Positional Dizziness – The Most Common Type of Vertigo

Many people experience an occasional episode of dizziness.  It’s only when the attacks of vertigo keep recurring that you might seek the help of a doctor.

Fortunately, the single most common cause of dizziness is easy to diagnose, and you don’t even need fancy medical tests to do it.

The most common cause of dizziness is a condition known as Benign Paroxysmal Positional Vertigo, though we’ll call it BPPV for short.

It’s considered to be Benign because it doesn’t involve an underlying disease that will worsen with time or cause other symptoms to emerge.

It’s called Paroxysmal because the attacks of vertigo occur suddenly and last only a brief time.

And it’s called Positional because the dizziness depends on the position or motion of your head.

BPPV occurs when calcium crystals (called otoliths), which normally float in certain parts of your inner ear, get lodged in the wrong channel.  Then, when you turn your head in a particular direction, the otoliths create abnormal stimulation of the nerve receptors, and you get dizzy.

How to Diagnose BPPV

You might have BPPV if

• you have episodes of spinning caused primarily by turning your head in a particular direction
• the dizziness lasts for about 30 seconds at most
• you feel well in between attacks

You might have a different diagnosis if

• the dizziness lasts for longer than 1-2 minutes
• you have symptoms other than dizziness or nausea
• you get dizzy spontaneously – without moving your head
• you feel faint-headed (not truly dizzy)  mainly when you sit up or stand up quickly

Two other fairly common causes of dizziness that need to be excluded are

• Meniere’s disease – in which the dizzy spells last far longer than in BPPV and also typically includes hearing loss and tinnitus (ringing in the ears), and

• Orthostatic hypotension – caused by a sudden drop in blood pressure when you quickly stand up, leaving you light-headed, not truly dizzy.

Fortunately, if you fit into the diagnostic criteria for BPPV, it’s unlikely that you need further diagnostic tests.

Simple BPPV Therapy

What’s even more fortunate is that BPPV is easily treated in most cases without drugs or surgery. Doctors have developed a series of head and body positions that, performed in sequence, allow for the offending otolith to reposition itself properly within the inner ear.  The most commonly recommended repositioning sequence is known as the Epley maneuver. But an alternative I’ve used in my own practice, since it seems simpler to self-administer, was developed by Dr. Carol Foster.

Need more information?  E-mail Dr. Lavine at drlavine@askdrlavine.com.