Vertigo – Symptoms And Treatment
Welcome back readers! This month we are switching focus to the head, and specifically a condition which causes a person to feel dizzy. We welcome you to the world of Benign Paroxysmal Positional Vertigo (BPPV). In simple terms, a non-serious sudden attack of dizziness brought on by a change in head position.
What Is Vertigo?
Vertigo is a type of dizziness where a person experiences the sensation of whirling, spinning or swaying. A person will usually feel that they, or objects around them are moving when they are not. There are several causes of vertigo, with the most common cause being BPPV. Other common causes include Ménière’s disease (vertigo with hearing loss and ringing in the ears) and labyrinthitis (inflammation of the inner ear).
The ear is made up of an outer, middle and inner section. The outer ear is the ear that we see on the head and the opening that leads into the head itself. This connects to the middle ear — a small area inside the head which houses the ear bones, connects to the inner mouth and also the inner ear. The inner ear is the section which houses our hearing and balance organs — the cochlea and the vestibular system. It is this most inner section which is involved with BPPV.
What Causes BPPV?
The structure of the inner ear is quite complicated. It is a maze of hollow chambers and canals all connected together and filled with fluid. There are three semi-circular canals which are expertly positioned to detect movement in the 3 planes that our head can move (nodding up and down, tilting left and right, and looking left and right). Inside the chambers live tiny crystals which, when movement of the head occurs, move and send important information to the brain about what type of movement is occurring. Sometimes these crystals become detached from the chamber and move into the canals where they can play havoc.
Basically, the crystals move through the fluid which stimulates nerve endings in the canal. The nerves then send a message to the brain which the brain perceives as movement, even though the head isn’t actually moving. Because this information doesn’t match with what the eyes are seeing and the ears are detecting, we experience vertigo. It is one big mismatch of information which is tricking the brain. And the effect is quite unpleasant!
An attack of BPPV can be brought on by a quick change in head position, when rolling over in bed, sitting up from lying down, or when looking up to the sky. A recent head injury or degeneration of the inner ear system can precede episodes of BPPV.
Signs And Symptoms
The main symptoms as discussed include a sensation of spinning or swaying. People may also experience feelings of light-headedness, imbalance and nausea. Attacks will usually only last a period of a few minutes and may come and go. It is not unusual for a person to have a period of symptoms followed by a period of no symptoms for months at a time. If symptoms persist for longer than a few minutes at a time, then it is likely the vertigo is from a different cause.
Some conditions that cause vertigo can also give symptoms of headache, hearing loss, numbness, pins and needles, difficulty speaking, and difficulty coordinating movements. Episodes of vertigo may also be much longer or constant. If you experience any of these symptoms they should be reported immediately as they could be signs of more serious issues, which will need to be investigated.
Can It Be Treated?
BPPV is very treatable. Many people with dizziness end up seeing their GP first, but it is common for a GP to refer these cases to us for ongoing management. After a thorough session of questioning and assessment, if we are happy with our diagnosis of BPPV, then we can get to work right away.
BPPV can affect any of the semi-circular canals mentioned above. For treatment, we need to first bring on the symptoms. It sounds sadistic, but it is necessary to ensure we resolve the symptoms for you. Treatment for BPPV consists of a series of head and body movements where you start seated, move into a lying down position and end sitting upright again. This series of movements is known as the Epley Manoeuvre and is used to treat the most common form of BPPV. If the source of the problem is coming from a different canal, then the treatment will be slightly different.
We then send you away with some general do’s and don’ts. You may have to keep your head relatively still for the rest of the day (sorry, heavy exercise is not recommended at this stage) and to sleep propped up for the first night after treatment. We will then organise for you to come back in within a few days to reassess and if necessary continue with another treatment.
Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so important that we have a thorough consultation, to ensure we develop the right treatment plan for you. If you think you are experiencing vertigo, please come in and speak to us.
- Vestibular Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV). [Online]. Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo. [Accessed 28 Feb 2020]
- 2018. Benign Positional Vertigo (BPV). [Online]. Available from: https://www.healthline.com/health/benign-positional-vertigo. [Accessed 28 Feb 2020]
- HANDI project team. 2013. The Epley Manoeuvre. Australian Family Physician. 42 (1). 36-37. Available from: https://www.racgp.org.au/afp/2013/januaryfebruary/the-epley-manoeuvre/
The Importance of Movement
arent or sibling), then we start to get rudimentary use of our upper limbs, then we learn to lift our head and role onto our stomach, and now we can use our arms to push ourselves up and our neck muscles to support our head. Then we start to get stability in our trunk muscles so that we can sit and start to reach out, and then we are crawling, toddling and eventually running.
In other words we go through a sequence of learning where we move with increasing complexity, from simple reflexes to the ability to stabilise ourselves against gravity and then the ability to perform complex volitional activity such as eating or running.
This means that if we need to restore movement, say after an injury or an illness, we need to think in terms of this hierarchy, reflexes - stability - complex movement.
Humans are unique in that we have a complex postural system that enables us to stand upright on two unstable pins, that's why it takes us three years to learn to walk efficiently. But it is under constant stress and it's ability to perform this task starts to deteriorate as we age unless we take steps to keep it in top condition.
In research published in Queensland: Falling is not just for older women: support for pre-emptive prevention intervention before 60 (J.C Nitz and N.L Low Choy 2008), the researchers assessed women between the ages of 40 and 80 for the risk of falling. 8% of women in their forties, 14% in their 50s, 25% in their 60s and 40% in their 70s had fallen in the previous 12 months. In addition, the risk of falling increased significantly if the woman had other health problems.
Their conclusions was that for women over 40 years old, the number of illnesses increase the risk of falling and the risks increased still further if they were over 60. Preventative program participation aimed at maintaining good health appears vital to prevent falls.
To put it another way, our stability starts to drop in our 40's. Falls are a natural consequence of reduced stability but they are not the only consequence. The early consequences are less efficient use of posture which leads to stiffness and back pain.
So, in order to perform any meaningful activity, we must first be stable. Stability is really the ability to maintain balance while we shift our weight. When it starts to drop it means that we have less ability to generate momentum to move forwards. And if we are unable to generate as much momentum, then our step gets shorter, and if our step gets really short we require a stick to help support ourselves. Thus our ability to move becomes compromised.
So as we get older we get stiffer and less stable, which leads to weight bearing changes. It also leads to restriction in movement. It's important therefore to not only keep mobile but also work on keeping yourself stable. Exercise that can help this includes dance, yoga and Tai Chi. It is also important to work on your posture. Posture is basically how well you control your relationship to the ground and how efficiently you are able to shift your weight in order to generate momentum.
Perfect Posture Program
If you want to lean more about posture and how to keep yourself mobile and pain free, then we have an educational program that maybe for you. Our Perfect Posture Program has been developed from 25 years of rehabilitation of chronic back pain, and 10 years of measuring balance and analysing posture with computerised posturography. The purpose of the program is to teach you how your postural system works, so that you can use it in any situation, whether you are standing at a meeting, sitting at your desk or putting your child in the back of the car. This six week program is suitable for anyone who wishes to improve their posture from children aged eight and above, right through to seniors.
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