Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness. BPPV affects 75,000 people in Australia every year. The disease is more common in the elderly and women. However, it can occur in all ages and both sexes. Falls, viral illnesses, or a blow to the head can trigger BPPV. However, the majority of cases happen without a cause.

What is Benign Paroxysmal Positional Vertigo?

BPPV usually causes intense brief episodes of dizziness or vertigo. Normally associated with moving the head, often when rolling in bed or getting up in the morning. These seizures are short, usually lasting from 10 to 20 seconds. As a result, it may cause nausea and vomiting. It also causes lightheadedness, imbalance, and nystagmus (involuntary rapid eye movement). Consequently, symptoms are usually triggered by a change of position of the head with respect to gravity.

Displaced otoconia (otoliths) causes BPPV. The inner ear is a maze of tubes and passages. Inside the maze are sensory organs containing small calcium carbonate crystals called otoliths. Otoliths attach to hair cells on a membrane in the inner ear. Changes in head movement cause the otoliths to tilt the hair cells. Subsequently, it is this action that allows our brain to know which way is up or down. The otoliths may become displaced by aging, infection, head trauma, or labyrinthine disease. They then become free-floating within the inner ear. Changing the position of the head causes the otoliths to move. This, in turn, causes the endolymph to stimulate the hair cells, resulting in vertigo.

What can our chiropractors do?

The Chiro & Sports Med chiropractors will perform a thorough medical history and examination of the entire nervous system. This includes the neck and back to rule out other possible causes for dizziness. Decreased movement in the neck, chest back, and jaw can be direct causes of vertigo. This should be examined by one of our chiropractors.

If our chiropractors suspect you have benign paroxysmal positional vertigo they will confirm the diagnosis by performing a maneuver called Dix-Hall Pike Test. The test involves the chiropractor putting the patient in the supine position, bending the head backward. The head is then rotated 45 degrees to one side and held in that position for 30 seconds. The maneuver is repeated to the other side. If this test triggers symptoms to either side, the test is positive. Most often the symptoms will be most striking in the first 10 to 20 seconds. Symptoms then slow down towards the end of the test.

What does the treatment consist of?

The treatment for BPPV consists of the chiropractor performing a technique called Epley maneuver. After the chiropractor has found what side the otoliths move, using the Dix-Hall Pike Test, it is then performed again.  30 seconds pass until the symptoms calm down.

• Firstly, the patient starts by sitting upright with their head turned 45 degrees to the affected side.
• Laying on their back, the patient’s head hangs about 30 degrees over the edge of the bed with the affected ear to the ground, then rotated by 90 degrees to face the opposite side.
• The head is held here as the patient rolls their body onto their side.
• The head is rotated so the patient is facing downward. Their nose is 45 degrees below horizontal.
• The patient then sits up sideways keeping the head in position.

Treatment is usually very effective and patients are often symptom-free after a few treatments. After treatment, our chiropractors at Chiro & Sports Med recommend that for 48 hours you do not drive. Try and avoid any quick movement with the neck. Sleeping upright with upper body 45 degrees raised, either in a chair or building up with pillows in bed will help. BPPV can be intermittent and may be present for a day, few weeks, or disappear and return.