Do you know the most common cause of vertigo?
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, and although it can affect anyone, it is most often experienced in older age groups. BPPV is mainly treated by maneuvers performed by specialists.
We spend our daily lives depending on it, but it is only when it fails that we realize how crucial it is to our lives. We refer to balancewhich allows us to lead a smooth daily life, from the moment we get out of bed in the morning to the moment we go back to bed at night, through all our daily activities such as preparing meals, walking, driving or working. When something compromises balance – for example, dizziness or vertigo – our quality of life is threatened and its cause must be determined.
Although often confused, vertigo and dizziness are two different things: the former occurs when the person, being stationary and nothing moving around them, has a false sense of motion, for example, they feel as if they are spinning, turning on themselves, or being pulled to one side; dizziness is a term commonly used, without precision, to describe a set of sensations, such as blurred vision, imbalance, unsteadiness, fluctuation, or even vertigo, leading to confusion between the two names.
Vertigo occurs when there is a problem in one of the different systems that contribute to our sense of orientation in relation to our body, for example, the vestibular system (responsible for balance and located in the inner ear), whereas vertigo occurs without this relationship. Dizziness and vertigo are both a symptom of something and not a disease in itself. It is important to look for the cause, especially since it can be very debilitating, especially if accompanied by nausea and vomiting. In addition, they are symptoms that can lead to serious problems, such as falls or accidents.
What is BPPV?
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo. It is estimated to affect about 20-30% of people who visit a vertigo specialist. It manifests as short episodes (usually less than a minute) of spinning sensation following head movements or changes in head position (hence the name “positional”), such as when the person turns, looks up, lies down, or gets up from bed. This vertigo may or may not be accompanied by nausea, vomiting or a rhythmic, involuntary eye movement (called nystagmus), but there are no other associated symptoms such as hearing loss or tinnitus.
This type of vertigo is also called “paroxysmal” because it occurs in sudden, rapid episodes, and it is also “benign,” meaning that it does not pose a serious health risk.
Who can be affected?
BPPV is extremely rare in children, but can occur in adults of any age, although most cases occur after age 60.
Apparently, this type of vertigo appears suddenly and without any causal link, i.e. it is not uncommon for the person to state that it all started one particular morning when they got out of bed and started to “see everything spinning”. Despite this, several correlations have been established, including trauma situations, migraine, inner ear infections, head or ear injuries, prolonged bed rest, ear surgery, diabetes, osteoporosis or reduced blood flow, among others.
What triggers it?
BPPV episodes are caused by the displacement of calcium carbonate crystals. (called otoliths or otoconia), which are usually found in the inner ear, where they play an important role in maintaining balance during normal body movements. When these crystals leave their correct anatomical location and enter the semicircular canals (most often in the posterior canal), the sensation of rapid rotation occurs. This is because when these particles move, they send a false message to the brain that the person is rapidly rotating, when in fact it is only a simple change of position or movement of the head.
Diagnosis and treatment
Knowing that the causes of vertigo can be diverse, the way to confirm the diagnosis of BPPV is a maneuver performed by the physician, which changes the patient’s position. The most common is called the Dix-Hallpike maneuver, which involves putting the head in a suspended position to trigger a seizure, allowing the physician to not only observe the rapid movement of the eyes, but also to understand which side is affected.
Similarly, the treatment of BPPV is usually based on crystal replacement maneuvers, namely the Epley maneuver (the most common), the Semont maneuver, or Brandt-Daroff exercises. The success rate is estimated to be about 90% (when one to three treatments are performed), but the maneuvers may need to be repeated. The exercises, on the other hand, are intended to be performed by the person at home, at the frequency indicated by the physician.
There is no evidence to support the prescription of medications to treat BPPV and some even argue that they can worsen the imbalance. In addition, the surgical option is only considered in very rare situations. If vertigo is accompanied by nausea or vomiting, the specialist may prescribe medication for these symptoms.
BPPV usually resolves spontaneously after a few weeks or months, but episodes may recur later, continuing for months or years. Fortunately, the symptoms tend to diminish over time as the brain adapts to the signals it receives.
It is essential to seek help
It is important to seek help from a medical professional – usually in the field of otolaryngology, such as otoneurologists – and there are already several hospital consultations specializing in vertigo, bringing together all the professionals involved in the correct diagnosis and treatment of BPPV.
Care during a episode of BPPV
- If the BPPV episode occurs on getting out of bedLie down slowly and wait for the dizziness to go away;
- Avoid sudden movements of the head or marked changes in position;
- As soon as you feel dizzy, and if you have someone nearby, let me know what happensso that the person can support you and help you sit or lie down if possible;
- After the symptoms have resolvedResume your daily activities, as movement and exercise are important for faster recovery of balance ;
- If you have been diagnosed with BPPV, make it a habit to Get up and down slowly and avoid tasks that require lifting your head..