Vertigo is a common symptom presenting in chiropractic patients, especially after head and neck trauma. Vertigo and dizziness can be a very disabling complaint.

It is a sense of dizziness or spinning, sometimes associated with symptoms such as nausea, vomiting and sweating.

It can have many causes and in most cases it is a treatable condition. The treatment used obviously depends on the cause. That is why the chiropractor has to do a thorough examination when you first come in for treatment.

In some cases you may have to be referred to a neurologist for further assessments. But the good news is that the most common causes respond well to conservative care.

One of the most common causes of vertigo and dizziness is Benign Paroxysmal Positional Vertigo (BPPV), also called Benign Vertigo or Positional Vertigo.

Generally about 20% of all cases of dizziness are due to BPPV and about 50% of all dizziness in older patients is due to BPPV. Other common causes include acute vestibular neuronitis or labyrinthitis.

There are other, more serious, causes of vertigo such as stroke, tumours and neurological diseases such as MS. With these conditions there are other symptoms present as well and they are normally picked up in the chiropractic and neurological examination.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a common condition that frequently goes undiagnosed and is treated symptomatically with drugs, such as Stemetil and Compazine (prochlorperazine), a sedative, which can make you feel very tired (If you take this drug you should not operate machinery or drive), and it can have many other side-effects.

A firm diagnosis and the right treatment can help you get rid of this disabling condition, and quickly.

BPPV is an inner ear condition that causes brief severe episodes of vertigo feeling like the room is spinning. Whilst it can occur in children, the older you are, the more likely it is that your dizziness is due to BPPV. About 50% of all dizziness in older patients is due to BPPV.

What does the name Benign Paroxysmal Positional Vertigo (BPPV) mean?

• Benign – a non-progressive condition
• Paroxysmal – sudden and unpredictable in onset
• Positional – episodes are caused by a change in head position
• Vertigo - a sense of dizziness or spinning

The inner ear contains fluid that allows the brain to sense movement and maintain balance. The cause of BPPV is a dis-lodgement of small calcium carbonate crystals, known as otoconia, that then float in the inner ear fluid. These crystals strike against the sensitive nerve endings and cause the symptoms of BPPV.

What are the causes of BPPV?

This inner ear condition often begins after:

• A head injury
• A severe cold or virus
• Due to ageing process
• Minor strokes
• Use of ototoxic medications e.g. gentamicin

The most common cause in the under 50’s is head trauma and whiplash.

In older people, the most common cause is degeneration of the vestibular system of the inner ear and BPPV becomes much more common with advancing age.

In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason.

What are the symptoms of BPPV?

Symptoms can include the following:

• Severe but brief episodes of dizziness,
• without hearing loss or ringing in the ears,
• feeling light-headed,
• and a feeling of imbalance and nausea.

The symptoms usually start suddenly and often when waking from sleep. Episodes are triggered by changes in the position of the head e.g. getting out of bed or turning over in bed, tipping your head back to look up and certain Yoga or Pilates positions such as the ‘down dog’.

Diagnosis of BPPV

Chiropractors are able to diagnosis this condition after taking a full case history and performing a physical and neurological examination. Specific tests, such as the Dix-Hallpike manoeuvre / test, are used to differentiate peripheral from central vertigo.

Treatment of BPPV

The condition is treated by certain repositioning manoeuvres such as the Epley or Semont Manoeuvre, which is a simple and well-tolerated technique that will help BPPV in the majority of patients.

The chiropractor will move you into specific positions depending on what has previously been found in the assessment, using gravity to move the calcium carbonate crystals away into an area of the inner ear where they will, hopefully, cause no further symptoms.

This is followed by home exercises, so called Vestibular rehabilitation exercises.

The treatment is very effective and within 3-4 treatments 80% are symptom free. The symptoms can recur and research shows a relatively low recurrence rate of about 15 percent per year.

Chiropractic treatment might not be the first thing you think of if you have dizziness, but the manoeuvres and treatment used is the same as you would have if you go to medical clinicians who specialize in these conditions.

Chiropractic is not suited for all types of dizziness, but if we can’t help you we will refer you back to your medical physician for further testing and a possible referral to a neurologist.

If you have any of the above symptoms and want further information, please call us.

Don’t rely on symptomatic relief. Taking tablets for this condition is not always the answer.