March 11, 2017

BPPV Vertigo: You Really Do Have Rocks In Your Head?

I recently had a patient come to see me for an orthopedic condition, but during her evaluation we discovered she became dizzy when she moved her head in certain directions. I learned from her that this dizziness had been going on for several years, but she had rationalized living with it, thinking it was “just part of getting older.” A quick exam confirmed a condition know as benign paroxysmal positional vertigo (BPPV) and within two treatments her symptoms were completely resolved. She could hardly believe it was so easy, and is grateful to not have that dizzy feeling any longer.


Every year, millions of people in the United States develop vertigo—a spinning sensation in your head that can be very unnerving. Imagine being on a carousel ride that never ends. Vertigo can be a complicated problem to treat, and there can be several causes.


One of the main types of vertigo is BPPV. It is surprisingly common, affecting nearly 10% of older adults. Our vestibular system is a very complex structure housed within our inner ear. It is made up by a series of semicircular canals, named by their anatomical location. Inside the canals are tiny calcium crystals, sometimes called “ear rocks”. BPPV occurs when these tiny rocks become dislodged and move to another part of the canal, usually the posterior canal. When you move your head a certain way, the crystals or “rocks” move inside the canal and stimulate the nerve endings, causing you to become dizzy. Often patients note dizziness with head movement such as when lying down, turning over in bed or looking up. So if you have ever thought you had rocks in your head, you were right!


The crystals may become loose due to trauma to the head, infection, conditions such as Meniere’s disease or aging, but in many cases there is no obvious cause. No medication has been found to be effective with BPPV. Fortunately, most people recover from BPPV with a simple but very specific head and neck maneuver performed by a physical therapist trained in vestibular disorders. The maneuver is designed to move the crystals from the semicircular canal, back into the appropriate area in the inner ear.


In my experience, this maneuver is the closest thing to a “miracle cure” that we have in physical therapy. Usually, within one to two visits we can completely rid a person of BPPV, and the misery of the vertigo. Although our treatment for this condition is usually a slam-dunk, it can sometimes reoccur. If it does reoccur it usually can be treated again with similar successful results. In fact, you may be able to learn to do the treatment yourself at home but a word of caution. There are many other causes of balance and dizziness problems which sometimes requires a team approach between physical therapy, audiology, and medical doctors to appropriately diagnose and treat.


If you think you have rocks in your head, you may be right! If you are dizzy, it is worth the time to get it checked out by a medical professional trained in vestibular and balance disorders.


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