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).