Benign paroxysmal positional vertigo (BPPV): Causes and treatment (original) (raw)

Benign paroxysmal positional vertigo, or BPPV, is a common cause of vertigo. BPPV occurs when crystals move from one part of the inner ear to another, disrupting signals to the brain.

When a person experiences vertigo, they may feel as though their surroundings are spinning or moving around them.

Although anyone can develop BPPV at any age, this condition usually affects people over the age of 50 years. BPPV is more common in people assigned females at birth than in people assigned males at birth.

BPPV is not a life threatening condition, but it can cause significant discomfort. In this article, we take a look at its symptoms, causes, and treatment options.

Symptoms of BPPV include:

• vertigo
• dizziness
• feeling light-headed
• loss of balance
• nausea or vomiting
• vision problems
• nystagmus, which is a medical condition that causes rapid, involuntary eye movements

BPPV symptoms vary among individuals in intensity and duration. A slight change of head position can cause severe symptoms in some people, while rapid or extreme head movements might produce only mild symptoms in others.

Although vertigo usually lasts for less than a minute, other symptoms can last for several days or weeks.

The inner ear contains two different structures:

• The cochlea converts sound vibrations into nerve impulses, which the brain interprets as sound.
• The vestibular system provides information about the body’s position and plays a vital role in balance and coordination. It consists of the bony labyrinth, the membranous labyrinth, and the semicircular canals.

BPPV occurs when calcium carbonate crystals, which usually appear in the membranous labyrinth, move to one or more of the semicircular canals.

When enough calcium carbonate crystals build up, they disrupt the movement of fluid through the semicircular canals, altering the signals that travel to the brain.

Moving the head can trigger vertigo because the solid crystals respond to gravity. The following head positions and movements can trigger vertigo in people who have BPPV:

• turning the head
• lying on the side of the head
• rolling over in bed
• bending the head forward
• leaning the head back

A doctor can confirm BPPV after reviewing a person’s symptoms and medical history. They may perform a physical examination and inspect the ear for signs that could indicate a different underlying condition.

Tests that a doctor can use to help them diagnose BPPV include:

• Dix-Hallpike test. During this test, a person lies on their back while a doctor rotates their head. These movements should induce vertigo if the person has BPPV. A doctor will also look for rapid eye movements that indicate nystagmus.
• Electronystagmography (ENG). A doctor will use this test to record a person’s eye movements under different conditions, such as when looking at a light or moving the head.
• Electroencephalogram (EEG). A doctor can use an EEG to measure brain activity and rule out any possible underlying neurological conditions.
• MRI scan. If a doctor cannot confirm a diagnosis, they may use an MRI to examine the head and inner ears.

Treatments for BPPV mainly focus on improving visual stability and reducing vertigo and dizziness.

Effective treatments for BPPV include the following:

Epley maneuver

The Epley maneuver involves performing a specific series of head movements to dislodge the calcium carbonate crystals from the semicircular canals.

A trained healthcare professional can administer this treatment and teach people how to perform the movements at home.

To do the Epley maneuver:

• Start by sitting on the edge of a bed.
• Turn the head 45 degrees to the right.
• Lie down on the back, keeping the head turned, then hold for 30 seconds.
• Turn the head so that it faces 45 degrees to the left, then hold for 30 seconds.
• Roll the body onto the left side, then hold for 30 seconds.
• Sit up on the left side.
• Repeat these steps on the other side, turning the head to the left first.

Repositioning maneuvers are incredibly useful for treating BPPV. In a 2019 study involving 359 people with BPPV, researchers found that repositioning maneuvers had a 75–100% success rate 1 month after treatment.

A doctor may advise a person to keep their head upright for a few days following the procedure. Doing this will prevent the crystals from moving back to the semicircular canals.

Brandt-Daroff exercises

These exercises are less effective than the Epley maneuver because they do not necessarily remove calcium carbonate crystals from the semicircular canals. Instead, these exercises spread out any buildups. However, Brandt-Daroff exercises can help reduce vertigo symptoms.

To do Brandt-Daroff exercises:

• Begin in an upright, seated position at the edge of a bed.
• Lie down on the left side, turning the head to the right so that the face points toward the ceiling.
• Hold this position for 30 seconds.
• Sit up and return to the starting position.
• Repeat this exercise on the right side.

Some people may feel dizzy or light-headed after completing a set of Brandt-Daroff exercises. If this is the case, they should wait for the dizziness to pass before standing up.

People should stop doing these exercises if they notice new or worsening symptoms.

Betahistine

Betahistine is a medication that doctors use to treat vertigo and BPPV.

In a 2017 study, 305 adults with vestibular vertigo received 48 milligrams of betahistine each day for 60 days. At the end of the treatment period, 94.4% of the participants had responded positively to the treatment, according to their doctors. A significant proportion of the participants experienced a reduction in vertigo-related symptoms, such as nausea, vomiting, and faintness.

In another 2017 study, people with BPPV who received treatment with both betahistine and the Epley maneuver showed earlier signs of improvement and fewer recurring episodes than people who received only one of these treatments.

People who have BPPV can work with an audiologist or physical therapist to develop a personalized treatment plan. This plan may include exercises, medication, and tips for coping with vertigo.

General tips for living with BPPV include:

• keeping track of head movements and head positions that trigger vertigo
• avoiding making sudden head movements
• keeping the head upright to avoid disturbing the calcium crystals

When experiencing dizziness or vertigo, it may help to move the head slowly into a neutral position or lie down on a bed or couch and wait until this symptom resolves.

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A person should see a doctor if they experience frequent episodes of vertigo, nausea, or vomiting.

People should see a doctor if they experience:

• frequent or long lasting episodes of vertigo
• nausea or vomiting
• headaches
• fever
• persistent fatigue
• neck pain

People should seek immediate medical attention if they experience the following symptoms after sustaining a head or neck injury:

• prolonged dizziness
• nausea or vomiting
• loss of consciousness
• a sudden, intense headache
• confusion or changes in mood
• difficulty using the arms or legs

BPPV is a common cause of vertigo. BPPV occurs when calcium carbonate crystals move from the membranous labyrinth to the semicircular canals in the ear.

Although this condition is not life threatening, it can cause significant discomfort and interfere with a person’s daily life.

BPPV can go away on its own once the body reabsorbs the calcium carbonate crystals. However, if symptoms do not improve on their own, people can choose from several effective treatment options.

BPPV treatments usually focus on removing the vertigo-inducing crystals from the semicircular canals. People who have BPPV can speak with a doctor about their treatment options.