of the day or the next day, however everyone is slightly different depending on the severity of the condition.
There are also exercises that you can do at home to help settle your symptoms.
These vary again depending on the type of vertigo you have and the severity of your condition at the time.
If treatment doesn’t help or your symptoms are slow to improve, we’ll refer you off to a vestibular specialist, as your condition may be slightly more complex!
My advice if you are experiencing vertigo
- If you’re able to get to the physio, come in as soon as you’re ready to have the problem assessed
- If you’re unable to get out of bed because the vertigo is too intense or you’re experiencing severe nausea, seek the advice of a doctor or pharmacist as to whether Stemetil is a suitable medication for you to help with these symptoms
- Try not to turn your head or change position too quickly
- Sleeping more upright with a couple of extra pillows can help
For such a debilitating condition, it can be quite easily treated.
The most important thing is we determine what is causing your dizziness. In most cases, it can be fixed very quickly and easily!
- Bhattacharyya N et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 139(5 Suppl 4):S47-81, 2008.
- Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980 Aug;106(8):484-485.
- Froehling DA, Silverstein MD, Mohr DN, et al. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 1991;66:596–601.
- Radtke, A., et al. (1999). “A modified Epley’s procedure for self-treatment of benign paroxysmal positional vertigo.” Neurology 53(6): 1358-1360.