This simple manoeuvre to treat vertigo can be surprisingly effective

by Ruth Nichol / 13 April, 2018
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Most people with benign paroxysmal positional vertigo are completely cured after one – or occasionally two – treatments with the Epley manoeuvre.

Jenny Whatman’s first episode of benign paroxysmal positional vertigo (BPPV) began – as it does for many people – when she rolled over in bed.

“Suddenly,” she remembers, “the whole room felt as if it had turned upside down and was swirling around.”

Any movement of her head brought on massive dizziness and terrible nausea, and although they lasted for only a minute or so, she was unable to go to work for several days. “I couldn’t sit at my computer, as any tiny movement set it off.”

She visited her GP, who assured her she didn’t have anything serious, such as a brain tumour. Instead, her symptoms were caused by tiny particles of calcium carbonate that had broken loose and fallen into the wrong part of her inner ear, stimulating the nerves that detect head rotation. Even small movements – such as looking up – sent a message to her brain that her head was spinning.

Her doctor performed what she calls a “ghastly manoeuvre thing” to try to reposition the particles and gave her some exercises to do at home. Her symptoms gradually disappeared – until they came back.

Rather inconveniently, Whatman’s next episode of BPPV happened during a tramping trip. “I did exactly the same thing – I turned over in bed and the little hut we were in started to whirl around.”

The nausea and dizziness weren’t quite as bad this time, so she was able to walk out on her own, but her pack had to be carried out by helicopter. Now retired, she’s been symptom-free for several years – but she tries not to jerk her head, just in case.

BPPV is one of the most common forms of vertigo, the name given to a sensation that either you or your surroundings are wildly moving or spinning. About one person in 40 will experience BPPV at some time in their life, and the incidence is much higher in older people, possibly because the degenerative process makes it more likely that calcium carbonate particles will break away. BPPV can affect one or both ears.

Melanie Collins.

In most cases, it happens spontaneously. “People just wake up one day or roll over in bed and there it is,” says Auckland ear, nose and throat (ENT) specialist Melanie Collins.

However, it can be caused by head injuries, migraine and prolonged periods of bed rest. About 15% of people who have the inner-ear disorder Ménière’s disease will also develop BPPV.

The good news is that it is easy to diagnose and – with care from trained professionals – easy to treat. “If you’re going to have vertigo, it’s the best one to have,” says Collins.

BPPV is diagnosed using the Dix-Hallpike test. The patient lies on their back with their head hanging off the end of the examination table and the doctor rotates their head about 45 degrees to see if they develop nystagmus – jumping of the eyes. If that happens, they have BPPV.

Treatment involves a series of head movements called the Epley manoeuvre to reposition the calcium carbonate particles. Collins says the manoeuvre isn’t complicated, but it must be done properly.

“There’s nothing magical about it, but you do need to do it in a very specific way for it to work. You have to be trained and also be doing it regularly enough that you’re familiar with what you need to do.”

She says not all GPs can perform the manoeuvre, and if that’s the case, they should refer patients to someone who can. This includes ENT specialists and some physiotherapists.

Most people are completely cured after one – or occasionally two – treatments with the Epley manoeuvre. They may also need to carry out similar movements at home, called Brandt-Daroff exercises, to get rid of their symptoms altogether. In cases where there are other factors involved, such as Ménière’s disease or migraine, the treatment may be only partially successful.

“It’s not always completely straightforward and in some cases they have to see a specialist, who will take a very careful history and check out the nuances to work out what’s going on,” says Collins.

Most people will have only one episode of BPPV. Others, such as Whatman, get it back again and need more treatment – but even then they’re likely to have a good response.

“It’s a rewarding thing to diagnose, because it’s treatable and resolvable.”

This article was first published in the March 24, 2018 issue of the New Zealand Listener.

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