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How Do You Treat Positional Vertigo?

Q. Please explain positional vertigo. Two of my siblings have woken up in the morning with it. What do you do if you experience it?

A. Positional vertigo is a common type of dizziness that can be treated with a simple maneuver.

Vertigo is an illusory sensation of motion that is often accompanied by intense nausea.

Benign paroxysmal positional vertigo, or B.P.P.V., is the medical term for positional vertigo. It is important to use this term, as there are other types of vertigo with different causes and treatments.

B.P.P.V. is caused by microscopic “stones” that are present on the ends of hair cells in the ear canal and that help you maintain your balance. Vertigo occurs when these stones break off and move from the body of the inner ear into its semicircular canals, which determine our perception of three-dimensional space. This usually occurs as a result of aging or head trauma.

Free-floating stones cause the inner ear to give faulty information to the brain about our position in space, creating a false sensation of motion.

The mechanism of B.P.P.V. was discovered almost a century ago by the Viennese physician Dr. Robert Bárány, who won a Nobel Prize for his work. In 1979, Dr. John Epley, an ear, nose and throat specialist in Portland, Ore., found that a simple maneuver could treat most cases of B.P.P.V. without the need for drugs or surgery.

The Epley maneuver is a series of rapid changes in position of the head that are performed in a doctor’s office. The maneuver repositions stones so they do not cause symptoms. Incidentally, B.P.P.V. has been reported to be cured in some people after they have ridden on roller coasters.

The Epley maneuver is surprisingly effective. It has proved to be beneficial in several randomized controlled trials. And some patients can be trained to perform the maneuver at home.

In straightforward cases of B.P.P.V., the American Academy of Otolaryngology — Head and Neck Surgery recommends against advanced imaging tests, such as M.R.I. and CT scans, as they are unnecessary. The group also recommends against the routine use of medications, as they have side effects and can interfere with testing.

Because other conditions can mimic the symptoms of B.P.P.V., such as inner ear infections, migraine, multiple sclerosis and stroke, diagnosis by a doctor is essential. Once diagnosed, however, B.P.P.V. is one of a select group of medical conditions for which a simple nondrug, nonsurgical technique can offer relief.

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