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Benign Paroxysmal Positional Vertigo

blog Do you feel like the world is spinning? You are nauseous, unsteady on your feet, feel like you are going to fall over, you can barely get out of bed and you just want to curl up and die.

Welcome to the world of BPPV, otherwise known as Benign Paroxysmal Positional Vertigo. It sounds very complex but it simply means harmless dizziness that comes and goes depending what position your head is in.

What is happening to me?  

Most of us just wake up with it for no reason at all. You may notice you roll over in bed and the whole world spins. Usually this will happen on one side only. You may also notice it bending over the tie your shoes or pick up something or when looking up to get something out of a cupboard. The vertigo or dizzy feeling, will feel absolutely terrible when it happens. BUT, there is some good news. It should last for only a few seconds and then subside. Despite this you will most likely feel nauseous for the first few days after the dizziness starts. Anti-nausea medication is effective in controlling this, but you will need to see your GP for a prescription.

What causes BPPV?  

BPPV is caused by small crystals in the inner ear dislodging from where they normally sit. The inner ear is made up of 3 canals that are filled with fluid. These canals connect to a vestibule which contains tiny hairs. Crystals sit on top of hair cells. The crystals weigh the hair cells down and respond to gravity. So when you bend your head to the side the crystals and hairs also bend to the side. The fluid moves in the canals, your eyes tell you your head is leaning to the side and the receptors in the joints of the neck tell you your neck is bending to the side.

When all the information matches you feel quite normal, but when the crystals dislodge they get stuck in the fluid filled canals where they are not supposed to be and the brain thinks the canals are giving it information that the head is moving. This mismatch in information between the eyes and neck and the fluid means we feel dizzy.

So what can we do to end this nightmare?  

If you have ever had BPPV you will know how hideous it feels and how frightening it can be to feel like you might fall over.

The course of BPPV may follow a couple of different paths. Sometimes it just goes away of its own accord. Big sigh of relief! But most frequently the dizziness persists and treatment is required.

Testing and Treatment  

Your GP or physiotherapist trained in this area, can assess you to see if you have BPPV by performing a Hallpike manoeuvre. If this test is positive your physiotherapist can perform a series of head movements that repositions the crystals back to where they will not cause you any trouble. This manoeuvre is quick, non-invasive and has good results. 80% of people will respond to one treatment, and a small percentage will need another treatment a week later. This mostly fixes the problem but in a very small percentage there may be persistence of symptoms.

What happens after vertigo treatment?  

You will feel a bit like you have been on a boat for up to a week after the manoeuvre is performed. However, what usually happens is there is a 10-15% improvement in your symptoms each day such that by a week after you are better. If you are not 95% better within a week following the manoeuvre, that’s when you need to second treatment.

Most people never have a recurrence of dizziness again. But a small number have repeated bouts and need treatment intermittently.

Pesistent dizziness – two possible causes:  

1) Following a bout of BPPV a small percentage of people develop a baseline “thick” feeling in the head. This can often be due to the joints in the upper neck, and a couple of treatments by your physiotherapist can resolve this problem quickly.

2) Some patients develop Psychosocial Anxiety following an episode of BPPV. This subconscious brain patterning maintains an element of dizziness, which can persist for years. It has a different cause from the original dizziness and it can be quite debilitating. There are approaches and treatment available for this form of dizziness, which you should discuss with your physiotherapist.

At Macquarie Street Physiotherapy located in the Sydney CBD, we have a physiotherapist who is trained to identify and treat your vertigo and dizziness. They can help make you more comfortable and confident that the world will keep turning, instead of spinning!

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