BPPV
BPPV stands for ‘benign paroxysmal positional vertigo’ and literally means dizziness when changing position, and without any sinister underlying cause. So, ‘benign’ means harmless, ‘paroxysmal’ means it’s sudden and brief, and ‘positional’ because the vertigo (the feeling like you’ve just got off a fairground ride) is triggered by changes in your head position.
The inner ear is a series of tubes that give us our sense of balance, as well as hearing, and in BPPV, tiny crystals collect in the tubes, disrupting this. It’s the most common cause of vertigo, the sensation of the room spinning around you. This gives brief episodes of dizziness lasting less than a minute, and usually triggered by certain head movements.
BPPV can also cause a loss of balance and nausea or vomiting. BPPV is more common the older you get, and in most cases occurs as a result of age-related degeneration of the ear system. About a third of the population will have experienced BPPV by the time they’re 70, with the peak age being in the 50s and 60s. It’s rare in children and young adults. There’s no specific cure for BPPV, but it’s not usually a sign of anything serious, and will usually get better on its own after several weeks although it can come and go.
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What causes BPPV?
In most cases BPPV has no identifiable cause. If you’ve had to hold a position for a prolonged period of time, such as reclining for a dental procedure or prolonged bed rest, this can prompt BPPV. Other cases occur if there’s damage or disruption to the inner ear, causing crystals to build up, such as a head injury – from mild concussion or whiplash to recovering from severe head injury – or surgery to the inner ear.
How can I manage my symptoms at home?
BPPV can resolve on its own after a few weeks without any treatment. In the beginning, try to avoid movements of your head in certain directions that might bring on dizziness. Later on, you will need to suffer a little of this discomfort and move your head to allow any crystals to disperse –this is called the Epley manoeuvre and should only be done by a trained health professional such as your doctor. Even though this can bring on symptoms, it will aid recovery.
Avoid injuries from falls by walking in good lighting and taking things slowly and easily - hold on to a rail or solid furniture if necessary. Don’t drive, and be aware of the signs of dizziness. Sitting down immediately will help alleviate the sensation.
When should I see my doctor?
If your dizziness is not resolved after several weeks, it is causing significant symptoms that affect your day-to-day activities or you get severe or prolonged episodes, you should see your doctor. They will examine your eyes and head movements, especially those that bring on symptoms, and they may examine your nervous system. If there are any concerns, your doctor may refer you to a specialist for further investigations, such as an MRI to see if there is another more serious cause for your symptoms.
If there are no concerns, your doctor may perform some simple exercises known collectively as the Epley manoeuvre to improve your symptoms. They may give you exercises to do at home called Brandt-Daroff exercises and a physiotherapist should also be able to help with this. In around 70% of cases, these exercises successfully clear away BPPV, and if second treatments are needed then around 90% of cases get better after this.
Your doctor may offer medication such as motion sickness tablets, but this only helps to ease symptoms rather than speeding up recovery time.
When should I seek help urgently?
If any of the following accompanies your dizziness, you should seek urgent medical attention, as there could be a more serious cause for your symptoms: a new or different type of headache, fever, blurred or double vision, loss of vision, sudden hearing loss in one ear, and weakness or numbness and tingling in the arms and legs.
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