From time to time, we can feel dizzy or lightheaded. Perhaps we stood up too quickly or maybe skipped breakfast and have low blood sugar. Vertigo is a medical condition which is sometimes confused with dizziness and the terms are incorrectly used interchangeably. Vertigo describes a spinning sensation while dizziness is a feeling of being lightheaded or foggy. It is imperative to separate these conditions as their cause and ultimately treatment is quite different.
The most common form of vertigo is Benign Paroxysmal Positional Vertigo (BPPV). It is called benign because it is not life-threatening. Paroxysmal means it comes in brief bursts. Positional because it is triggered by sudden head movements.
To understand BPPV, we need to first understand how our bodies figure out our position. There are two structures and three canals in the inner ear. The structures have tiny calcium “rocks” called otoconia and the canals are filled with a thick fluid. (So yes, if anyone asks if you have rocks in your head, you can say yes with confidence!) When we move, there is a shift in those rocks and fluids and the brain interprets those shifts. In BPPV, calcium rocks end up getting into the fluid and this affects the messages sent to the brain.
There is no blood test or diagnostic scan for BPPV. Diagnosis is performed by your doctor or nurse practitioner after a careful review of your symptoms. They will next perform exercises to position the head so that the crystals move and cause vertigo. Risk factors include age (usually over 50), female sex, diabetes, high blood pressure, low vitamin D and head trauma.
Medications are generally ineffective for BPPV. Some medications like anti-nauseants may help with acute symptoms but are often not necessary. In most cases, the symptoms are short lived and improve once the head movement has stopped.
Since the primary cause of BPPV is the presence of calcium rocks in the canals, repositioning exercises are performed to try and dislodge them and return them to their proper place. This is known as a Particle Repositioning Maneuver or PRM. The most commonly used PRM is the Epley maneuver, but others such as the Semont or three-position maneuver may be employed. These are performed by professionals properly trained, as it takes a certain skillset to perform them correctly.
Recurrence rates are common and the literature reports between 18-40% over a 5-year period. For those who suffer chronically, cognitive behavioral therapy (CBT) can help with the anxiety that goes with an attack. As I said at the beginning, we all experience dizziness from time to time, but if you are experiencing vertigo and it’s sudden and intense in nature, you should make an appointment with your primary healthcare professional for an evaluation. Take care of yourself and each other.
By Steve Bond, BSc. Phm
