Positional Vertigo

What is positional vertigo?

Positional vertigo is an inner ear problem. It causes brief but sometimes severe feelings of spinning. Some people feel that their head or body is spinning. Others feel the room is spinning. People often say they are dizzy, but dizzy is a very general term. Vertigo, on the other hand, is the very specific feeling of uncontrollable spinning.

Positional vertigo happens suddenly when you change the position of your head. Another name for this problem is benign paroxysmal positional vertigo.

How does it occur?

In the inner part of your ear are 3 semicircular canals. Movement of the fluid in these canals helps your brain maintain your balance and know what position you are in (for example, standing up, lying down, or standing on your head).

Sometimes small crystals of calcium develop and float in the fluid in the inner ear. This can happen after a head injury, with a severe cold, or simply as a part of normal aging. The crystals can cause vertigo when you change head position and they strike against nerve endings in the semicircular canals. Usually the calcium crystals dissolve in a few weeks and stop causing vertigo. However, sometimes the crystals do not dissolve and the vertigo returns from time to time.

What are the symptoms?

A sudden feeling that you are spinning, or that the room is spinning, is the main symptom. You may feel the vertigo when you first wake up. It may seem that any turn of your head brings on brief but intense spells of vertigo. It may happen when you tilt your head, look up or down, or roll over in bed.

You may have nausea and vomiting along with the vertigo. Even if a spell of vertigo is brief, you may have a feeling of queasiness for several minutes or even hours afterward.

How is it diagnosed?

Your health care provider will ask about your symptoms and examine you. You may also be given a Dix-Hallpike position test.

You start the Dix-Hallpike test by sitting upright on the examining table. Your health care provider slowly brings your head down over the edge of the table and turns your head to one side. If you have positional vertigo, your provider will see your eyes making fast, jerky movements called nystagmus. If no nystagmus is seen, your provider will repeat the test, this time turning your head to the opposite side, to test the other inner ear. If you then have nystagmus and vertigo, the ear that is pointing toward the floor is the one causing the problem. The nystagmus and vertigo will slow down and stop after 15 to 20 seconds. If you do not move your head, no more symptoms will occur. When you sit back up, you will have vertigo again, but for a shorter time.

Other tests you may have are:

• an ear exam
• an audiogram to check your hearing
• a test of your nerve responses
• an electronystagmogram (ENG) test.

How is it treated?

Mild vertigo is often treated with medicine. The most common medicine for this problem is meclizine. It is taken up to 4 times a day for the vertigo and nausea or vomiting. One of the problems with this medicine is that it causes drowsiness. This is not as much of a problem if you have severe vertigo, which usually requires bed rest. Then the medicine can help you sleep and get relief from the vertigo while you sleep.

Your health care provider may recommend techniques that use gravity to move the crystals away from the nerve endings into an area of the inner ear that won't cause any problems. These are called repositioning techniques.

One repositioning technique is the Epley maneuver. It can be very helpful. Your health care provider will move your head into 4 positions. You will hold each position for about 30 seconds.

Your health care provider may also suggest that you do Brandt-Daroff exercises. Your provider may recommend that you do these exercises 3 times a day for 2 weeks. To do these exercises:

• Start by sitting upright on your bed.
• Lie on your left side, with your head angled upward about halfway. (Imagine that you are looking at the head of someone standing about 6 feet in front of you.) Stay in this position for 30 seconds, or, if you are having vertigo, until the vertigo stops.
• Return to the sitting position for 30 seconds.
• Lie on your right side, and follow the same routine.

Your health care provider may refer you to a physical therapist to learn and practice these repositioning techniques.

Rarely, when repositioning techniques don't help and the vertigo has not gone away after a few weeks, severe cases may eventually require surgery.

How long will the effects last?

Even without treatment, positional vertigo usually goes away within several weeks. Sometimes it recurs despite treatment.

How do I take care of myself?

• If your vertigo is mild, you may be able to continue your usual activities, especially if you have opportunities to sit when you have vertigo.
• If your vertigo does not allow you to continue your usual routine, you should rest at home.
• Use medicine as prescribed by your health care provider to help stop symptoms of dizziness, nausea, and vomiting.
• Follow your instructions for using the repositioning techniques.
• Do not try to drive, operate tools or machinery, or do other tasks, even cooking, that could endanger yourself or others if you suddenly become dizzy.
• Follow your health care provider's recommendations for follow-up visits.
• Contact your health care provider if:
  • Your symptoms seem to be getting worse, more frequent, or longer lasting.
  • You develop new symptoms, such as a loss of hearing or severe headache.