“Dizzy my head is spinnin.  Like a whirlpool it never ends…you’re makin me dizzy.” — The Archies

By popular depiction, vertigo seems most at home in the world of cartoons. After a comedic encounter with an anvil, the character wobbles around with stars orbiting the head. In movies, you may have seen a camera go in out and of focus, or have the plane of sight shift back and forth. Whether or not you’ve had vertigo, you probably have an assumption about what it’s like to experience vertigo.

But what is vertigo? Vertigo is a type of dizziness that occurs when a person experiences the perception of motion due to dysfunction of the vestibular system in the inner ear. Interestingly, your balance and the experience of motion emerge from hair cells in your ear. The fluid that resides in the three vestibular canals in your inner ear brushes the hair cells. These biological sensors convert displacement from head motion into neural firing. These neural firings tell your body about its motion experiences and help you automatically track with your eyes and contract your muscles to support movement.

Benign Paroxysmal Positional Vertigo (BPPV)

While vertigo fits into multiple categories and explains different kinds of atypical experiences, the most common type of vertigo is Benign Paroxysmal Positional Vertigo (BPPV).

Those are some big words so let’s break it down a bit. Benign means not harmful or malignant. In essence, you are not facing a life-threatening issue. Paroxysmal refers to the fact that the symptoms only occur intermittently. Positional references the occurrence of vertigo at specific states of motion, most often when the head is moved into certain positions. And finally, vertigo is a feeling of dizziness as defined earlier.

Put it all together and Benign Paroxysmal Positional Vertigo (BPPV) is a period of dizziness due to a specific motion, which causes a sudden outburst that isn’t overly harmful. Symptoms are often preceded to a bump of the head and sometimes they occur spontaneously. Inside the vestibular canals, the hair cells are embedded in a gel like material that is stabilized by small sand like pieces of calcium called otolith organs. The small stones can be dislodged and then float into the canal. Like dropping a stone into water, the otolith creates a ripple in the canal fluid, which then sweeps the hair cells creating the feeling of motion.

Symptoms

They key symptoms of BPPV are triggered when lying down, rolling over in bed, bending over, turning the head and looking up. More practically, you might discover these symptoms while at the hair salon or while you are changing oil under the car.

Sometimes, these balance problems last for many hours or even days after the vertigo has stopped. Even still, spontaneous remission is common. Vertigo can be disruptive and exceedingly annoying.

On Diagnosis

So how can you treat BPPV? It’s important to test for it first. The testing is simple and is called the Dix-Hallpike maneuver after the doctors who developed it. Once confirmed, there are a few maneuvers you can execute to help deal with vertigo.

When it comes to testing, the Dix-Hallpike position is a two-step process you go through. Move from a sitting position to a supine position, meaning lying down facing upward. While lying down, your head should be positioned 45 degrees to one side and extended about 20 degrees backward. While here, your physical therapist will observe eye movements and your reactions to the maneuver. Observation is made for a flicking motion of the eyes, the onset of the vertigo symptoms. If necessary, the patient moves back to a sitting position, waits for 30 seconds, and does the Dix-Hallpike position again with the head moving to the other side.

On Treatment

For treatment, there are 4 maneuvers that can be used to help return the otolith stones to the gel they reside in.

The key treatment is called the Epley maneuver.

The treatment is a series of maneuvers that are aimed at moving the stones back home. Often, after this treatment the symptoms disappear. Over the next 24 hours, it is important to sleep elevated at least for one day. Avoid sleeping on the treated side. And finally, avoid bending over and looking up or down, or rotating in the offending direction.

We’ve all seen the popular rendition of vertigo in film, but it can be scary and frustrating to deal with it if it comes to you. If you are struggling with dizziness, come by PromoPT and we’ll help you through the process so you don’t need to deal with this annoyance anymore!