Vertigo: symptoms and treatment
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 here at Beachealth 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. Osteopaths
are highly trained medical practitioners who can help treat more than you think. Call us today on
(416) 546-4887 to book your consultation.
Vestibular Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV).
Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-
Healthline. 2018. Benign Positional Vertigo (BPV). Available from:
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/