In a prior post, Epley Maneuver Rocks, I discussed both my personal experience using the Epley maneuver for benign paroxysmal positional vertigo (BPPV) and my experiences in the office.  That post has generated so many off-line contacts that in this post I’ll discuss more about vertigo, BPPV in particular and the Epley maneuver and how and when to use it.  Vertigo is quite common and because treatment of vertigo can be frustratingly ineffective at times patients with vertigo can become very frustrated.  Dizziness and vertigo are common complaints in my office, as they are for primary care providers in general.

When a patient presents with dizziness first I need to assure that they do not have a life-threatening disorder with severe hypotension and shock.  Then the question I need to answer is whether the dizziness is vertigo or lightheadedness.  Vertigo is perceived by patients as a sensation of abnormal motion of some sort, typically as a feeling that they are spinning or that the room is spinning, but sometimes as a feeling of being off balance like they are going to fall to one side or another.  It is often similar to motion sickness for readers who get sea-sick or car-sick.  Other patients describe the feeling of vertigo as being like the feeling of imbalance that they associate with drinking too much and being a bit drunk.  Vertigo is often associated with nausea or vomiting and may sometimes be less severe if they lie or sit perfectly still.  Lightheadedness is the type of feeling you get if you stand up too quickly from lying or sitting, especially if you are mildly dehydrated.

If you feel you have lightheadedness the first thing to decide is whether you are simply a bit dehydrated.  If you suspect dehydration you need to drink more fluids and restore your fluid volume status.  Other causes of lightheadedness include medications, especially anti-hypertension medications, allergic reactions severe enough to cause hypotension, and serious infections.   If it is not clear what is causing your lightheadedness you should consult your doctor and try to find out the cause and get appropriate treatment.

If you have vertigo most of the time you should see your doctor to find out the cause.  Some causes of vertigo are really serious, and it is not a symptom that I can recommend that you try to figure out on your own.  The common causes of vertigo are inner ear viral infections called labyrynthitis or vestibulitis, benign paroxysmal positional vertigo, and Meniere’s disease.  Less common but serious causes can be acoustic neuroma (an auditory nerve tumor), other brain masses including benign and malignant tumors, brain infections like encephalitis, concussions and other head injuries, and other less common disorders.

BPPV is typically worse when turning your head to one side than to the other side, and is common in patients of all ages though more common as you get older.  The Epley Maneuver is a procedure that can be used at the physician’s office or at home to treat BPPV with varying degrees of success.  See the video clip on the prior post for a quick lesson on how to the the Epley maneuver on your own.  Many patients find it more helpful to have the procedure at the doctor’s office because it can make you very vertiginous during the procedure and you may benefit from reassurance and support of your doctor to get through the Epley maneuver.  If you do the Epley maneuver yourself and find no help it is even more important that you see a physician to find out if there may be another cause that needs further evaluation.  Unfortunately the other very common cause of vertigo, acute viral labyrynthitis, may cause vertigo even more severe than BPPV and can be refractory to treatment.  Fortunately acute labyrynthitis usually is self-limited, resolving on its own in a few days to weeks.  We have drugs to help a bit with the symptoms, but none to hurry the cure.

Even though as I implied in my prior post headline the Epley Maueuver Rocks, vertigo definitely does not, and I hope both you and I never have to go through it (again for me).

I finally tried the Epley maneuver a few months ago after struggling with vertigo for a few weeks.  As a family physician I was certain that I had benign paroxysmal positional vertigo (BPPV), and that it would likely improve if I just waited it out, but I was getting pretty tired of walking around the office like Frankenstein, head held still, trying not to move suddenly.  For years I had been referring my patients with persistent BPPV to ENT doctors for repositioning therapy, but had not been doing it in the office. Most of the time patients just get better in a week or two without specific treatment.

Finally I used Dr. Google to look up home repositioning therapy after one of my younger partners told me about the Epley maneuvers.   These are really pretty simple, and I did them myself with excellent relief.  Within 2 days I was about 95% free of vertigo symptoms.  Yesterday morning I awoke with a recurrence of the vertigo again.  I use my iPhone as my alarm now, and it was lying on the floor charging at the bedside.  On rolling over to turn off the alarm I got so dizzy with the whole room spinning that I had to quickly lie down and let the alarm keep going.  I finally managed to get the alarm off, but felt pretty lousy.  I got to the office and went right to an exam room, and put myself through the Epley maneuvers, with only slight help.  I struggled through a reduced workload day, and last night again did the maneuvers.

I took care last night to avoid rolling to the left, my affected side, and this morning am much better, at least 90% improved, with no true vertigo.  For those readers who say, “What’s vertigo?” first I’m happy for you that you’ve not experienced this miserable symptom.  It is the type of dizziness where there is a sensation of spinning or movement of yourself or the surroundings. It feels like motion sickness, often associated with nausea and severe imbalance.  It can be caused by inflammation or other disorders of the inner ear, particularly the vestibule (semi-circular canals).  BPPV is a type of vertigo where the fluid and tiny granules in the vestibule get out of position, leading to a sensation of motion and vertigo.

I think I managed to practice for 30 years without knowing about the Epley maneuver because John Epley didn’t describe this treatment until 1980, the year I graduated from Med School, and somehow I never heard about it until recently.  The procedure is really simple, though it can produce really miserable vertigo during the procedure for many patients, and can be tough to do without support from a confident helper, like your physician if your vertigo is severe.  It’s also important not to just assume your vertigo is BPPV as there are other more serious causes that may need diagnosis and treatment.  If there is any doubt of the diagnosis see your physician for evaluation.  Here is a You Tube of the maneuver:

As you can see, it’s not really difficult to do, and I now often suggest to my patients to do it at home, or sometimes do it with them at the office. Now I can just send them to this post for details :.) For more  information on the Epley Maneuver and vertigo and dizziness see a later post on the Epley Maneuver.