Positional Vertigo

What is positional vertigo?

Positional vertigo is an inner ear problem. It causes brief but sometimes severe feelings of spinning. Some people feel that their head or body is spinning. Others feel the room is spinning. People often say they are dizzy, but dizzy is a very general term. Vertigo, on the other hand, is the very specific feeling of uncontrollable spinning.

Symptoms of positional vertigo happen suddenly when you change the position of your head.

What is the cause?

In the inner part of your ear are 3 semicircular canals. Movement of the fluid in these canals helps your brain maintain your balance and know what position you are in (for example, standing up, lying down, or standing on your head).

Small crystals of calcium float in the fluid in the inner ear. These crystals can get into the semicircular canals and cause vertigo. When you change the position of your head, they then strike against nerve endings in the semicircular canals and cause the feelings of spinning.

What are the symptoms?

A sudden feeling that you are spinning, or that the room is spinning, is the main symptom. You may feel the vertigo when you first wake up. It may seem that any turn of your head brings on brief but intense spells of vertigo. It may happen when you tilt your head, look up or down, or roll over in bed.

You may have nausea and vomiting along with the vertigo. Even if a spell of vertigo is brief, you may have a feeling of queasiness for several minutes or even hours afterward.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may also be given a Dix-Hallpike position test.

You start the Dix-Hallpike test by sitting upright on the examining table. You will then lie on your back, slowly bring your head down beyond the edge of the table, and turn your head to one side. If you have positional vertigo in this position, your provider will see your eyes making fast, jerky movements called nystagmus. If no nystagmus is seen, your provider will repeat the test with your head turned to the opposite side to test the other ear. If you have nystagmus and vertigo in one of these positions, the ear that is pointing toward the floor is the one causing the problem. The nystagmus and vertigo will slow down and stop after 15 to 20 seconds. If you don’t move your head, no more symptoms will occur. When you sit back up, you will have vertigo again, but for a shorter time.

Other tests you may have are:

• an ear exam
• an audiogram to check your hearing
• a test of your nerve responses
• an electronystagmogram (ENG) test

How is it treated?

Mild vertigo is often treated with medicine. The most common medicine for this problem is meclizine. It is taken up to 4 times a day for the vertigo and nausea or vomiting. One of the problems with this medicine is that it causes drowsiness. This is not as much of a problem if you have severe vertigo, which usually requires bed rest. Then the medicine can help you sleep and get relief from the nausea and vertigo while you sleep.

Your healthcare provider may recommend techniques that use gravity to move the crystals away from the nerve endings into an area of the inner ear that won't cause any problems. These are called repositioning techniques.

One repositioning technique is the Epley maneuver. It can be very helpful. Your healthcare provider will move your head into 4 positions. You will hold each position for about 30 seconds.

Your healthcare provider may also suggest that you do Brandt-Daroff exercises. Your provider may recommend that you do these exercises 3 times a day for 2 weeks. To do these exercises:

• Start by sitting upright on your bed.
• Lie on your left side, with your head angled upward about halfway. (Imagine that you are looking at the head of someone standing about 6 feet in front of you.) Stay in this position for 30 seconds, or, if you are having vertigo, until the vertigo stops.
• Return to the sitting position for 30 seconds.
• Lie on your right side, and follow the same routine.

Your healthcare provider may refer you to a physical therapist to learn and practice these repositioning techniques.

Rarely, when repositioning techniques don't help and the vertigo has not gone away after a few weeks, severe cases may eventually require surgery. Two types of surgery may be used to stop the vertigo.

• Because most of the loose crystals cause problems in the posterior semicircular canal, this part of your ear may be surgically plugged to keep the crystals from moving. The lining tissue will be scarred closed with a laser and the remaining space will be filled with tiny bone chips and special glue.
• The other surgery cuts the nerve that connects the brain with the posterior semicircular canal. This prevents vertigo by keeping your brain from sensing the movement of the crystals.

How long will the effects last?

Even without treatment, positional vertigo usually goes away within several weeks. Sometimes it recurs despite treatment.

How do I take care of myself?

• If your vertigo is mild, you may be able to continue your usual activities, especially if you have opportunities to sit and rest when you have vertigo.
• If your vertigo does not allow you to continue your usual routine, you should rest at home.
• Use medicine as prescribed by your healthcare provider to help stop symptoms of dizziness, nausea, and vomiting.
• Follow your instructions for using the repositioning techniques.
• Do not try to drive, operate tools or machinery, or do other tasks, even cooking, that could endanger yourself or others if you suddenly become dizzy.
• Follow your healthcare provider's recommendations for follow-up visits.
• Contact your healthcare provider if:
  • Your symptoms seem to be getting worse, more frequent, or longer lasting.
  • You develop new symptoms, such as a loss of hearing, severe headache, or slurred speech.