Benign positional vertigo

Alternative names 
Vertigo - positional

Definition
Benign positional vertigo causes sudden sensations of spinning, typically provoked by head movement.

Causes, incidence, and risk factors

Benign positional vertigo is the most common cause of vertigo. It is caused by a disturbance within the balance organs of the inner ear. The inner ear has tiny stones that move as you change position, allowing your brain to interpret your body’s position and maintain your balance. In benign positional vertigo, these stones break off and float free within the semicircular canals of the inner ear. This may happen in one ear more than another, sending the brain confusing messages about your body’s position. The result is vertigo.

There are no major risk factors that make you more likely to get benign positional vertigo, although it may be partly hereditary. Also, a prior Head injury or an infection of the balance organs (labyrinthitis) may make some people more likely to get benign positional vertigo.

Symptoms

Vertigo, or a spinning sensation, is the main symptom. The sensation often starts suddenly and can be triggered by head movement. Most often, affected patients complain of the inability to roll in bed or to look up high at something. When severe, the vertigo is often accompanied by vomiting. Patients may also have visual complaints, such as a perception that things are jumping or moving.

Signs and tests

To make a diagnosis, the doctor will often have you perform a test called the Dix-Hallpike maneuver. In this procedure, the doctor holds your head in a certain position and asks you to lie quickly backward over a table. As you do this, the doctor will look for abnormal eye movements and ask if you experience vertigo. The doctor may use various methods to help evaluate your eye movements.

The results of the rest of the physical exam are otherwise normal. In some cases, differentiation from other causes of vertigo may be needed. In this case, tests may include:

     
  • Head CT  
  • Head MRI  
  • Caloric stimulation (tests eye reflexes)  
  • Electronystagmography  
  • EEG  
  • Evoked auditory potential studies

Treatment
The most effective treatment is a procedure called “Epley’s maneuver”, which can reposition the stones inside your inner ear. There are other exercises that can readjust your response to head movements. Occasionally, medications such as antihistamines, anticholinergics, and sedative-hypnotics may be prescribed to reduce the symptoms of vertigo, although these are often minimally effective.

Expectations (prognosis)

Benign positional vertigo is uncomfortable, but it is not medically dangerous, and usually improves with time. This condition may re-occur unpredictably.

Complications
Patients with severe vertigo may get dehydrated due to frequent vomiting.

Calling your health care provider
Call your health care provider if vertigo develops that has not been evaluated or if treatment is ineffective. Also call if you develop any associated symptoms (such as weakness, slurred speach, visual problems) that may indicate a more serious condition.

Prevention
Avoid head positions that trigger positional vertigo.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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