Vertigo

Vertigo is the perception of motion of either the sufferer or of the environment. So, either the person feels like the world is spinning around them or they feel like they themselves are spinning/tilting/falling. One of the most common cause of vertigo is BPPV (Benign paroxysmal positional vertigo), accounting for about 25% of vertigo causes in adults. BPPV occurs suddenly, is associated with changes in head position, and can follow a cold or flu, head injury or dental work. It is also more common as you age with the risk being 7 times higher in the over 60’s.


Symptoms come on with change of head position, so things such as rolling in bed, getting in or out of bed, looking up to hang up washing, looking down to put on shoes, looking over your shoulder to reverse the car.


The semicircular canals inside the ear provide sensory information about the head movement and position. There are 3 canals: anterior, posterior and horizontal. When there is loose debris (otoconia) in the canals, it can cause vertigo symptoms. The posterior canal is the most commonly affected canal (80% of cases).


There are 2 types of BPPV

1.       The debris is free moving. As the head moves and changes position, the debris will move and settle at the lowest part of the canal. The moving debris stimulate the sensory nerves which cause the vertigo symptoms. These symptoms can take 1-40seconds to start and usually settle within 60 seconds.

2.       The debris is fixed/adheres to the cupula (less common). As soon as the head is put in the provocative position, vertigo symptoms will begin and will continue until the head is taken out of the provocative position.


If you have the first type of BPPV, there is a technique you can try at home called the Epley’s Manoeuvre. It will bring on vertigo symptoms with possible nausea so have a sick bag or bowl close at hand, just in case.


1.       Sit upright on bed. Have a pillow on the bed so when you lie back, your shoulders will be on the pillow and your head off the pillow and tilted back.

2.       In sitting, turn your head 45degrees to the side of dizziness and lie back over the pillow. Try to do this fairly quickly. It is expected you will feel dizzy doing this but try to stay in this position until the dizziness eases. It should resolve within 1 minute but may take up to 30seconds to start. Wait a further 30-60seconds after symptoms resolve

3.       Turn head 90degrees and again wait for an extra 30-60seconds after symptoms resolve.

4.       Keeping head at 45degrees from the midline, roll body onto side (you will now have your head facing the floor). Again, wait until symptoms subside plus 30-60seconds

5.       Drop the legs off the side of the bed and push yourself up into sitting, keep head still rotated. You may experience strong dizziness at this stage


Example self treatment for vertigo associated with lying on the right:

(Modified from Parnes et al 03. CMAJ 169, 681-693)


The Epley manoeuvre is safe to do, but might not be the right technique for you, either due to back and neck issues, or your vertigo symptoms aren’t caused by BPPV (or are related with the less common canals). It is recommended to always get your vertigo symptoms assessed by a qualified professional. If you notice other symptoms such as double vision, difficulty talking or swallowing, difficulty walking and or nystagmus (eyes flicking) while not moving the head, seek medical attention.


Vertigo can be a very distressing experience, but with a good diagnosis it is often very easily treated.



Sophie Hellings

Sophie is a senior physiotherapist at BodyWise Physiotherapy. She has completed a Masters of musculoskeletal physiotherapy at Curtin University, and has many years experience managing a wide range of pain and musculoskeletal conditions. Her particular interests incoude chronic and persistent pain, headache management and complex conditions such as vertigo