Medical Edge Newspaper Column

Managing Vertigo

September 30, 2007
Dear Mayo Clinic:
I turned on my side in bed one morning, and the room spun. That was six months ago. A specialist had me perform Epley maneuvers, and gave me some Brandt-Daroff exercises to do at home. But my balance is still off. Is there anything else I should do? Will I be like this forever?

Answer:
The condition you describe sounds like benign paroxysmal positional vertigo (BPPV). But the first thing you should do is to make sure the vertigo is not caused by some other problem. A second opinion may be in order. If you are not sure where to turn, a good source of doctors experienced in diagnosing and treating BPPV is the Vestibular Disorders Association Web site (www.vestibular.org).

The most common form of vertigo, BPPV is characterized by brief episodes of intense dizziness that occur when you change the position of your head. It's usually caused by particles or crystals that break loose and float in the fluid within the part of your inner ear that controls balance (vestibular labyrinth). In certain positions, these particles can mechanically stimulate a portion of the balance organ in the inner ear, giving your brain a false signal of movement and causing the sensation of spinning.

Treatments like the Epley maneuver and Brandt-Daroff exercises involve the use of specific, sequential movements and are appropriate for BPPV. These procedures are intended to move the particles causing the problem into an area of your inner ear where they can't stimulate the inner ear balance organ, thus eliminating the false signals it is sending to your brain.

In general, medication is not appropriate for BPPV. It's a condition that can simply go away on its own, and return, without warning. And while we never say that we have cured BPPV, because it can recur, the exercises you mention are the most effective way to manage the condition.

If the exercises have helped somewhat, but the condition continues, I recommend you see a physical therapist who is certified in and specializes in balance and dizziness. BPPV may persist for a variety of reasons, even though the maneuvers have provided some relief. You need further assessment to find out what's going on. Once that assessment has been done, it's likely you'll be able to receive more specific treatments that may help relieve the symptoms of BPPV. Even in cases where management is less effective, time and continued use of the appropriate exercises typically do bring resolution to the problem.

— Neil Shepard, Ph.D., Vestibular Laboratory, Mayo Clinic, Rochester, Minn.