Benign Positional Vertigo - BPV

Benign positional vertigo (BPV) is a condition in which a person develops a sudden sensation of spinning, usually when moving the head. BPV is the most common type of vertigo.

Causes

Benign positional vertigo is due to a disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance. This information allows the brain to make precise adjustments in eye movement to maintain visual focus while moving.

Benign positional vertigo develops when a small piece of bone-like calcium breaks free and floats uncontrollable within the tube of the inner ear. This sends the brain confusing messages about your body's position.

There are no major risk factors. A prior head injury or an inner ear infection called labyrinthitis may make some people more likely to develop the condition.

Symptoms

The main symptom is a spinning sensation, which:

  • Is usually triggered by head movement
  • Often starts suddenly

Most often, patients say they cannot roll in bed or tilt their head up to look at something.
Other symptoms can include:

  • Vision complaints, such as a perception that things are jumping or moving
  • Vomiting (in severe cases)

Exams and Tests

To diagnose benign positional vertigo, the health care provider will often perform a test called the Dix-Hallpike maneuver. The doctor holds your head in a certain position and asks you to lie quickly backward over a table. As you do this, the doctor will look for abnormal eye movements and ask if you feel a spinning sensation. The doctor may use various methods to help evaluate your eye movements.

A physical exam is otherwise normal. A complete medical history and careful neurological exam should be done to rule out other reasons for your symptoms. Tests that may be done include:

  • Electronystagmography (also called a VNG for videonystagmography)
  • Head CT
  • Head MRI
  • Magnetic resonance angiography of the head

Treatment

The most effective treatment is a procedure called "Epley's maneuver," which can move the small piece of bone-like calcium that is floating inside your inner ear. Other exercises that can readjust your response to head movements are less effective. You can visualize the Epley maneuver on You Tube, where there are dozens of videos of how to perform the therapy.

Occasionally, medications may be prescribed to relieve the spinning sensations. Such drugs may include:

  • Meclizine
  • Valium
  • Benadryl

However, such medicines often are not very effective for treating vertigo.

Outlook (Prognosis)

Benign positional vertigo is uncomfortable, but usually improves with time, often several weeks or even months. This condition may occur again without warning.

Prevention

Avoid head positions that trigger positional vertigo.

Click here for Vertigo Instructions

INSTRUCTIONS For VERTIGO

  • Minimize dietary salt intake.
  • Take the medications prescribed over a period of approximately 10 days unless otherwise instructed and then discontinue them. They are to be resumed again in the event of recurrence of symptoms and you are to return to doctor as advised.

Be extremely cautious driving a vehicle or working in high places which -night be dangerous either to yourself or to others. If you do not have warning regarding impending attack you must not undertake either of these activities.

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