Vertigo: benign positional vertigo

 Vertigo: benign positional vertigo 

What is benign positional vertigo (BPV)? 

BPV or positional vertigo is a spinning sensation of the head (vertigo) brought on by a certain position of the head, usually sudden changes of position. The word ‘benign’ means that it is not a serious condition and is likely to eventually get better. 

changing position of head or neck causes vertigo

 What is the cause of BPV? 

In most people the cause is unknown, but it can follow accidents causing neck or head injuries in some people. There are two theories to explain BPV: 

1. A problem exists in the neck, usually a ‘kink’ in some of the swivel joints of the neck. The neck is connected to the balance centre by special nervous pathways. 

2. There are tiny pieces of floating debris (possibly calcium carbonate crystals) in the balance centre of the inner ear (the labyrinth). These little bits of sediment somehow upset the balance centre when disturbed.

 What are the symptoms?

 • A brief attack of severe dizziness (vertigo), usually for about 10 to 30 seconds, that comes on a few seconds after a certain head movement 

• Quickly subsiding dizziness

 • Nausea .

The head movements that provoke an attack can be: 

• tilting the head backwards 

• changing from a lying to a sitting position 

• lying on one ear or the other 

• turning the head to the side with the neck injury. 

Who gets BPV? 

Although it can occur at all ages, the elderly are affected most. It is the most common cause of vertigo in the elderly. Women are twice as likely as men to get it. BPV is a surprisingly common problem.

 How long do the bouts of BPV last?

 Each attack usually lasts less than 30 seconds but can last 60 seconds or so. The attacks tend to come in bursts but usually settle within a few weeks and most people are able to return to work within a week. The bouts tend to come back after months or years, but some people only ever have one attack. 

What are the effects of BPV? 

There are usually no ill effects in the long run. Unlike some other causes of severe dizziness, there is usually no vomiting, tinnitus (ringing in the ears) or deafness. The affected person has to be careful with driving. 

What is the treatment? 

There is no special treatment. Drugs are not effective at preventing the attacks. It is basically a matter of allowing the bouts to run their course, but there are some things that may help:

 • Avoid head positions that provoke the attack. 

• Do special neck exercises.

 • Obtain mobilisation treatment to the neck by a qualified therapist.

 Sometimes it may be necessary to be referred to a specialist to make sure it is just BPV and not a problem with the circulation to the brain. 

Special exercises, either the Epley manoeuvre or the Brandt & Daroff exercises, can dislodge the debris in the labyrinth and restore balance.

Vertigo: exercises for benign positional vertigo 

This set of exercises, called the Brandt & Daroff exercises, is used to treat the disturbing problem of benign positional vertigo. They are specifically designed to treat those cases in which the cause is considered to be clumps of debris (like fine sediment) collecting in one of the canals of the inner ear. The exercises disperse this debris away from the delicate balance membrane.

 Rules

 • Perform 3 times daily (if possible). 

• Take about 10 minutes each time. • Usually do 5 or more times to each side. 

• They are beneficial only if dizziness is reproduced.

 • Take antisickness tablets if nausea is a problem. 

Method 

1. Sit on the edge of bed; turn your head slightly to the left side (about 45°). Lie down quickly on the right side (ensure the back of the head rests on the bed). Wait for either 20 to 30 seconds or for any dizziness to settle.

 2. Sit up straight. Wait for 20 to 30 seconds or for any dizziness to settle. 

3. Repeat on the other side: turn the head slightly to the right side before lying down quickly on your left side. 

Note: • It doesn’t matter on which side you lie down first.

 • Turn your head away from the side on which you lie down. 

• It is important to reproduce dizziness with the exercises. 

• If the exercises are done regularly, the symptoms should settle over a period of several days but this may vary from 3 to 4 days to weeks.