Benign Paroxysmal Positional Vertigo: Symptoms and Treatment Options

Q: Benign Paroxysmal Positional Vertigo: Symptoms and Treatment Options

Hello： You mentioned that over the past two weeks, you have experienced dizziness frequently when turning your head, bending over, looking down and then up, or getting up from a lying position for a few seconds (especially noticeable when turning to the left, though not every tim

Consult a physician?

Hello Doctor: Two weeks ago, when I tried to get up and turn over to sit up, I noticed that the scenery in front of me was spinning.
I felt dizzy to the point where I couldn't maintain my balance (at the moment of turning over).
That day, I was so dizzy that I couldn't sit up, and I was taken to the emergency room.
The doctor diagnosed it as "Benign Paroxysmal Positional Vertigo" (BPPV).
Over the past two weeks, I have noticed that it often occurs when I turn my head, bend over, look down, or get up from a lying position for a few seconds (especially noticeable when turning to the left, but not every time).
However, sometimes when I turn my head to the right, it also happens (though less frequently).
I would like to ask if this is normal? (I found online that it seems to usually occur on one side only).

My second question is that recently (especially during the days when the dizziness first occurred), after getting up, I often feel a sharp pain in my temples or the back of my head.
Is this dizziness normal?
My third question is whether medication is necessary to improve the spinning symptoms of vertigo? Will it recover naturally? Thank you, Doctor.

YuCing, 20~29 year old female. Ask Date: 2019/01/29

Dr. Jiang Junyi reply Neurology

Hello: You mentioned that over the past two weeks, you have experienced dizziness frequently when turning your head, bending over, looking down and then up, or getting up from a lying position for a few seconds (especially noticeable when turning to the left, though not every time).
However, sometimes when I turn my head to the right, I also experience it (though less frequently).
I would like to ask if this is normal? I found online that it seems to only occur on one side.

A: The characteristics of benign paroxysmal positional vertigo (BPPV) include brief episodes of dizziness related to changes in head position, such as bending over, leaning back, lying down, getting up, rolling over, and sudden head turns.
This may be accompanied by symptoms such as nausea, vomiting, palpitations, cold sweats, and a feeling of weakness.
The causes are often unknown, but some may be due to inflammation, degeneration, or head trauma leading to the displacement of otoliths in the inner ear's utricle into the semicircular canals.
When the head position changes, the movement of these otoliths within the semicircular canals alters the neural potentials in the inner ear, resulting in vertigo.
Your second question is about experiencing a sharp pain in your temples or the back of your head upon waking, especially during the days when the dizziness occurred.
Is this normal?
A: This may suggest cervical-related circulatory issues or tightness in the cervical muscles.
Your third question is whether medication is necessary to alleviate the spinning sensation associated with dizziness, or if it can resolve on its own.

A: Issues related to inner ear imbalance can improve over time, similar to motion sickness; adequate rest often leads to self-resolution.
I recommend consulting an otolaryngologist for evaluation and treatment.
Wishing you good health and happiness.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2019/01/29

More Info

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder that can cause episodes of dizziness or vertigo, particularly when changing the position of the head. It occurs when tiny calcium carbonate crystals, known as otoconia, become dislodged from their normal location in the utricle of the inner ear and migrate into one of the semicircular canals. This can lead to abnormal signals being sent to the brain, resulting in the sensation of spinning or dizziness.

Symptoms of BPPV
The primary symptom of BPPV is brief episodes of vertigo, typically triggered by specific changes in head position. Common scenarios that can provoke symptoms include:
- Turning over in bed
- Sitting up from a lying position
- Looking up or down
- Bending over
Patients often describe the sensation as a spinning or whirling motion, which can be accompanied by nausea. In your case, the dizziness occurs particularly when turning your head to the left, which is not uncommon as BPPV can affect one ear more than the other. The pain you experience in your temples or the back of your head after episodes of dizziness could be related to muscle tension or strain from the sudden movements or the stress of experiencing vertigo.

Treatment Options
The treatment for BPPV primarily involves repositioning maneuvers that aim to move the dislodged otoconia back to their original location. The most commonly used maneuver is the Epley maneuver, which involves a series of specific head and body movements performed by a healthcare professional. This maneuver has been shown to be effective in relieving symptoms in many patients.

In addition to the Epley maneuver, vestibular rehabilitation therapy (VRT) may be recommended. VRT involves exercises designed to improve balance and reduce dizziness. This can be particularly helpful if you experience persistent symptoms or if your balance is affected.

Medication
While medications such as antihistamines or anticholinergics can help alleviate symptoms of dizziness, they do not address the underlying cause of BPPV. Therefore, they are typically used for symptomatic relief rather than as a primary treatment. Many patients find that their symptoms improve naturally over time, but this can vary from person to person.

Prognosis
The prognosis for BPPV is generally good. Many individuals experience significant improvement or complete resolution of symptoms with appropriate treatment. However, some may have recurrent episodes, and it is not uncommon for BPPV to return after a period of remission.

Conclusion
In summary, your symptoms of dizziness when changing head positions are characteristic of BPPV, and while it can be distressing, it is a treatable condition. The pain you experience in your temples or the back of your head may be related to the stress of the episodes or muscle tension. It is advisable to consult with an ear, nose, and throat (ENT) specialist or a physical therapist who specializes in vestibular disorders for a proper evaluation and to discuss the most appropriate treatment options for your situation. With the right approach, you can expect to see improvement in your symptoms and regain your balance.

Similar Q&A

Understanding Benign Paroxysmal Positional Vertigo: Symptoms and Causes

Hello, Doctor: Yesterday morning, I suddenly experienced dizziness upon waking up. It worsened when I lay down, and I couldn't stand steadily. I felt so dizzy that I kept wanting to vomit, but I couldn't. The symptoms lasted for a long time. Eventually, I had to go to t...

Dr. Chen Junliang reply Otolaryngology
There are many causes of dizziness. In addition to a detailed description of the patient's medical history, a thorough neurological examination and vestibular function tests are necessary. Benign paroxysmal positional vertigo is just one of the potential causes. If your symp...

Understanding Vertigo: The Impact of Canalithiasis and Recovery

I have been experiencing dizziness for four months, during which I felt like the world was spinning. After ruling out all examinations from neurology, psychiatry, and psychosomatic medicine, I was finally diagnosed with benign paroxysmal positional vertigo (BPPV). Previous tests ...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, dizziness can have numerous potential causes: 1) If accompanied by a dull pain in the left posterior part of the head, it may suggest poor blood circulation in the head and neck. 2) If there are symptoms of ear fullness, ear pressure, or hearing loss, it may indicate sudde...

Understanding Persistent Dizziness: Causes and Solutions for Your Symptoms

Hello Dr. Jiang: About two years ago, I experienced similar symptoms where I felt dizzy every day, especially when moving or turning my neck, and even while chewing food. Although I felt dizzy, it wasn't severe enough to cause nausea or vomiting. At that time, I underwent ex...

Dr. Jiang Junyi reply Neurology
Hello, based on your description, Benign Paroxysmal Positional Vertigo (BPPV) should be considered first. The characteristic symptoms include brief episodes of dizziness related to changes in head position, such as bending over, tilting back, lying down, getting up, rolling over,...

Managing Positional Vertigo: Understanding Symptoms and Treatment Options

Hello, doctor. My mother recently experienced sudden positional vertigo. When she turns her head to the right or bends down, she feels a spinning sensation at the top of her head. She has taken medication prescribed by an ENT specialist, which has slightly improved her symptoms, ...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, based on your description, it is possible that you have displaced otoliths. However, it is still advisable to take the time to see a doctor for an examination to rule out other potential conditions. Wishing you safety and good health.