Fast, Effective Treatment for BPPV
At Vortex Physical Therapy and Balance, our physical therapists are highly skilled in treating Benign Paroxysmal Positional Vertigo (BPPV). As specialists in dizziness and inner ear disorders, we successfully treat patients with BPPV every day.
While BPPV can be disorienting and may disrupt your normal daily activities, it is easily treatable and can often be resolved in as little as 1-2 visits. If you received a diagnosis from your doctor or suspect you have BPPV, please contact our office to schedule an evaluation and treatment. We can usually accommodate you within one or two days.
Current research indicates that only 20% of BPPV cases recover spontaneously within one month, and only 50% resolve after 3 months. Waiting for BPPV to resolve can significantly impact your quality of life—interrupting daily activities, causing you to miss work, and in some cases, increases your risk of falls, anxiety or depression.
Get the treatment you need, when you need it, so you can get back to enjoying life.
What is BPPV?
BPPV is the most common inner ear disorder and cause of vertigo. It can occur for no reason and affects individuals of any age. However, the incidence of BPPV is greater in individuals over 65.
The onset of BPPV is normally sudden. The first time you experience it, you may feel a violent sensation of spinning. Most often individuals with BPPV experience vertigo when changing their head position, such as rolling from side to side in bed, moving from lying down flat to sitting up, bending down or looking up. Common symptoms include short episodic spells of vertigo or spinning sensations when changing positions, nausea (sometimes vomiting), feeling disoriented and unsteady.
BPPV occurs when microscopic calcium carbonate crystals become dislodged from their position in the inner ear and move into one of three semicircular canals. This causes the inner ear to send false signals to the brain when you move your head position, causing vertigo and dizziness.
The Dix-Hallpike and Supine Roll Test are testing procedures used by trained medical professionals to identify BPPV. These tests alter the position of the head relative to gravity; loose crystals will move through the semi-circular canal, inducing a sensation of spinning or vertigo. The corresponding nystagmus (abnormal eye movements), produced by the moving crystals indicates which ear and which canal the displaced crystals are located. With three semicircular canals in each ear, there are 6 different canals in which crystals can become displaced. Our team is trained to test and treat them all.
Treatment of BPPV is accomplished by completing a Canalith Repositioning Maneuver (CRM). There are several different CRMs and a trained medical professional will select the appropriate treatment based on the results of your positional testing. For each of the semicircular canals, there is a different CRM procedure.
During testing and treatment, it is common to feel dizziness, vertigo or spinning, and nausea. In a few cases, some people vomit following treatment. Our office is prepared to handle this. However, we suggest you do not eat a meal before coming in for BPPV treatment.
We also highly recommend having someone drive you to this appointment.
Immediately following repositioning, there is an increased risk of falls due to imbalance. For several hours after repositioning, you are encouraged to relax and give your body time to recover. Current professional guidelines suggest BPPV post-repositioning precautions, such as limiting head movement or sleeping propped up on pillows, are unnecessary and ineffective.
You may continue to feel sensitive to movement for a few days. This does not mean your repositioning was unsuccessful. These mild symptoms can take a few days to resolve. It is important to return to your normal activities because motion and movement will help to speed your recovery.
However, if you experience spinning after the repositioning or have motion sensitivity for more than a few days, please call our office. It may take several visits to reposition the crystals and fully resolve the BPPV.
Commonly Asked Questions
How do I know I have BPPV and not something else?
If you think you have BPPV, ask yourself the following questions:
- Am I experiencing the sensation of spinning or the world around me spinning?
- Does it happen when I am changing positions? (going from laying to sitting, looking up or down, turning head quickly to the side)
- Does the spinning stop after a few seconds to a minute?
If you said yes to these questions, you are probably experiencing BPPV. Contact a trained medical professional, such as an otolaryngologist (ENT doctor) or vestibular therapist for treatment. YOU DO NOT HAVE TO SEE A DOCTOR BEFORE COMING FOR BPPV TREATMENT.
*If you are experiencing constant vertigo or spinning or are uncontrollably vomiting, you should immediately seek help from a doctor to rule out other potentially life-threatening issues.
Do medications help? Will they make my vertigo go away?
If you visit your doctor, you may be prescribed a vestibular suppressant, such as meclizine, lorazepam, or diazepam to reduce motion sickness or nausea. These mask symptoms; they DO NOT resolve the vertigo or make it go away. Vestibular suppressants should only be used as needed for nausea and motion sickness. They are not meant for long-term use.
For more information on medications, check out this resource page from VEDA and speak with your doctor: http://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-medication
How can I find a trained vestibular therapist?
When looking for a new medical provider, it is always a good idea to assess a provider’s experience; especially within a specialty like vestibular therapy, which requires continuing education courses and training.
A trained vestibular therapist will have a firm understanding of how the vestibular system works, and will be trained in evidence-based treatments for a variety of vestibular dysfunctions, not just BPPV.
Do your homework to find the right provider. Start with an online search for vestibular therapy in your area. The APTA Neurology Section and the Vestibular Disorders Association (VEDA) both have directories you can use to find local physical therapists who treat vestibular issues.
Once you find a local provider, check the facility’s website for more details. The website should provide information on the vestibular therapy services it provides. It should also include a staff bio page which includes details about who the vestibular therapist is with an overview of their vestibular experience. If the website is lacking content for you to make a sufficient decision, call the office and ask some questions before booking an appointment. Here are a few sample questions:
- Which of your physical therapists provides vestibular therapy?
- How many years of experience does this person have treating vestibular issues? What percentage of their patients are being treated for vestibular issues?
- Is the therapist trained to treat other vestibular issues besides BPPV?
*In our experience, an experienced vestibular therapist is going to have at least half their caseload focused on vestibular therapy and they will be happy to provide you with details on their experience and training.
I don’t like medications. What else can I do to relieve my nausea?
Simple ways to reduce nausea include:
- Use peppermint or ginger which are both known to alleviate nausea. We recommend drinking peppermint or ginger tea or sucking on hard candy. However, both are also available in other forms, such as chews and gum.
- Using peppermint essential oils (check to see if yours can be applied topically or should be used in a diffuser)
- Try SeaBands, a set of cotton wristbands with an acupressure button on the inside of the wristband. The button exerts pressure and stimulates the pressure point in your wrist that is supposed to relieve nausea and vomiting.