Benign Paroxysmal Positional Vertigo, also known as BPPV, is a type of Vertigo which is by far the most common in Vertigo patients.
BPPV is caused by an inner ear issue, & leads patients to feel as if the room around them is spinning & their surroundings are moving even when they are perfectly still.
BPPV is usually not a serious condition, as the term Benign in its name specifies. It is usually triggered by certain head movements, as the term positional in the name suggests.
BPPV symptoms also hit suddenly & last for short bursts of time, as suggested by the term positional in its name.
If you have BPPV, you don’t need to worry at all. It is quite a common condition, & can be easily treated by a Vertigo doctor.
BPPV symptoms often resemble those of other conditions, & can be quite hard to diagnose at first.
BPPV is usually not fatal, unless it increases your chances of falling while performing certain activities like walking, jumping, mountain climbing, driving, weightlifting, etc.
BPPV Symptoms:
BPPV symptoms occur suddenly, & often makes the patient feel as if they’re spinning, moving, or about to fall down.
They are often triggered by a change in the position of the head, or any movement that can irritate the position of the calcium crystals misplaced inside the semicircular canal.
Some of the most common BPPV symptoms include:
A feeling of the surroundings spinning or moving,
Nausea or vomiting,
Motion sickness & general unsteadiness,
Lightheadedness & fainting
How to test which ear is affected by BPPV?
Sit up on your bed such that your head hangs over the edge when you lie down.
Turn your head in the right direction & quickly lie down.
Wait a minute before performing the next steps. If you feel dizzy during this time, then it means that your ride sight is affected by BPPV.
If no dizziness occurs, sit up, wait for a while, & repeat the test on the left side.
If you feel dizzy when doing the test on your left side, then that means your left side is the one affected by BPPV.
BPPV Causes:
Inside the ear, lie tiny calcium crystals also called otoconia. Sometimes, these crystals can break from their original position inside the middle ear & deposit inside the semicircular canal of the inner ear.
When this happens, they cause problems with the way the vestibular system located inside the inner ear functions to keep the body’s balance.
These tiny calcium crystals are motion sensitive, thus causing false sensations of motion everytime the patient moves their head in certain ways.
Many actions can trigger the feelings of BPPV. These include:
Rolling over to the side of bed,
Getting in & out of bed,
Bending during yoga,
Tripping your head back during a session at the salon,
Performing any activities that require certain specific head movements
BPPV diagnosis:
In order to provide you with an accurate BPPV treatment plan, your doctor will have to diagnose your condition with precision.
Your doctor will usually ask for a history of your symptoms, & any other illnesses or injuries you have had in the recent past.
Your doctor will also look for any abnormal eye movements, also called nystagmus. Nystagmus is an undeniable physical symptom of Vertigo, which will pretty much seal your BPPV diagnosis.
Your doctor will also check if any of your symptoms occur when you move your head in certain ways & directions, another tell-tale sign of BPPV.
If a physical exam is inconclusive, your doctor might also recommend the Electronystagmus test( the ENG test), &/or the Videonystagmoraphy test( the VNG test), along with the MRI test.
BPPV treatments:
Most cases of BPPV episodes are short-lasting in nature, & go away on their own.
BPPV treatments usually focus on reinstating the misplaced calcium crystals in the inner ear back to their original position.
They do this with the help of certain exercises called the canalith repositioning maneuvers, which help move the displaced calcium crystals back to their original position.
The most common canalith repositioning maneuvers that doctors use to move the displaced calcium crystals back into their original position are:
Epley Maneuver: The Epley Maneuver is a very well-known Vertigo exercise that vertigo specialists recommend for BPPV treatment. The Vertigo exercise involves moving your head in certain directions to help the displaced calcium crystals fall back into their original position.
The Epley Maneuver is known to be very effective when it comes to long-lasting BPPV treatment. It involves a few very simple steps that you can even carry out at home. Although in the beginning, you will be required to perform the Epley Maneuver under the supervision of a Vertigo specialist.
Semont Maneuver: The Semont maneuver takes about 15 minutes to complete, & involves certain specific head movements similar to the Epley Maneuver.
Although it is a bit less common than the Epley Maneuver, it has a wide success rate in BPPV treatment, next only to the Epley Maneuver.
Medicines: BPPV treatment also includes various medications like meclizine, diazepam, dramamine, phenergan, & scopolamine. Patients are supposed to take Vertigo medicines along with performing dizziness & vertigo exercises for effective BPPV treatment.
Surgery: In some cases, surgical interventions may be required for effective & long-lasting BPPV treatment. Doctors will aim to remove the displaced calcium crystals inside the ear with the help of surgical instruments to effectively treat your BPPV symptoms once & for all.
The surgical approach is usually taken when all other BPPV treatment procedures fail, & your BPPV symptoms are getting worse overtime.
Want to know more about BPPV, its signs, symptoms, diagnosis, treatment, & prognosis? Visit www.vertigoandearclinic.com.
Vestibular Migraine is a condition in which people with an existing history of migraines experience recurring dizziness or Vertigo.
The way it differs from traditional migraines is that the patients of Vestibular Migraine don’t always experience headaches.
Vestibular Migraines are known by multiple names, some of which are:
Migraine-associated Vertigo,
Migrainous Vertigo,
Migraine-related Vestibulopathy,
Vestibular Migraine symptoms:
Vestibular Migraines don’t always have noticeable symptoms. The primary symptom seems to be dizziness that comes & goes.
The word Vestibular refers to the inner ear, which houses the body’s vestibular system that is responsible for controlling & maintaining the body’s balance.
If you suffer from Vestibular Migraines, you may feel one or more of the following symptoms:
Dizziness that doesn’t go away even after a few minutes,
Nausea & vomiting
Problems with balance & orientation
Feeling dizzy when you move your eyes, head, or neck, otherwise known as extreme motion sensitivity
Feeling confused or disoriented,
A general feeling of unsteadiness,
Sound sensitivity
It’s important to note that you may experience balance problems & dizziness without necessarily having vestibular migraine.
The vertigo symptoms may occur after, before, or during an episode of Vestibular Migraine.
In some cases, patients might suddenly begin experiencing Vertigo symptoms a long time after getting diagnosed with Vestibular Migraine.
Vestibular Migraine causes:
While most doctors & experts aren’t exactly sure as to what causes Vestibular Migraine, many believe it to be because of certain misfires between the brain & the various nerve cells that carry balance/movement information.
It can be hard to figure out just how many people are affected by Vestibular Migraine, although medical researchers put it close to 1% of the entire population. This number however, could very well be higher.
Much like traditional migraines, the incidence of Vestibular Migraine is higher among women as compared to men.
While most people begin experiencing Vestibular Migraine symptoms around the age of 40 years, it is not a hard & fast rule. The condition has also been observed in kids & young adults.
Vestibular Migraine diagnosis:
There are no blood or imaging tests that can tell doctors for sure if a patient indeed has Vestibular Migraine. Although the International Headache Society & other related organizations have rolled out a criteria to help doctors diagnose Vestibular Migraine in patients. The same is listed below.
A patient can be suffering from vestibular migraine if:
They have had migraines or an episode of migraine in the past,
They have had at least 5 episodes of Vertigo that makes them feel like they are spinning or moving. The latter two symptoms are important as this feeling has to be different from general fainting & motion sickness.
Each of these episodes last anywhere between 5 minutes to 72 hours,
The symptoms are in the range of moderate to severe. They have to be significantly affecting the patient’s daily life & their ability to perform daily tasks.
The patient has experienced one of the following symptoms in at least half of the migraine episodes: A headache that is either one-sided, pulsing, with moderate to severe intensity, & gets worse with time; sensitivity to light or sound; seeing shimmering or flashing lights in your vision, also called a migraine aura.
Your doctors are also likely to run an MRI test on your brain & hearing + balance tests to rule out any other causes of your symptoms. These other causes can include Meniere’s Disease, which can be easily ruled out with a hearing test, &/or brainstem stroke, which requires immediate attention.
Treatment for Vestibular Migraine:
There are no specific medications for vestibular migraines. The treatment for Vestibular Migraine focuses on abortive therapy instead of a reductive one. The various medications that are used in the treatment for Vestibular Migraine are:
Triptans, which should be taken at the first occurrence of a headache,
Vestibular suppressants, which work on the balance centre inside the inner ear & reduces dizziness along with motion sensitivity. Medicines under this category include benzodiazepines like lorazepam (Ativan), anti-nausea drugs like promethazine and antihistamines like meclizine.
For severe migraine headaches, your doctor might recommend drugs that are similar to traditional migraine preventive medicines. You need to take these regularly to reduce the frequency & severity of vestibular migraine attacks. Seizure medicines, blood pressure medicines ( including beta blockers & calcium channel blockers), & antidepressants. There is also another class of preventive medicines called CGRP inhibitors that your doctor might recommend in case any other medications don’t work.
Additionally, certain medications might also be used as part of your treatment for vestibular migraine to provide you with a little relief from your symptoms. These include:
Antiseizure drugs like gabapentin (Gralise, Horizant, Neurontin), topiramate (Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR), or valproate (Depakote, Depakene, Stavzor).
Blood pressure medicines
beta-blockers - atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Hemangeol, Inderal LA, Inderal XL, and InnoPran XL)
calcium channel blockers; verapamil (Isoptin)
Tricyclic antidepressants - amitriptyline, nortriptyline (Aventyl, Pamelor)
SSRIs - citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra), paroxetine (Paxil, Pexeva), and sertraline (Zoloft)
SNRIs - duloxetine (Cymbalta, Irenka) and venlafaxine (Effexor)
Certain diet changes like reducing the intake of chocolate, cheese, alcohol, and foods with the preservative MSG, & avoiding common vestibular migraine triggers can also help in treatment for Vestibular Migraine.
To read more about Vestibular Migraine, its diagnosis, treatment options, & management therapies, click here.
It is characterized by sudden spinning sensations, where the patient feels as if the world around them is spinning or moving even if they are perfectly still.
Patients often feel disoriented, off-balance, nauseous, & also experience symptoms of motion sickness when suffering from BPPV.
BPPV affects about 80% of all Vertigo patients, & is also quite easy to treat once diagnosed properly.
BPPV Causes:
BPPV causes range across a variety of medical conditions. Usually, BPPV is caused by inner ear infections & problems that make it difficult for the vestibular system to send & receive balance-related signals from the brain.
The body’s vestibular system is made up of the eyes, the ears, & the brain. These three have to work in absolute harmony for the body to be properly balanced at any given time.
When the patient experiences an inner ear infection, it can give rise to BPPV symptoms.
The various inner ear conditions that can cause BPPV include:
The displacement of calcium crystals: The primary cause of BPPV is tiny calcium crystals in the middle ear getting accidentally dislodged in the semicircular canal of the inner ear, & causing problems with the detection of proper balance signals by the brain.
These calcium crystals, also called canaliths, are sensitive to motion, & help the brain detect the body’s position in space according to various motion stimulants.
When they get dislodged from their original position & get deposited inside the semicircular canal, they cause confusion between the body’s actual position & the motion stimulants perceived by the brain due to the misplaced crystals.
This confusion is what causes dizziness, nausea, & motion sickness in BPPV patients.
How it is treated:
BPPV treatment for BPPV caused by misplaced calcium crystals in the inner ear include:
Canalith Repositioning Maneuvers: Canalith repositioning maneuvers are exercises designed to help replace the misplaced calcium crystals inside the semicircular canal.
These exercises include the well-known Epley Maneuver, the Brandt-Daroff maneuver, the Semont-maneuver, & other assorted exercises.
These exercises can either be performed at home by yourself, or under the supervision of a doctor or a licensed practitioner.
They consist of easy maneuvers designed to help facilitate the movement of calcium crystals from the semicircular canal to their original location.
1. Brandt-Daroff Exercises
Brandt-Daroff exercises utilise gravity to help dislodge crystals from the semicircular canal so that they no longer pose a problem in maintaining the body’s balance.
This exercise can be performed at home in a few simple steps as given below:
Sit in the bed with your feet on the floor, then turn your head 45 degrees in the right direction.
Without changing the direction of your head, lie down on your left side on the bed. Maintain this position for about 30 seconds.
Slowly return to the starting position, & take a 30-second pause.
Now, turn your head 45 degrees in the left side, & repeat the previous steps in the right direction.
Return to the starting position & pause for 30 seconds.
Repeat this set of procedures for about five times in a single sitting.
2. Epley Maneuver
The Epley Maneuver is another popular & commonly recommended exercise for Vertigo. Most patients with Vertigo get relief from their symptoms with the Epley Maneuver.
Although the original Epley Maneuver can only be performed with the help of at least two other people, the modified Epley Maneuver can be easily performed by yourself at home.
Below is the procedure for performing the Epley Maneuver at home if you have left-ear BPPV. In case of right ear BPPV, just perform the steps in the opposite direction.
Sit on the bed in an upright position, while placing your legs straight ahead in front of you with a pillow behind you.
Next, turn your head 45 degrees to the left.
Lie on your back quickly until your shoulders are on the bed. Hold this position for 30 seconds.
Next, turn your head 90 degrees to the left without lifting it up. Hold this position for 30 seconds.
Now, turn your body & head another 90 degrees to the right & hold for 30 seconds.
Next, sit upright on the right edge of the bed.
3. Semont Maneuver
The Semont Maneuver, also known as the liberatory manoeuvre, is another exercise for Vertigo recommended for BPPV treatment. It takes less time to perform than the Brandt-Daroff exercise; however, these should best be done in the presence of a healthcare provider.
For the below set of exercises, we’ll assume that you have left-ear BPPV.
Sit on the edge of your bed in an upright position & turn your head 45 degrees to the right.
Quickly drop to your left until your head is on the bed, & hold this position for 30 seconds.
Next, quickly move your body to the right side in a single movement without changing the position of your head.
Hold this position for 30 seconds, then slowly return to the starting position.
Surgical Alternatives:
In some cases, where no other BPPV treatment options seem to be working for the patient, your doctor may recommend the canal plugging surgery to you.
This surgery involves using a bone plug to block the portion of the inner ear that is causing the problems.
This surgery is often the last resort for patients for whom no other BPPV treatment options seem to be working.
The success rate for canal plugging surgery is about 90%, & it is a safe, long-lasting alternative for desperate situations of BPPV.
Looking for effective resolution of your Vertigo symptoms & adequate Vertigo management options? Visit www.vertigoandearclinic.com for more information about Vertigo, its symptoms, vertigo treatment options, & management process.
Migraine headaches are a fairly common condition among many people today. General migraines are characterized by moderate to severe headaches, which are pounding & throbbing in nature.
Vestibular Migraines, on the other hand, are characterized by
migraine headaches along with vestibular symptoms such as nausea, vomiting,
disorientation, & dizziness.
Some of the most common Vestibular Migraine symptoms are:
●
Severe, throbbing headache that is usually
concentrated to one side,
●
Nausea & Vomiting
●
Sensitivity towards light, smell, & sounds.
Other Vestibular Migraine symptoms:
●
Vertigo, that usually lasts for a few minutes
to hours, & in certain cases, can also last for a few days,
●
Unsteadiness, disorientation, & loss of
balance,
●
Sensitivity towards motion & motion stimuli
Certain subjective hearing symptoms, such as ringing, fullness,
& pressure in one or both ears are also common, although if you suffer from
significant hearing loss, you should go for a diagnosis of Meniere’s Disease.
Vestibular Migraines often cause a person to experience a range of
vestibular symptoms such as visual aura, or sensitivity to visual stimulation
& motion at the same, or different times. These symptoms can also occur
with headaches, or without.
Vestibular Migraine causes:
Most cases of Vestibular Migraine are hereditary. That said, women
are also more likely to suffer from Vestibular Migraine. For women, Vestibular
Migraine symptoms also tend to worsen at the time of menstruation.
Additionally, people with Vestibular Migraine experience the
following disturbances after their migraine episodes; altered sleep patterns,
MSG, disturbances in menstrual cycles, etc.
Vestibular Migraine Diagnosis:
Since a vast majority of people with Vestibular Migraine do not
experience vestibular symptoms along with migraine headaches, it can become
difficult for doctors to diagnose them with Vestibular Migraine.
The symptoms of Vestibular Migraine can also present as other
illnesses such as:
●
Benign Paroxysmal Positional Vertigo(BPPV)
●
Meniere’s Disease
●
Transient Ischemic attack, also known as a
‘mini-stroke’
It is also quite a common occurrence for these three disorders to
exist together, thus making the diagnosis even more difficult.
Vestibular Migraine treatment:
Vestibular Migraine treatment is similar to that of general
Migraines. It includes minimizing the usage of meclizine or any other medicines
that suppress the vestibular system, using them only during an active episode.
In case the patient is experiencing recurrent, frequent attacks,
your doctor may prescribe certain medications like:
●
Beta-blockers,
●
Calcium channel blockers,
●
Tricyclic antidepressants
●
Serotonin or norepinephrine reuptake
inhibitors(SSRIs or SNRIs)
●
Topiramate
Along with these medicines, patients suffering from vestibular
migraines are also advised to maintain a regular sleep & meal schedule, get
proper sleep of 8 hours everyday, reduce their intake of alcohol &
caffeine, & avoid known migraine
triggers.
Vestibular Migraine patients are also advised to engage in
activities that reduce stress, & avoid situations that can trigger an
involuntary neurological response, such as harsh lighting, loud, shrill sounds,
& engaging in activities that produce an adrenaline rush.
To know more about Vestibular Migraine & how the condition
affects a person’s everyday life, along with more about its diagnosis, new
treatment breakthroughs, & management options, visit Dr. Anita Bhandari’s
Vertigo And Ear Clinic, here.
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