Vertigo is something everyone has probably experienced: it seems as if the room is spinning or swaying around you. Vertigo can come in different forms and have numerous causes. The most common type in adults is positional vertigo.
What is positional vertigo?
Benign paroxysmal positional vertigo (BPLS) is the most common type of vertigo in adults. All affected individuals complain of attacks of vertigo lasting approximately thirty seconds after changes in position. Benign paroxysmal positional vertigo (BPLS) is the most common form of vertigo in adults. All sufferers complain of attacks of dizziness lasting about thirty seconds after changes in position, for example when lying down, turning the head or raising and lowering the head. Some patients also suffer from nausea and vomiting as well as the feeling of walking on absorbent cotton. Despite these symptoms, positional vertigo is medically defined as unpleasant and restrictive to everyday life, but not pathological. For this reason, there is a lack of clear studies on the frequency of this benign form of vertigo. It is known that it increases in frequency between the ages of 60 and 80 and that women are more likely to be affected than men. Current figures from Germany and the United States suggest 64 new cases per 100000 population annually.
Causes
The cause of benign paroxysmal positional vertigo lies in the inner ear and is quite complex. When the otoliths, which can be broadly described as sensory and balance cells of the inner ear, detach from the ear cavity and migrate into the semicircular canal, they move whenever the head is tilted. The brain then receives a message of movement, but no other body organ can confirm it, and responds to the confusion with vertigo. The reasons for which the otholites become detached have not yet been adequately explained. Science suspects this process to be a normal part of aging. Risk factors for positional vertigo include craniocerebral trauma, inner brain surgery, and inflammation of the inner ear. Positional vertigo is also common in migraine patients and those affected by Meniere’s disease. In addition, it can occur with brain dysfunction.
Diseases with this symptom
- Concussion
- Transient ischemic attack
- Circulatory disturbances
- Migraine
- Meningitis
- Motion sickness
- Inner ear infection
- Ménière’s disease
- Stroke
Diagnosis and course
Very often, positional vertigo occurs spontaneously, so that a visit to the doctor becomes unnecessary. If the symptoms persist for a long time, an ear, nose and throat specialist should be consulted in any case to rule out more serious causes and to initiate adequate therapy. The doctor will first test the patient’s hearing and balance to rule out a hearing loss and more serious consequences and causes of the vertigo. In a detailed anamnesis, all symptoms and peculiarities of the patient’s vertigo are then discussed in order to clearly diagnose the form of vertigo. If, after the detailed diagnosis, there is a suspicion that the causes of the vertigo lie in the brain, the ear, nose and throat specialist will initiate further examinations. These include imaging procedures, neurological examinations and measurement of brain waves. Often, positional vertigo disappears after some time, but long-lasting courses over months and years are also possible. In addition, more than two-thirds of patients experience a recurrence of vertigo over the course of two years.
Complications
Positional vertigo is considered a benign condition that can usually be cured with simple exercises. However, it happens from time to time that the therapy takes a little longer after all. Then the symptoms of vertigo can limit the quality of life of those affected. Many people find the vertigo attacks to be frightening. When the vertigo attacks occur very frequently, a high level of distress develops. Positional vertigo does not leave any permanent damage. In the long term, however, psychological problems can develop. Sometimes an attitude of fear of the next attack develops. Some patients need psychotherapeutic care to cope with the psychological consequences. Often, sleep disturbances also occur.These develop due to the fact that vertigo attacks often occur during sleep. This happens very often because positional vertigo is always triggered by changes in the position of the body. During sleep, there is often a change in the position of the body. Another complication is the possible occurrence of falls. This is especially a problem for elderly patients, as these falls can easily lead to bone fractures and other injuries with dangerous consequences in them. Thus, a dizzy spell in the elderly can sometimes even become an emergency. In addition, the risk of positional vertigo increases with age. But even in young people, falls pose a major health risk.
When should you go to the doctor?
Benign paroxysmal positional vertigo is a harmless condition, despite the spinning attacks that often seem very threatening to patients. In terms of physique, a visit to the doctor is not necessary because of this benign and usually self-receding form of vertigo. Nevertheless, there are cases in which the visit of a family doctor or an ENT specialist or neurologist is quite reasonable. Here, the first visit when the positional vertigo occurs is in the first place in the sense of an exact diagnosis. Because in view of the violent vertigo attacks, which can cause the patient anxiety especially at the first times of their occurrence, it often helps to reassure the patient that behind the pronounced symptoms there is no stroke or other serious illness. The one-time visit to the doctor has another advantage: the doctor can show the affected person exercises that can be used to eliminate the dizziness symptoms through self-help. Once the patient has learned the exercises that are helpful against positional vertigo, he no longer needs to see a doctor because of the unpleasant but completely harmless clinical picture. However, there are some exceptions: Thus, the physician should be asked again for advice if the exercises do not help or if the dizziness is joined by other symptoms such as headaches and fainting. In addition, in the case of strong anxiety in relation to the harmless dizziness, behavioral therapy with a psychologist or psychotherapist can help.
Treatment and therapy
Despite the good prospects of spontaneous recovery, positional vertigo should be treated. This is particularly necessary to counteract avoidance behavior in patients, as this can have functional consequences and prolong the duration of suffering. In addition, if the symptoms are specifically triggered, albeit unpleasantly, there is a chance of habituation, so that the brain loses its irritation and the symptoms recede. The detachment of the othilia is not reversible. However, with appropriate movement and positioning exercises, if performed correctly, it should be possible to move the othilia out of the archways and into a harmless resting position. The best known exercise is the Epley maneuver, the efficacy of which has been demonstrated in several independent studies. Because it is important that this treatment be done under expert guidance to avoid complications, it is not described in detail here. Medications and surgical methods, such as removal of the organ of balance, are not used for positional vertigo because they have too severe side effects.
Outlook and prognosis
Positional vertigo usually does not require a visit to the doctor. In most cases, the symptom disappears on its own and does not require treatment. However, if symptoms persist for a long time, the otolaryngologist may be consulted for advice. It is not uncommon for positional vertigo to also cause a reduction in the patient’s hearing and vision. How severe these limitations will be cannot be generally predicted. Often there is a severe headache and nausea. With this symptom, spontaneous recovery occurs in many cases. However, patients may suffer from positional vertigo for several years. Due to positional vertigo, the patient’s life is restricted. Often it is no longer possible to go to work without further ado. In addition, there are sometimes sleep disturbances or depression. Due to positional vertigo, accidents with bone fractures can occur more frequently and more easily. The symptom also increases the risk of strokes and sudden fainting. The symptom is not usually treated by medication or surgery.If positional vertigo is triggered by certain processes, these must be avoided by the patient.
Prevention
There is no way to prevent positional vertigo. Avoiding appropriate head movements is also harmful, as it works against healing.
Here’s what you can do yourself
Positional vertigo feels exceedingly uncomfortable. Nevertheless, it is harmless in itself. However, every affected person can counteract the sometimes massive attacks of vertigo with certain exercises. These also feel very unpleasant at first, because the affected person triggers exactly the dizziness he would like to avoid by exactly prescribed jerky movements. However, there is no alternative to this. In acute cases of vertigo, sitting still, conscious and slow head movements are indicated. In mild cases of positional vertigo, making conscious and much slower movements with the head may be sufficient. Occasionally, positional vertigo then subsides after a few days. However, since positional vertigo can occur more frequently with increasing age, sufferers should devise helpful strategies in good time. This will enable them to respond better to the first occurrence of a new attack of positional vertigo. From a doctor’s point of view, counter-strategies such as the Epley maneuver are the only means that are helpful against positional vertigo. The exercises against positional vertigo that can be found on the Internet can be internalized and practiced at the first occurrence of positional vertigo. In addition, patients also have the option of using acupressure points, hand or foot reflexology massages, or the Dorn method to provide relief. These are measures that anyone affected by acute attacks of dizziness can try. Whether they are helpful varies from individual to individual.
