Welcome back readers! This month we are
switching focus to the head, and specifically a condition which causes a person
to feel dizzy. We welcome you to the world of 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
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
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 Inner West Health Clinic 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
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 9078 2455 to book your consultation.
Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV).
[Online]. Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo. [Accessed 28
2018. Benign Positional Vertigo (BPV). [Online]. Available from: https://www.healthline.com/health/benign-positional-vertigo. [Accessed 28
- 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/