How to Treat Vertigo At Home
Benign Paroxysmal Positional Vertigo, also known as BPPV, or simply "Vertigo" is a common disorder of the vestibular system. It can be described as an intense spinning sensation brought on by changes in position.
The condition is "benign" as it is not life threatening, but depending on the intensity of the spinning sensation, it can place person at an extremely high risk for falls, which can lead to significant injury and hospitalization. It can be extremely debilitating due to the rapid onset and intensity of symptoms that are brought on by seemingly simple motions such as rolling in bed, standing up/sitting down, or even looking up. In most cases patients being affected are afraid to move due to fear of onset of symptoms.
What causes vertigo?
The vestibular system is a sensory system responsible for providing information regarding the orientation of the body in space and is a primary contributor to coordinating movements necessary to maintain a sense of balance. The area of the vestibular system that BPPV affects is the inner ear. The inner ear consists of 3 semicircular canals that are filled with fluid, and the utricle and saccule, which contain calcium crystals, known as otoconia or otoliths. These structures have the function of maintaining a normal balance sensation during everyday life. When these otoconia (calcium crystals) dislodge themselves from the utricle, they can migrate into the semicircular canals. The accumulation of these crystals interferes with the normal flow that endolymph is supposed to do, sending an abnormal balance sensation to the brain, which causes the intense sensation of dizziness as experienced in BPPV.
Treatment for BPPV
Any type of dizziness should be considered a serious medical symptom and should be evaluated by a physician. With that being said, there are signs and symptoms that are unique to BPPV. The primary symptom of BPPV is an intense feeling of the surroundings spinning that lasts for less than 1 minute. After the spinning subsides, the individual may experience a lingering feeling of nausea or imbalance up to several minutes. The symptoms are consistently brought on by quick changes in head position such as looking up, rolling over in bed, getting in/out of bed, bending over, or looking over one’s shoulder.
It is important for a person experiencing a possible case of BPPV to make an appointment with their primary care physician to receive a diagnosis of vertigo. Your physician may do some testing with head movements to assess for nystagmus (involuntary eye movements), but will likely refer you to a physical therapist with specialized training in treating vestibular disorders.
In most cases of BPPV, treatment consists of performing maneuvers that use gravity to guide the otoliths back to their normal position. These maneuvers are called Canalith Repositioning Maneuvers. When performed correctly, positioning maneuvers are 90% effective in resolving cases of BPPV within 2 visits or treatment sessions. Your therapist will perform testing to identify the canals are involved and will then determine the correct maneuvers to perform.
Due to the orientation of the canals to the utricle, 85% of BPPV cases involve the posterior semicircular canal primarily diagnosed using the Dix-Hallpike maneuver. Primary treatment for this type of BPPV is the Epley maneuver.
How to perform the Epley manuever at home (symptomatic when looking left): 2:36 in video below
Start in sitting with head turned to the LEFT with a pillow lined up with middle back
Lie down onto your back doing a backbend over the pillow keeping your head turned to the LEFT
The spinning dizziness may happen in this position. DO NOT LIFT YOUR HEAD. The spinning sensation usually stops in 10-20 seconds but can last up to a minute.
AFTER the spinning stops, stay in the position tipped back over the pillow with the head to the LEFT for 1 minute.
Then roll your head to the RIGHT keeping it tipped back over the pillow and stay in that position for 1 minute.
Then roll onto your RIGHT side with your face toward the floor and stay in that position for 1 minute.
Then sit up keeping your chin pointing toward your RIGHT shoulder and tucked down slightly as you do so.
Then slowly move your head to facing forward.
Wait 1-3 minutes and repeat maneuver.
Do 3 repetitions of the maneuver in the same session if able. Perform every other day until symptoms are gone.
Again, it is important to seek out medical attention if you experience sudden dizziness. If you are diagnosed with BPPV, your physician or physical therapist will instruct you on the correct maneuver to perform. In this blog, we discussed the Epley maneuver since it is used to treat the most common semicircular canal (posterior) involved in BPPV. In conclusion, BPPV is a debilitating condition, but treatment for it is very effective and most cases resolve fairly quickly.
Written by Daniel Le, DPT