How to Treat the Most Common Cause of Vertigo

Vertigo photography

A number of clients have spoken to Melissa about problems they’re experiencing with vertigo. There was a feature on Radio 4’s Inside Health last week on this subject, looking at the best way to treat vertigo. It is a common complaint and the accompanying nausea and unsteadiness can be very unsettling. Below are the key points from the programme which might be of help for anyone suffering from this problem.

There are a number of possible causes of vertigo ranging from migraine and Meniere’s to strokes and tumours, but by far the most common cause is a condition called BPPV – Benign Paroxysmal Positional Vertigo. It results from debris floating around in the fluid in the balance sensors of the inner ear and typically affects people over 40. Fortunately there is a relatively simple way to treat it, albeit much underused.

BPPV sufferers will usually describe episodes of intense vertigo provoked by certain characteristic head movements, e.g. turning over in bed or when looking up. If you find that reaching up to get something off a high shelf, changing a light bulb or washing your hair in the shower provokes an episode of vertigo then you may be suffering from BPPV. GPs or other health professionals do a simple diagnostic test, which involves putting the patient into a position that will trigger the symptoms.  They also look for a characteristic movement in the eyes called nystagmus.

Vertigo photography

The good news for anyone diagnosed with BPPV is that it’s easy for the doctor to treat there and then in the consulting room. The problem in BPPV is  loose chalk crystals in the inner ear. The chalk crystals are there naturally but they can break off. The crystals float around the fluid-filled spaces of the inner ear, bouncing into the tiny hairs found inside this very delicate mechanism, which then sends spurious signals to the brain. The inner ear balance organ is your head movement detector.  When these crystals get loose they cause false signals to be sent to the brain, telling it that your head is moving when it is not.

Treatment for BPPV involves guiding the crystals out of the narrow part of the inner ear where they cause trouble and into the wider part where they do not. The doctor does this by carefully manoeuvring the patient’s head around, a little bit like a child’s toy with a ball in a maze in a box where you’re trying to get the ball to go where you want it to by moving the whole box. The doctor moves the patient’s head to guide these crystals around the bends of the inner ear into a place where they’re not going to cause a problem. The procedure takes about five minutes. The commonest manoeuvre is called the Epley manoeuvre, which involves putting the patient’s head in four positions. The chance of curing BPPV with this method there and then is 80%.

Unfortunately BPPV sufferers are often misdiagnosed and put on medicines instead of being treated with the Epley manoeuvre. BPPV is one condition where medicines like Prochlorperazine or Stemetil, the vestibular suppressant medications, don’t have much of a role to play in curing the problem. Indeed such medicines are potentially quite damaging to take long term, with side effects that can make people feel even more unsteady. It’s very important therefore that such medications are used only for very short term episodes of nausea or vertigo or dizziness.


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