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I Suffer From Vertigo BPPV

Benign Paroxysmal Positional Vertigo Treatment (BPPV)

Amongst patients who present with vestibular conditions or vertigo symptoms, 17-42% of them will be diagnosed with Benign Paroxysmal Positional Vertigo (BPPV).  BPPV is easily diagnosed after a history of your symptoms is recorded and is confirmed with physical examination, it will rarely require any further investigation.

BPPV is a common disorder affecting the otolith organs inside your inner ear. These otolith organs are essentially the inner ear balance system, designed to detect the gravitational and acceleration forces in our head during movement so that we can adjust and stay upright.  BPPV occurs when these organs become impaired. They will detect head movements that are normally fine, and react by causing symptoms of vertigo. This lower threshold for quite severe symptoms of vertigo can be quite debilitating for BPPV sufferers.

Our modern, world-leading techniques are safe, gentle, medication-free and non-invasive, and we expect to see positive results within the first 6 sessions, as we do with 85-90% of our patients. Ready to experience the benefits? Take action today and schedule your initial session for a brighter, pain-free future.

Understanding Your Symptoms

What are the common symptoms of Vertigo BPPV?

Amongst patients who seek treatment for vertigo symptoms, 17-42% of them will be diagnosed with BPPV, as will between 11-64/100,000 people in Sydney each year. Benign Positional Paroxysmal Vertigo is easily diagnosed after your medical history is collected and is confirmed with physical tests, ruling out any conditions with similar or overlapping symptoms such as Meniere’s Disease or cervicogenic dizziness. The main BPPV symptoms that our patients experience are:

  • Vertigo
  • Dizziness
  • Light headedness
  • Struggling to control balance
  • Nausea
  • Vomiting
  • Nystagmus (rapid, unidirectional involuntary eye movements, unnoticed by the patient)

 

Scans are most often not required in BPPV diagnosis. These physical tests will assess the balance organs in your inner ear, which are known to be the cause of BPPV.

Chronic Daily Headache - Sydney Headache & Migraine Clinic

Understanding Your Headache

What causes Vertigo BPPV?

Common Causes

Some common known causes of Benign Paroxysmal Positional Vertigo (BPPV) include head injury, complications following ear surgery, age-related deterioration of the vestibular system, and general inner ear issues such as severe inner ear infections, an inner ear disorder or inner ear disease like vestibular neuritis. These conditions can displace calcium carbonate crystals inside the inner ear canals resulting in episodes of vertigo. BPPV manifests in various forms depending on the affected semicircular canal: anterior canal BPPV is induced by tilting the head forward, while posterior canal BPPV is elicited by movements that alter head position, such as rolling over in bed with the head turned towards the side of the affected ear. Recognising the triggers of vertigo episodes, their underlying causes, and specific types is essential for precise diagnosis and management of BPPV.

BPPV Theory

There are two main theories about the cause of BPPV. These theories both speak about abnormal detections which trigger vertigo symptoms, regarding changes in the endolymph that flows in the semicircular canals of the otolith organs. These two theories are as follows:

The ‘Cupulolithiasis Model’

This model suggests that loose matter in the endolymph becomes stuck in the cupula, or the sensory organs that are located in the otolith. 

The ‘Canalithiasis Model’

This theory suggests that the cupula detects free-flowing particles in the endolymph.

There are two physical tests that can be used to accurately diagnose BPPV and determine which is the affected canal. The Dix-Hallpike Test can be used to detect dysfunction in the posterior semicircular canal of the otolith, while the supine roll test can be used to assess the horizontal canal. In positive tests; the patient will experience their symptoms of vertigo, and the therapist will observe for signs of nystagmus, or rapid beating of the pupils. In the rare case that the superior semicircular canal is affected, the Dix -Hallpike test would be positive and the therapist will observe nystagmus.

About The Assessment Stage

What To Expect During The Assessment


1. Comprehensive and in-depth examination

We instigate an in-depth assessment to identify all possible related factors that could be causing your headaches or migraines. The upper cervical spine, in particular, is thoroughly examined to identify possible issues.



2. Ligamental stability and vertebral arterial tests

We undertake careful examination of neck ligaments and vertebral arteries, ensuring only the highest standards of patient safety and comfort.


3. Temporarily reproduce your headache and migraine symptoms

As a part of the treatment process, we apply gentle and selective stress to the upper cervical spine in order to reproduce headache symptoms, which subside after 20-30 seconds. This helps to identify and treat the cause of your headaches.

More about Vertigo BPPV

Living with Vertigo BPPV

A lot of the patients that we see will experience all of the symptoms of BPPV, but the results of their physical tests are unclear, or treatment isn’t as effective as expected. In these cases, it is likely that increased sensitivity in their brainstem is the true cause of their symptoms. The vestibular nerve will send ‘normal’ information to this hyper-sensitive brainstem that is interpreted as a threat, causing the patient to experience vertigo.

Chronic Tension Type Headache

Chronic tension type headache is classified as headache pain being bilaterally on both sides of the head, where pain is usually symmetrical and equal from left to right. Compared to migraines, chronic tension type headache causes mild to moderate pain, and feels more of a tightening and pressing sensation rather than a pulsating pain.

Hemicrania Continua

Hemicrania continua is usually a more severe headache that typically affects one side of the head. The headache does not shift from side to side, and is usually locked on one side unilaterally. This headache is present all the time with no pain free periods. Pain is usually a moderate pain in nature, however tends to have severe spikes of pain throughout the day.

People who suffer from this headache may also experience autonomic features such as a watery eye, swollen or droopy eye-lid, redness in the eye, block or runny nose. Migraine-like symptoms can also occur such as sensitivity to light, sound or smell, nausea and vomiting.

I’ve tried it all, is there anything else that can help my BPPV?

BPPV Treatment Sydney

The gold standard physical therapy treatment for the most common type of BPPV, posterior canal, is the Epley Manoeuvre. This benign paroxysmal positional vertigo treatment technique involves manoeuvring the patient into a series of different head positions, placing shifting matter and endolymph through the semicircular canals. This manoeuvre is commonly taught to patients to be performed regularly at home.

The patients that we see at Sydney Headache & Migraine Clinic have often had mixed results with the Epley Manoeuvre, have tried various BPPV vertigo treatment options and  medications (such as motion sickness medications), some have even tried surgical intervention. They sometimes have mild results, but it is often short-lived, finding that their BPPV symptoms persist. This is because they often haven’t been thoroughly assessed to determine if a sensitised brainstem is the true cause of their symptoms. 

If we assess you and can determine that, yes, the brainstem and upper cervical spine are the true cause of your BPPV then we can start a treatment plan right away with a tailored solution to your BPPV, including manual therapies, vestibular rehabilitation techniques and much more.

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