In most cases you do not need to see a doctor or physical therapist to treat your own vertigo. Here is a guide to treating your vertigo.
What is Positional Vertigo or BPPV?
I like to use the analogy of a hot water tank in our home and the hot water pipes. We all have rocks in our head. These crystals tell our brain where gravity is due to their weight. If they get fractured or broken off they end up at the bottom of the ‘hot water tank’ or vestibule. But if they end up in the pipes, the semi-circular canals, then they cause all sorts of problems depending on where they go. Check out this video from a group of ENT’s in Virginia, Fauquier ENT Consultants, for a great explanation of positional vertigo.
In our practice we see positional vertigo clients from all ages, from teenagers to seniors. These pictures show otoconia or otolith crystals intact and another closer view showing fracture lines. Trauma and age can cause this. (Adopted from Jang et al 2006)
Head injury or whiplash can create fractures in the Otolith crystals. Over time pieces of the otolith can break off. If they stay in the vestibule then there are no symptoms. If they end up in the semicircular canals then vertigo can occur.
The Cause of Vertigo
When our head stops moving the endolymph or fluid in our semicircular canals settles and also stops moving, like a calm pond. The sensing organ, the cupula, stops its deflection telling the brain that there is no longer any acceleration or movement changes to the head.
What happens next is the cause of vertigo.
A crystal starts to sink (you dropped a stone in the calm pond and ripples form) 'stimulating' the cupula or sensing organ of it’s canal to fire while the other 5 canals are telling the brain that there is no movement of the head. It is this abnormal information that causes vertigo. In over half of vertigo cases the canal that is the problem is the posterior canal and the best treatment is the Epley maneuver. We recommend ‘playing the odds’ and betting that your vertigo is coming from a posterior canal and following this process.
Steps to treating your own vertigo
First - DO the Dix Hallpike Maneuver
Start sitting up, turn your head 45 degrees, tilt your head backwards, then lie back quickly.
This is the hardest part, wait. If you have positional vertigo your symptoms will be delayed, not immediate. The room spinning is what you are waiting for. Wait for it to pass while holding your head still.
- Most positional vertigo problems are a posterior canal and the Epley maneuver is the best treatment for this.
- The side that the Dix Hallpike test felt worse is the side you treat.
- You can try the other side but if your vertigo feels intense go ahead and turn your head quickly to the other side, 90 degrees, or 45 degrees rotated the other direction. You are now doing the Epley maneuver.
Next - DO The Epley Maneuver
Here is a video of an actual client with a posterior canal BPPV or positional vertigo. You can see his eye beating or what is called nystagmus. The treatment is an Epley maneuver. It took only one treatment and his vertigo immediately improved.
Your Vertigo will get better with time
If you don’t do anything your vestibular nuclei or control center for your inner ears will adjust and start to ‘ignore’ the input from the side that you have the crystal issue on. This is the basis for vestibular rehabilitation. The idea is that you keep stimulating the vertigo sensation and your brain will get ‘tired’ of the bad feeling and try to ignore it. If you do nothing to treat a positional vertigo problem you will get better. It is when other dizziness systems are affected that symptoms carry on.
If your problem is a crystal issue affecting a horizontal or anterior canal then simply rolling will most likely be ineffective and not work. Why? These canals are “stickier” in that liberating maneuvers are needed to loosen up the crystal while attempting to free and then move them out of the canal. Without these maneuvers treatment does not work.
Horizontal and Anterior Canals need liberating maneuvers. Rolling alone does not work.
Be careful of treatments that continue on and on attempting to treat positional vertigo. If you are not getting better in a few treatments then try something different. This may include testing other systems that cause dizziness.
I feel no different or worse after vertigo treatment!
This is a great indicator that positional vertigo treatment is not working. You should feel immediately better. You should have less nausea and walk better with better equilibrium or balance. Once a crystal clears the stimulation to that cupula or canal is gone!
If you have nausea, continued dizziness, feel like throwing up, your positional vertigo treatment was not successful.
If after a few tries you are not significantly better then you either have a different canal involved and imaging is your best chance of success. Or this is not positional vertigo and finding the cause of dizziness is what you should do next.
Over the years I have treated hundreds of positional vertigo cases. Not one person threw up after testing or treatment. You should feel immediately better, not worse.
Check out this link for Best tests for Vertigo.
Symptoms of Positional Vertigo
The world is spinning but I am OK
Vertigo happens after a head position change
A delay in vertigo after a head position change
Looking up or down causes vertigo
Turning over in bed causes vertigo
Lying down causes vertigo
Turning too quickly when you are walking.
- It is most likely positional vertigo when your vertigo sensation is delayed after a head position change. Immediate dizziness is less likely positional vertigo and is most likely coming from a neck problem.
- If you have constant dizziness it is less likely to be positional vertigo.
- If you feel drunk or like you have had alcohol to drink you may have a cupulolithiasis.
- You do not need a machine to treat vertigo. (Your problem could actually get worse)
There is only one way to treat positional vertigo. Gravity
Find the canal.
Head position is critical with pauses and quick head turns. Liberating techniques are needed for horizontal and anterior canal problems.
Here are clinics in Colorado Springs that have the knowledge and imaging to treat positional vertigo.
Colorado Hearing and Balance, Cameron Shaw MD
Colorado ENT and Allergy
Balance Point Rehab
Orthopedic Rehab Associates, Danielle Spivey PT
Cornerstone Physical Therapy (Yup, its a thing here!)
There are others that will advertise that they treat vertigo but without imaging you are just as likely to be successful by treating your most dizzy side with an Epley maneuver on your own. It can be helpful to have someone guide you through this process but our recommendation is to try on your own first.
Remember, if you try the Epley Maneuver a few times and it doesn’t work then get imaging.
Reasons why positional vertigo treatments fail
The Wrong Canal or Side
The Wrong Treatment – Gyrostim or Brandt-Daroff
It's Not Positional Vertigo
The reason these treatments do not work for treating positional vertigo is that they do not respect or control the head position.
Head position is CRITICAL in treating positional vertigo.
For more on treatments that do not work check out this link. How to treat Vertigo. (And what not to do)