Positional vertigo: causes, symptoms & what to do?

Positional vertigo: causes, symptoms & what to do?

Fast movements of the head lead to dizziness. This can be a sign of something called benign positional vertigo. This form of dizziness is due to a disturbance in the vestibular system. Specific exercises and so-called positioning manoeuvres are part of the treatment. In the following, you will find out everything you need to know about positional vertigo, for example, how it occurs, what causes it can have, whether there is also malignant positional vertigo and whether medication is required for treatment. We also present one of the exercises that can be used to treat the symptoms.

What is positional vertigo?

Dizziness (vertigo) is a symptom that can have various causes. It describes a feeling where the environment is perceived as swaying or spinning. A unique form of vertigo is positional vertigo, also known in technical jargon as benign paroxysmal positional vertigo (BPL).

If those affected quickly change the position of their head, they will feel dizzy a few seconds later. This happens, for example, when tilted to the side or backwards, bending forward and bending over, turning or getting up from a lying position.

Benign (benign) paroxysmal (seizure-like) positional vertigo is the most common form. Older people, in particular, suffer from it.


Does malignant positional vertigo exist?

Positional vertigo is generally harmless and is always described as benign. From a medical point of view, malignant positional vertigo does not exist. However, it is sometimes called malignant positional vertigo when the dizziness is perceived as very stressful, both professionally and privately. For example, in the long term, it can lead to stress and inability to work, impair driving or increase the risk of falls.

Symptoms: How do I know if I have positional vertigo?

Benign positional vertigo is accompanied by dizziness, known as rotary vertigo. This means those affected have the impression that everything revolves around them, similar to a carousel ride. Dizziness occurs within a minute of changing head position and usually does not last long. After a few seconds or minutes, the dizzy spell will go away on its own.

At the same time as the vertigo attack, nausea and vomiting, as well as sweating and feelings of anxiety, can also occur in positional vertigo.

Uncontrolled trembling of the eyes, known as nystagmus, is also familiar. The nystagmus usually lasts 10 to 20 seconds but never lasts more than a minute.


Benign paroxysmal positional vertigo: causes

Loose deposits cause benign paroxysmal positional vertigo in the inner ear’s semicircular canals, one of the organs of balance.

The inner ear is a duct system that is filled with fluid. Tiny sensory hairs in the semicircular canals are bent when moved by the liquid and thus perceive the position of the head. If there are loose deposits in the inner ear in the form of tiny stones (ear stones, also otoliths or otoconia), these can trickle into the semicircular canals when you move your head. This stimulates the sensory cells located there. Perception and balance are disturbed, and false information is sent to the brain. The result is a dizzy spell.

Otoliths can be found on the right, left, or bilateral ears. It depends on which ear triggers the positional vertigo or whether it is both ears.

The dizziness often occurs increasingly with age, usually due to ageing processes in the vestibular system. But dizziness attacks can also occur more often with migraines, after falls or as a result of craniocerebral trauma. Being bedridden for a long time, for example, as a result of an illness, is also one of the possible triggers.

Diagnosis of positional vertigo

Benign paroxysmal positional vertigo is relatively easy to diagnose. However, it is often not recognized correctly because there are many different types of dizziness and causes for the symptoms of dizziness, which can sometimes be similar.

If you experience dizziness symptoms, it is always advisable to consult a general practitioner or an ear, nose and throat (ENT) practice. To describe the dizziness symptoms, those affected should be able to answer the following questions:

  • When does dizziness appear?
  • How long does a dizzy spell last?
  • How common is dizziness?
  • How does the dizziness feel?

Often, the doctor treating you can express a corresponding suspicion based on the description of typical symptoms and situations. In addition, the following examinations may be necessary:

  • Ohrmicroscopy
  • Testing for nystagmus (eye trembling)
  • Functional tests of the vestibular system

To test the functions of the vestibular system, the affected person’s head is placed in certain positions intended to cause a dizzy spell (positioning test). These so-called diagnostic manoeuvres include:

  • Dix-Hallpike manoeuvre
  • Hallpike-Stenger-Maneuver

If such a manoeuvre causes dizziness, one can assume it is positional vertigo.

Self-test for diagnosis

If positional vertigo is suspected, the test manoeuvres mentioned above can also be carried out yourself to be able to assess the symptoms better. However, a medical examination must be carried out for a reliable diagnosis.

This is how the Hallpike-Stenger manoeuvre works:

  1. Sit upright with your legs straight on a high edge of the bed, recliner or sofa.
  2. Turn your head 45 degrees to the right or left.
  3. Let yourself sink backwards carefully but quickly, maintaining your head position so the cervical spine is hyperextended.
  4. If there is positional vertigo, a feeling of dizziness occurs. The eyes can also tremble uncontrollably.
  5. Dizziness occurs only when the head is turned to the side where the balance organ is affected. It makes sense to repeat the test on the other side.

This is how the Dix-Hallpike manoeuvre works:

  1. First, find someone to supervise and assist you with this manoeuvre.
  2. Sit upright on a high edge of the bed or chaise longue, directly across from your helper.
  3. Rotate your head 45 degrees to the right or left.
  4. Gently but quickly lower yourself to the other side. If you turn your head to the left, tilt your upper body to the right. The head should protrude over the mattress or lounger so that the head hangs sideways.
  5. If there is positional vertigo, you will feel dizzy. Uncontrolled eye movements can also occur.
  6. The dizziness should subside after a few seconds or minutes, and you should sit up again.


Treatment of positional vertigo: exercises

The therapy for positional vertigo consists primarily of special physiotherapeutic exercises while sitting or lying down, the so-called liberation manoeuvres. With these exercises, the loose otoliths are removed from the semicircular canals and returned to their original location. The exercises usually only have to be performed a few times and have a success rate of almost 100 per cent. Drugs are not usually needed to treat dizziness.

The most crucial liberation manoeuvres are the positioning manoeuvres after the following:

  • Epley
  • Semont
  • Barbeque

The manoeuvres are learned in physiotherapy if it is a medically diagnosed positional vertigo. The exercises can also be carried out independently at home according to instructions.

Even without treatment, in most cases, the dizziness goes away independently after a few weeks to months. Appropriate therapy can, however, accelerate healing considerably.

Example exercise: Positioning exercise according to Sémont

The manoeuvres are best learned under expert supervision. To give you a first impression of the type of exercises, we present the positioning manoeuvre according to Sémont for the right ear below. The movements must be carried out in a mirror image if the left ear is affected.

  1. Sit in the middle of the edge of the bed or lounger, leaving enough space on either side of you, and remove any pillows or blankets that might interfere with the manoeuvre beforehand. Turn your head 45 degrees to the left.
  2. Keeping your head in the same position, let yourself sink quickly to the right side, your head resting on the mattress, your gaze diagonally upwards. Let the dizziness subside, which usually takes one to two minutes.
  3. Now, lay your upper body down on the left side of your body as quickly and energetically as possible. The head position remains unchanged so that your gaze is directed towards the mattress. Again, wait a few minutes for the dizziness to subside.
  4. Slowly come back to the upright sitting position and let the dizziness subside.

This manoeuvre should be performed three times in a row and several times daily. A suitable time is in the morning after waking up. If the symptoms disappear, the exercises should no longer be used.

Sleeping position in positional vertigo

To this day, precisely which processes lead to positional vertigo is unknown. The results of various studies indicate that there may be a connection between the position of the head during sleep and the occurrence of positional vertigo. It has been shown that many sufferers sleep on the ear, which is where the dizziness originates.

Those with positional vertigo should pay attention to the correct sleeping position. Sleeping on your back is recommended.

Everyone has to try and decide for themselves which pillow is best suited for positional vertigo. It is essential that the head and neck are well stabilized and that the cervical spine can assume its natural shape.

Further studies must clarify whether changing sleeping positions can prevent positional vertigo.

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