Medications and Epley maneuver
Did you ever lay down in bed and looked up to the ceiling only to notice that it is spinning around you? If you did, then you experienced vertigo. Vertigo is a symptom which is usually described as the feeling like objects and persons around them move or spin while in fact they stand still.
Causes
Vertigo is a very common symptom which can occur in a lot of different diseases. The most common causes are problems with the inner ear, brain tumors or stroke, migraine, head injuries or neck injuries, medicines, etc.
Benign paroxysmal positional vertigo (BPPV) is a very common cause of vertigo. It is not a serious condition, meaning that it will not endanger patient’s life. It occurs all of a sudden and doesn’t last long, in most cases shorter than a minute. It is caused by changes in the position of the head. (1)
Under normal circumstances, inner ear contains small calcium particles which move with every head movement and send signal to the brain that the head is moving. In case of BPPV, those particles migrate into one of the inner ear canals and clog it, causing sending of false signals to the brain. The brain starts thinking that the head is moving when it is not. This causes symptoms of vertigo. (1)
It can occur in any age group, but it is common among the elderly population. There is no exact explanation why it happens, but there are indications that it might be related to previous trauma, infection, migraine. In case of BPPV, vertigo might be accompanied with nausea and vomiting.
Some other inner ear causes of vertigo are a Meniere’s disease, vestibular neuritis, labyrinthitis. Meniere’s disease is caused by increase of fluid and changes of pressure inside the inner ear. Vertigo is usually accompanied by hearing loss and feeling of ringing in the ear. (2)
In case of vestibular neuritis or labyrinthitis, tinnitus is caused by infection and inflammation of the inner ear.
Diagnosis
Some of the disorders which cause vertigo have specific symptoms which help the physician to easily diagnose it. In case of BPPV, the patient will complain about vertigo which occurred after changes in head position. Most patients will tell that symptoms started once he/she get up from the bed, rolled over in bed, bending over, etc. (1)
Physical examination is also very important. It can discover the presence of nystagmus (unwilling movements of the eyeball). Nystagmus is commonly associated with BPPV. Tests like Roll-Test or Dix-Hallpike can help to diagnose BPPV.
Electronystagmography and videonystagmography are special tests which are used to detect nystagmus after the head is placed in different positions or stimulated with help of water or air. They can be also used to find out whether nystagmus is caused by problems with the inner ear.
MRI is another diagnostic method which is used in diagnosis of BPPV. The main role of MRI is to exclude other possible causes of vertigo (brain injury, tumor, etc.).
Therapy
If you suffer from BPPV, you should visit your physician which can refer you to a specialist. Medicines will provide no relief. However, there is a solution if you suffer from BPPV. It is important to determine which inner ear canal creates a problem so that the problem can be mechanically removed. Different maneuvers called Canalith reposition maneuvers, use the gravity force to move the calcium particles within the ear to relieve the symptoms. 9 out of 10 patients feel relief after 1–3 treatments which involve maneuvers. In case that multiple channels are involved, multiple maneuvers might be needed. (1)
Surgery is another possibility. It is reserved for cases which don’t show improvement on canalith reposition maneuvers.
Epley maneuver
One of the most commonly used Canalith reposition maneuvers is Epley maneuver.
At the beginning of maneuver the patient will sit on the table with extended legs. Head will be rotated to degrees on one side after which the examiner will bring the patient into a lying position with head hanging over the edge of the table. The patient will be in this position for 30 seconds. After 30 seconds, the examiner will rotate the head into the same position on the other side and keep it hanging over the edge of the table for 30 seconds. Next, the examiner will help you lay on your side while keeping your head in the same position as earlier. This position will be held for 30 seconds. The last step is to help the patient sit with his legs hanging off the side of the table. (3)
However, it should be used with precaution because in some cases it might not cause relief. It would be the best to consult your physician and get a proper evaluation and recommendations whether Epley maneuver is right for you.
Recommendations
- If you often feel dizziness, consult your physician
- Learn reposition maneuvers to resolve your symptoms
- Get slowly from the bed
- If you often fall, start using cane or crutches while walking (4)
BPPV is a condition which re-occurs in almost half patients. But once you have learned maneuver techniques, it will be a lot easier for you to manage your symptoms.
Sources:
2. http://www.webmd.com/brain/vertigo-symptoms-causes-treatment#1
3. http://www.webmd.com/a-to-z-guides/liberatory-maneuvers-for-vertigo-epley-maneuver
4. http://www.mayoclinic.org/diseases-conditions/vertigo/basics/lifestyle-home-remedies/con-20028216
