, Gloucester, MA

April 5, 2013

On the Mend: When you're in a state called vertigo

On the Mend
Joe DiVincenzo

---- — To put it lightly, an acute attack of dizziness can leave you feeling quite unnerved.

Benign paroxysmal positional vertigo (BPPV) affects millions of Americans every year and is the chief reason persons over the age of 50 consult a physician for dizziness.

Fast onset episodes of vertigo can be just as frightening as they are disabling. If you’ve ever had one you probably understand why entire medical and physical therapy sub-specialties are dedicated exclusively to the treatment of vertigo.

BPPV is hallmarked by lightheadedness, imbalance, dizziness and occasionally feelings of nausea (typically without vomiting). Although it can range in severity between individuals and between episodes in the same person, most cases seem to have a baseline for intensity and duration of symptoms.

Diagnosing BPPV is a collaborative team effort between medical and physical therapy clinicians. A complex battery of physical tests are performed to elicit symptoms and establish a treatment regimen, so don’t be surprised if you lose your sea-legs after an appointment.

Fortunately, though, as its name suggests, the condition is benign in nature. Most cases of vertigo are fleeting and rarely cause prolonged incapacitation.

Dizziness, nausea and balance issues are not issues to be fooled with, however. Occasionally they’re indicators that a serious pathology is at work. So if these signs and symptoms are new to you, you’ll need to know the following information:

BPPV worsens with certain head and neck movements — not by poor dieting, restless sleep or prolonged exposure to light. The theoretical foundation for BPPV is based in the physical dislodging of small crystals that live in the ear canals. The previously noted triggers are associated with migraine-type dizziness and not with mal-positioned crystals.

BPPV classically does not respond to anti-nausea medication prescribed by a physician. Because BPPV is characterized as a physical problem within the canals of your inner ear, it’s likely that no medication will alleviate your symptoms effectively.

Skilled physical therapy should work — every time. Through careful assessment, a treatment protocol is established and aimed at finding the optimal series of head and neck movements to reduce symptoms. Persistent symptoms should be further investigated by brain CT or MR imaging.

You need to know F.A.S.T – it stands for face, arms, speech and time or telephone. The first three are the body parts primarily affected during a stroke. Your face might droop, it’s practically impossible to hold your arms at an even keel and your speech may sound slurred or irregular to another person. Time is of the essence — and so is the telephone – call 911 immediately.

BPPV primarily affects people over the age of 50, but there are cases of vertigo appearing in younger individuals. It should not occur in people younger than 25, so if you’re dealing with a school or college-aged “child,” a speedy workup is in order.

Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted by email to