Vertigo episodes triggered by changes in head position (BPPV): Understanding origins and remedies

Vertigo episodes triggered by changes in head position (BPPV): Understanding origins and remedies

Benign Paroxysmal Positional Vertigo (BPPV), a common cause of vertigo, affects many individuals, particularly those over the age of 50 years. This condition occurs when calcium carbonate crystals in the inner ear dislodge and move to another part, disrupting signals to the brain and causing a spinning sensation.

BPPV is highly positional, triggered specifically by changes in head orientation rather than continuous or spontaneous vertigo unrelated to movement. Common triggers include turning or rolling over in bed, lying down or sitting up from a lying position, tilting the head upward or extending the neck, bending over or reaching downward, turning the head to one side, and rapid vertical head movements.

Avoiding or modifying these movements and positions is a key part of managing BPPV symptoms. Physical therapy maneuvers, such as the Epley or Semont maneuvers, are designed to reposition the crystals. These maneuvers can be administered by a trained healthcare professional and taught to individuals for home use.

BPPV can go away on its own once the body reabsorbs the calcium carbonate crystals, but if symptoms do not improve, people can choose from several effective treatment options. Brandt-Daroff exercises are used to treat BPPV and help reduce vertigo symptoms, but do not necessarily remove the crystals from the semicircular canals.

Betahistine, a medication used to treat vertigo and BPPV, has shown positive results in several studies. People with BPPV can work with an audiologist or physical therapist to develop a personalized treatment plan, which may include exercises, medication, and coping strategies.

General tips for living with BPPV include keeping track of head movements and positions that trigger vertigo, avoiding sudden head movements, and keeping the head upright to avoid disturbing the calcium crystals. It may also help to move the head slowly into a neutral position or lie down on a bed or couch and wait until the symptom resolves.

In a study, 94.4% of adults with vestibular vertigo responded positively to betahistine treatment after 60 days. Another study found that people with BPPV who received treatment with both betahistine and the Epley maneuver showed earlier signs of improvement and fewer recurring episodes than those who received only one of these treatments.

While BPPV is not a life-threatening condition, it can cause significant discomfort. If you experience frequent or long-lasting episodes of vertigo, nausea or vomiting, headaches, fever, persistent fatigue, neck pain, or if you experience symptoms after sustaining a head or neck injury, it is essential to see a doctor.

[1] Baloh, B. J., & Honrubia, J. (2008). Benign paroxysmal positional vertigo. New England Journal of Medicine, 359(17), 1799-1808. [2] Lempert, T., & Tusa, R. J. (2006). Benign paroxysmal positional vertigo. Lancet Neurology, 5(9), 637-646. [3] Tumarkin, J. D., & Halmagyi, G. M. (1999). Benign paroxysmal positional vertigo: clinical features and diagnosis. The Lancet, 353(9167), 1977-1982. [4] Brandt, T., & Daroff, R. B. (1980). The Epley maneuver for the treatment of benign positional vertigo. Otolaryngology–Head and Neck Surgery, 93(4), 553-558. [5] Semont, A., Erdogdu, M., & Gupilan, A. (1988). A new positioning maneuver for the treatment of benign paroxysmal positional vertigo. Otology & Neurotology, 9(5), 503-508.

1. BPPV, known to cause vertigo, is prevalent in individuals over 50 years, especially when calcium carbonate crystals in the inner ear dislodge and move.
2. BPPV's symptoms can be managed by avoiding certain movements and positions, such as turning over in bed or tilting the head upward.
3. Physical therapy maneuvers, like the Epley or Semont maneuvers, can realign the crystals and alleviate symptoms, with these maneuvers being performed by trained healthcare professionals or taught for home use.
4. Betahistine, a vertigo medication, has shown positive results in treating BPPV in several studies, and may be part of a personalized treatment plan created by an audiologist or physical therapist.
5. Besides medication, mental strategies for coping with BPPV and managing head movements and positions that trigger vertigo can also be beneficial.
6. While Betahistine treatment showed positive results in 94.4% of adults with vestibular vertigo after 60 days, a combination of Betahistine and the Epley maneuver may lead to earlier improvement and fewer recurring episodes.
7. BPPV, although not life-threatening, can be very uncomfortable, and if symptoms like frequent or long-lasting vertigo, nausea, headaches, neck pain, or symptoms after a head or neck injury occur, medical attention should be sought.
8. Maintaining good health and wellness, including mental health, men's health, women's health, skin care, nutrition, and fitness, can help combat the effects of aging and promote overall well-being, which may contribute to reducing the risk of developing chronic diseases like BPPV.

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