Dr. Elaine Screaton on Vertigo

Is the room spinning? Are you spinning in the room? This is one of the most common symptoms of vertigo, and you certainly aren’t alone. Of the various types of vertigo, BPPV (Benign Paroxsysmal Positional Vertigo) is by far the most common cause, accounting for 17% of vertigo patients (1). It is estimated that 2.4% of us will experience BPPV at some point in our lifetime (2). Unfortunately, most often BPPV is idiopathic (50-70% of the time), meaning it comes on without a cause (1).  BPPV can also be the result of trauma (think a fall where you hit your head, whiplash, concussion) and accounts for 7-17% of cases.

While we don’t always know what caused the BPPV, typically it has to do with displacement of crystals in the inner ear, causing a mismatch between the position our ears THINK we are in and the position our EYES think we are in. We rely on a variety of mechanisms to sense our position in space (also called proprioception). We rely on our eyes to tell our brain where our head is in space, and we also rely on our inner ear (more specifically the semicircular canals) to detect where our head is in space. When the signals our eyes and ears detect match, we don’t have any dizziness. But, when these signals don’t match we can start to feel dizzy, or like the room is spinning. With BPPV, the crystals that rest in the semicircular canals (called otoconia) are thought to be displaced (no, they haven’t left the ear, they simply are resting on a portion of the otolithic membrane that is an abnormal resting position). It is this abnormal displacement that creates the signal mismatch, that can lead to vertigo.
Interestingly, it is women between the ages of 50–70 that are most commonly affected by BPPV (1), and it is more prevalent in ‘cooler’ months of the year (ie winter), thought to be due to a relative vitamin D deficiency.
The hallmark symptoms of BPPV are often a very sudden onset (attack) of vertigo where the room is spinning or the floor is unsteady, often precipitated by common movements like rolling over in bed, looking up to the ceiling, or looking down to the floor (1). It also characteristically affects one ear or the other (ie laying on the left side will always precipitate an attack, while laying on the right side never precipitates an attack).
BPPV is diagnosed by performing the Dix-Hallpike Maneuver , which is considered the ‘gold standard’ in combination with a thorough history for diagnosing BPPV (1). To treat BPPV, experienced and trained clinicians perform what is called the Epley Maneuver which is designed to reposition the inner ear crystals. In the literature, the Epley maneuver has been reported to have between 80-100% success rate, with little chance of recurrence (<30%) (1). Additionally, alleviation of symptoms can be achieved in as little as one treatment, however sometimes multiple visits are required (1)
Dr. Elaine Screaton (DC, BSc) is a Chiropractor currently practicing at Synergea Family Health Centre in Calgary, AB. Always consult your health care provider for a proper diagnosis and treatment.
1.  Parnes, L. S., Agrawal, S. K., & Atlas, J. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Canadian Medical Association Journal, 169(7), 681-693.
2.  Epidemiology of benign paroxysmal positional vertigo: a population based study.J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. Epub 2006 Nov 29.