Q: I have been having dizziness when moving my head in certain positions and getting up and down out of bed. Sometimes it goes away on its own, other times it lingers for days and makes me feel sick. My friend thinks I have vertigo and should see a physical therapist. What can you do for me?
A: This question from a Chapel Hill reader really hits home with me because I myself have had episodes of vertigo. Benign Paroxysmal Positional Vertigo, also known as just Benign Positional Vertigo or BPV, is one of the most common causes of vertigo and can be treated with some of the movements that I will describe in this column and hopefully a therapist can show you how to properly perform.

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I would suggest that you first go and see a specialist to help confirm the diagnosis of BPV. Even though its prevalence is high (about 85% of positional vertigo is caused by BPV) there are still some diagnostic tests that the specialist will perform to confirm the diagnosis (such as the Dix-Hallpike Maneuver). The dizziness that comes with changes in movement associated with BPV is generally accepted in the literature to be due to debris, which has collected within a part of the inner ear. This debris is called otoconia and is small crystals of calcium carbonate. As these crystal fall and tumble through the semicircular canal different types of nystagmus and dizziness are evident depending on the rate and length of the fall. Symptoms of BPV not only include nystagmus and dizziness, but also lightheadedness, imbalance, and nausea.

During treatment of BPV at the clinic, a physical therapist or a physician tries to reposition the particles by using a series of movements that traces the path of the canals until the crystals are situated correctly. The treatment movements are all very similar but have slight differences based on clinical findings of where the physician or therapist felt the particles were (i.e. Posterior canal, anterior canal, lateral canal). Since only a small percentage of cases in the literature were felt to be in the anterior or lateral canals, the most likely treatment chosen would be the canalith repositioning procedure or Epley maneuver. This procedure has been modified for self-treatment and has about a 93% success rate. It involves moving your head through a series of positions while your head is extended over a pillow.

In conclusion, 20% of ALL dizziness is contributed to BPV in the literature. Having said this, many of the affected walking around do not have sustained symptoms and are not seeking treatment. Those of you who do have consistent and persistent dizziness, I would again encourage you to see a specialist to confirm the diagnosis and be shown the correct way to perform the self-treatment procedure.

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