Ugh. Vertigo.

I am unfortunately inspired by recent events to write about Benign Positional Vertigo.  May you never suffer it but, if you do, here are some very important things to know.  First, you are not dying.  For the rest, read on.

Ugh. Vertigo. Or more accurately, Benign Positional Vertigo – BPV. I would not wish it on my worst enemy. Well, come to think of it, maybe I would. Can you imagine an entire army suddenly overcome with the inability to walk a straight line, falling over left and right, and vomiting if they do anything but stay completely still? Maybe that would be a good tactic to use against your enemy. There you go, US government, a nonlethal defense tactic, offered up by yours truly. Now, all you have to do is figure out a way to induce vertigo.   This may prove difficult, though, as we still don’t know what causes it. There are lots of theories… head trauma, change of altitude, fluid in the inner ear, etc. Get to work and good luck!

I remember my first bout of vertigo very vividly. I rolled over in bed and looked at my clock and it was moving left and right. I tried to sit up and the whole room was spinning. It was as if I had been drinking heavily the night before, with all the repercussions but none of the fun. I tried to walk to the bathroom and fell over. I crawled on my hands and knees to the bathroom where I promptly threw up. But there was no relief after vomiting, like when you have a stomach bug and you feel better after having thrown up. Nope. The room was still spinning and I still felt like death warmed over. The strange thing about vertigo is that, other than all the spinning and the vomiting, you feel totally fine. You are suddenly completely unable to function even though the rest of your body is working well.

You can see why people end up in the emergency room with this condition. It is totally frightening. As a family doctor, I recognized this for what it was. I remembered my teaching on vertigo and was able to match my classic symptoms to that diagnosis. Your average non-medical person, though, has got to think they are dying. And when you go to the ER, especially as an elderly person, with the inability to walk and vision change and vomiting… what are you going to get? You are going to get the million dollar work up, that’s what you are going to get. After all, it could be a stroke or a hemorrhage or a brain tumor.

Luckily, there is a simple test that the doctor can do to tell if this is BPV. Though you, as someone suffering from vertigo, are not going to find it very pleasant. Basically, we lay the person back, turning their head to one side and then the other (This is called the Dix-Hallpike maneuver). In someone suffering from an acute attack of vertigo, this is going to induce the symptoms of spinning and nausea. Not so much fun. But the doctor, in being able to reproduce the symptoms with this maneuver, and in watching your eyes start to move in an atypical rotatory pattern, can diagnose BPV without a huge workup.

Thankfully, there are some pretty easy steps to take to get this to stop. The theory is that there are little cells in the inner ear (you’ll also see them referred to as “rocks” or “crystals”) that are supposed to be aligned a certain way. In BPV, these cells somehow get out of alignment. The treatment, apart from giving you a nausea medicine so you don’t continue to throw up, is to get the cells back into alignment. We do this with a type of physical therapy for your inner ear, called Vestibular Rehab. If you are someone who gets very nauseated with vertigo, you will have to get your anti-nausea medication (we commonly use Meclizine, sold over the counter as LESS DROWSY Dramamine or Bonine) on board first or else you won’t be able to do the therapy exercises. The first time this happens, we usually refer someone to a Vestibular Rehab therapist to demonstrate the maneuvers (called Epley’s Maneuvers) that can then be done at home. It is important to pay attention to what side tends to trigger the symptoms (meaning, when you turn your head to the left or to the right, which side brings your symptoms on the strongest?) as the rehab exercises are geared towards a particular side, left or right. Once you can control the nausea, and put yourself through rounds of these exercises, you will be able to stop the vertigo episode in its tracks. Afterwards, you may be left feeling a little bit off balance. We recommend that you don’t lie flat or let yourself turn to your affected side during sleep for a week after one of these episodes, so as not to allow recurrence.

As a sufferer of vertigo, I can tell you that these exercises work and you don’t have to wait for a full-blown episode to do them. Vertigo can recur so, if you start to get a sense that trouble is brewing, you can put yourself through your exercises before you even get a severe case of spinning and nausea.   My advice – keep the exercises and some meclizine in your nightstand (I even carry meclizine in my purse so it is with me at all times). You never know when one of these episodes is going to hit. Don’t suffer needlessly. These episodes, left untreated, can last many days – many days in which you are completely incapacitated. Learn the exercises and do them. Trust me. You will thank me later!


Don’t diagnose yourself! The first time this happens, a medical professional should see you for proper diagnosis. BPV presents fairly classically, but there are much more serious conditions that can present similarly so get checked out!

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