One of the most common reasons patients are referred to a neurologist is for “dizziness”. Dizziness is a general term and can mean different things to different people. Some people report dizziness when they are actually feeling lightheaded or as if they may faint. Others claim to feel dizzy when they are feeling off balance or as if they are rocking on a boat. The final interpretation is a feeling of frank room spinning, which we classify as vertigo.

We’re going to walk you through the most common cause of vertiginous dizziness — Benign Paroxysmal Positional Vertigo (BPPV). Let’s break that down:

• Benign: It’s not dangerous.
• Paroxysmal: It comes in sudden bursts.
• Positional: It is triggered by changes in head position.
• Vertigo: The feeling that the room is moving around you.

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What’s happening in your body?

BPPV is not a condition of your brain but rather, your inner ear. Inside your inner ear are tiny crystals called otoliths. Their role is to help you feel a sense of balance.

In BPPV, some of these crystals drift inappropriately into the semicircular canals(the fluid-filled structures that detect motion). A consequence of that migration is the crystals shifting and moving in ways that they shouldn’t every time you move your head- resulting in sudden spinning vertigo with head turning.

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How we diagnose BPPV

As neurologists, we can often recognize BPPV based on the patient's history. The most important clues are that the vertigo is brief, positional, and reproducible. Many patients will report rolling over in bed first thing in the morning as a major trigger. Oftentimes, the vertigo is accompanied by profound nausea.

To confirm our suspicions, we may perform a test called the Dix-Hallpike maneuver, in which we guide the patient from a sitting to a lying position with their head turned. If this triggers vertigo and a darting back-and-forth movement of the eyes called nystagmus, the diagnosis is confirmed.

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How we treat BPPV

The good news is that BPPV is very treatable.

Canalith (the new name for the otoliths after they enter the semicircular canals) repositioning maneuvers, such as the Epley maneuver, are the primary treatment for this condition. These maneuvers involve a series of specific head and body movements to move the crystals out of the canals and back where they belong. Oftentimes, patients feel better after the first treatment. There’s nothing more satisfying as a neurologist in the emergency room than diagnosing BPPV and making the person instantly better by performing the Epley maneuver.  

Unfortunately, BPPV tends to recur. The Epley maneuver can be found online and reproduced at home if the patient is comfortable with their diagnosis and familiar with the treatment. Avoiding sudden head movements, rolling over in bed, etc., can help alleviate symptoms in the meantime.

While BPPV is benign, patients should not assume that it is universally the cause of their vertigo. If dizziness is accompanied by other neurological deficits such as weakness, numbness, difficulty speaking or swallowing, it could indicate a stroke or another neurological emergency. In those cases, even if you have a history of BPPV, seek immediate medical attention.

BPPV is one of the most common causes of vertigo. Just because it is common does not mean that it is comfortable. It can be unsettling, even frightening, especially when you experience it for the first time. Luckily, it is not dangerous, and with the right diagnosis and treatment, most people get rapid, lasting relief.

If you’re experiencing vestibular symptoms, book a video visit with one of our neurologists today to find answers.

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