The most common cause of vertigo
The most common reason people experience vertigo is due to a condition called Benign Paroxysmal Positional Vertigo (BPPV). Although this condition is not dangerous, vertigo can be a very disabling symptom. Vertigo is described as a hallucination of movement - most commonly it is experienced as spinning. Often our patients describe it: “when I lie down, I feel the entire room is spinning” or “when I look up, it can feel as if the world is going upside down and I could fall”.
Common features of BPPV
This type of dizziness primarily occurs with changing the position of your head relative to gravity - this can include lying down, sitting up from lying, rolling in bed, looking up or bending over to pick something up. BPPV does not occur if your head is still - for instance it will never occur if you are just standing stationary or sitting and watching TV. The vertigo spells are short - usually lasting a maximum of 60 seconds, however vertigo spells can occur several times a day. The short vertigo spells can be accompanied by nausea, vomiting, and imbalance. Often the sense of imbalance can last hours to days after a spell. BPPV can go away on its own without treatment, but in some cases spells can be persistent and require treatment.
Why does BPPV occur?
BPPV is a balance disorder of the inner ear. Your inner ear is responsible for 2 things: hearing and balance. We will focus on the balance organs, as those are what are affected with BPPV. The organs of balance are made up of 3 semicircular canals, a saccule and a utricle. The utricle and saccule have sense receptors that are embedded with tiny calcium crystals that help detect movements such as gravity and acceleration. If some of these crystals become loose, they can float freely into the fluid of one or more of the semicircular canals (which detect head movements). When this happens, moving your head in certain positions will cause these crystals to shift and travel within that fluid. This will irritate the balance organ, and will send false signals to your brain and eyes. Your eyes will move in a specific pattern called “nystagmus”, which will make it feel and look like the room is spinning.
There are a few reasons why crystals may become loose inside your inner ear and cause BPPV. The most common cause in people under the age of 50 is a mild to moderate head injury (including whiplash). You can also develop it after an inner ear infection (vestibular neuritis), if you have Meniere’s disease, and often we see it with aging. Despite these known causes, more than 50% of the time it happens for no known reason. There is some new research suggesting that low vitamin D levels may be a contributing cause.
How we confirm you have BPPV
We can determine if this is the cause of your symptoms through a careful history and physical exam - we look for nystagmus in the eyes when we do positional testing maneuvers. The most common maneuver is called the Dix-Hallpike test where we ask you to sit on the bed with your head turned to one side, and then help you lie down quickly to one side. This quick movement causes the loose crystals in your inner ear to move in the fluid, triggering your vertigo. With special infrared recording goggles we are able to analyze the nystagmus in your eyes and diagnose which canal the loose crystals are in so that we can do the appropriate “particle repositioning maneuver” to send those crystals back in the utricle where they originated. Many patients symptoms will resolve after just one maneuver!
If you think this condition fits your symptoms, we are here to help. Remember with BPPV dizziness/vertigo typically lasts 60 seconds or less and is associated with position change. If your vertigo comes on without movement or is lasting longer, there may be other causes. We would be happy to help you figure it out!
Thumbnail image source: Wellcome Collection
