If vertigo leaves you in a whirl, special positional maneuvers
can help bring stability.
by Polly Campbell
When Tonya Robson, 43, got out of bed nearly four years ago, the world started spinning.
“It felt like my brain was a top just spinning inside my skull and then it settled down in seconds,” says Robson, a fitness instructor in Beaverton, Oregon. “But every time my head was parallel to the floor the spinning started again.”
That topsy-turvy sensation is a feeling more than seven million Americans experience when they move in a way that causes small calcium carbonate crystals in their ears to become dislodged. These crystals help with stability, and routinely move before being reabsorbed. But in vertigo the crystals get stuck in the canals of the inner ear and throw off one’s sense of balance, according to the Vestibular Disorders Association (vestibular.org).
Technically called benign paroxysmal positional vertigo, this condition is sometimes the result of a head bump, advancing age or a virus.
“Some research suggests that BPPV can also be influenced by low levels of vitamin D, which alters the body’s ability to absorb the calcium crystals,” says Richard Gans, PhD, executive director of the Florida-based American Institute of Balance. “But sometimes people just experience ongoing dizziness without any obvious reason.”
Robson doesn’t know what prompted her vertigo. But for months, every time she tipped her head back or leaned over, the movement set her spinning. Once, the vertigo became so bad she couldn’t discern the floor from the ceiling.
Treatment involves a series of “particle repositioning” movements in which practitioners move the patient’s head and body in ways that move the crystals back into a place where they can be naturally reabsorbed, Gans says. “It works a lot like moving the ball-bearing in the child’s toy through the maze and back into the hole in the center,” he explains.
All the different maneuvering techniques, which Gans describes as hybrids of the Epley maneuver first introduced in 1980, can be performed in a clinician’s office in 10 or 15 minutes with a success rate nearing 100%, he says.
Yet the maneuvers themselves usually provoke symptoms. “I felt awful, like I was going to be sick during the whole procedure, and even for hours after,” says Robson, who worked with a physical therapist. “But, finally that spinning sensation and the dizziness stopped. That was good. But still, I had to be careful sleeping and the follow-up exercises were brutal.”
Patients are often encouraged to stay upright for several days—Robson slept in a chair—and perform home exercises to keep the crystals from slipping back. But these exercises left Robson feeling so nauseated that she had a hard time functioning. She gave them up after a few days, but the vertigo did not return.
Gans is opposed to patients performing these exercises at home; he says they are difficult to do alone and pose risks. However, Carol Foster, MD, an otolaryngologist and associate professor at the University of Colorado, says she has developed the home-based half-somersault maneuver when she herself became dizzy with BPPV.
While she believes in the effectiveness of maneuvers performed by clinicians, Foster was looking for a quick treatment for her own symptoms.
You can tell which ear is affected, Foster says, by lying in bed and turning your head to the left and right. Whichever way you are facing when the vertigo takes hold, is the side you need to treat. If you aren’t sure, do the maneuver on both sides.
In the half-somersault, kneel (on a cushion if it’s more comfortable) and start by looking up at the ceiling. Then lean over, and tuck your chin as though you are going to do a somersault, and then turn your head to the affected side. After turning the head to a 45-degree angle, wait until the spinning subsides and then move quickly, lifting up until you are on hands and knees with the head and back aligned and flat, horizontal to the floor. Once the spinning subsides, with the head still turned, raise up quickly vertical until kneeling. Sometimes it can take several repetitions, Foster says, but then the vertigo subsides.
If her vertigo returns, Robson will probably try the half-somersault first. “If I can deal with it immediately in my living room without getting a babysitter and scheduling an appointment with the physical therapist, I’m all for it,” Robson says. “With vertigo it isn’t just the dizziness; it’s also very unsettling. It’s a relief to have a treatment that works.”