Vertigo is the sudden sensation that you’re spinning in the room.  While there are several causes, the most common is benign paroxysmal positional vertigo (BPPV). BPPV causes brief episodes of mild to intense dizziness that can come and go and commonly last less than a minute. It is usually triggered by specific changes in your head’s position. This might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in bed.

Besides a sense that you or your surroundings are spinning or moving (vertigo), BPPV can also cause loss of balance or unsteadiness, nausea, and/or vomiting.

Often, there’s no known cause for BPPV.  When there is a known cause, BPPV is often associated with a minor to a severe blow to your head.  Less common causes of BPPV include disorders that damage your inner ear or, rarely, the damage that occurs during ear surgery or long periods positioned on your back, such as in a dentist chair. BPPV also has been associated with migraines.

So, what happens?  A crystal that’s usually firmly attached inside your inner ear can get dislodged, and while floating around, move the fine hairlike sensors that tell your brain where your head is in space.  Your brain is told that you are moving, even though you aren’t.

Luckily, there is an exercise that helps to move that crystal to a place in your ear that doesn’t have those sensors.  It’s fairly easy [though can be disturbing to do, since you deliberately put yourself into positions that cause vertigo], and IF this is the cause of your dizziness, very effective.

Many of my patients choose to come in and let me guide them through the exercise, called Epley’s maneuver.

Here are the steps:

• First, you have to decide if the problem is made worse when you turn your head to the right or left. There is usually some rapid eye movement that can be observed when you move your eyes toward the side of the problem.
• Position yourself on your bed in such a way that when you lie back, your head will be off the end of the bed [or position a pillow so that your mid-back to the base of your neck will be on the pillow, and your head tilts back when you lie back] and you are close enough to the edge of the bed that you’ll be able to sit up when you are on your other side [so if your dizziness is worse when you turn your head to the left, you’ll be close to the right edge of your bed].
• Turn your head toward the side that makes you dizzy 45 degrees. Keep your head at that angle and lie back, letting your head tilt back, either off the bed or off the pillow.  The first time you do this, you’ll be very dizzy.
• You need to stay in that position for at least 30 seconds and until your dizziness resolves. If it takes longer than 30 seconds, stay in this position until you are no longer dizzy.
• Keep your head tilted back and turn your head to the opposite side, 90 degrees. Again, you’ll be very dizzy.  You need to stay in that position at least 30 seconds and until your dizziness resolves.  If it takes longer than 30 seconds, stay in this position until you are no longer dizzy.
• Keep your head in that position in relation to your shoulder and turn onto your side, so that you are looking toward the floor while your head is still tilted. If you used a pillow, you’ll kick the pillow out behind your back.  Again, you’ll be very dizzy.  You need to stay in that position for at least 30 seconds and until your dizziness resolves.  If it takes longer than 30 seconds, stay in this position until you are no longer dizzy.
• From that side-lying position, put your feet off the side of the bed, push off with your arms, and sit up. You should be less dizzy, though probably not totally so.

Repeat the exercise until you either can’t stand it any more of the dizziness is totally gone.  In our office, we seldom ask you to do the exercise more than three times, as it can be very uncomfortable.  You can do this exercise at home three times a day until you have had no symptoms for 24 hours.

NOTE:  Once you’ve had this, you are likely to get it again.  Putting off treatment just means more days of misery.  I have patients who are prone to this problem, who do the exercise once a week routinely so that they never have to deal with dizziness again.  Others wait until the vertigo returns and do the exercise enough to resolve the current issue.