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What is positional vertigo?

Roughly 2 in 100 people are affected by positional vertigo at least once during their lifetime, with women falling into this group about twice as often as men. Increasing age increases the likelihood of occurrence. Positional vertigo is manifested by a specific, often very unpleasant feeling of vertigo. The vertigo gets its name because it usually starts when there is a change in the position of the head, both when lying down and when standing or walking. Consequence is a strong, spinning or swaying feeling of vertigo, which can be scary and partly restrictive for everyday life. Let it be said in advance: This form of vertigo is usually harmless! You will learn below what causes positional vertigo, how it manifests itself, and what practical exercises can provide you with relief.

Benign Paroxysmal Positional Vertigo (BPLS)

In connection with positional vertigo, one often hears of Benign Paroxysmal Positional Vertigo. This is the usually harmless form of vertigo described above. The technical term can be translated as "seizure-like" and thus indicates the manifestation of positional vertigo: it occurs at certain movements and lasts for only a few uncomfortable seconds to minutes. Such vertigo attacks can occur several times a day. It is also often referred to as peripheral paroxysmal positional vertigo. This expresses that the vertigo has a cause in the peripheral area of the body and is not triggered, for example, by profound diseases.

Good-type positional vertigo

In the vast majority of cases, positional vertigo is characterized by harmless, brief attacks of vertigo. Starting with stones in the inner ear, where the organ of balance is also located, sensory perception is disturbed, causing vertigo. Often, the seizures disappear on their own after a short time; exercises guided by the physician or performed by the patient himself can accelerate the subsiding.

Vicious positional vertigo

Medically, there is no such thing as malignant positional vertigo. The term benign positional vertigo may be confusing here. However, the term exists only to make clear that no direct damage is caused by or underlies the vertigo. Subsequent damage due to falls or nervous stress, however, cannot be ruled out. In addition, in cases of persistent vertigo, negative effects on daily life may justify the perception of positional vertigo as "malignant."

Positional vertigo causes

The cause of positional vertigo is located in theinner ear. This is where the so-called archways are located, which are part of the organ of balance. Sensory cells that detect movements of the head are located in them. If depositions occur in the arcuate ducts in the form of pebbles, movements of the head cause the pebbles to move. The consequence of this is irritation of the sensory cells, which transmit misinformation that is not in harmony with the perception of other sensory channels. A feeling of vertigo results. Why the accumulation of the pebbles occurs in the first place is not entirely understood. However, the deposits appear to be related to the aging process. In rare cases, skull injuries, ear infections, or circulatory problems are the culprits.

Positional vertigo symptoms

Typical symptoms of positional vertigo include:

  • Jerky, uncontrolled eye movements (nystagmus)
  • Nausea, in rare cases vomiting
  • Strong but brieftwisting or staggering dizziness.
  • Often accompanied by balance disorder.

The symptomatology is expressed in the following situations:

  • When changing the position of the head
  • When turning the head
  • When lying on the neck of the head
  • When sitting up from the lying position
  • Turning while lying down
  • Bending

If you notice positional vertigo in the above situations, circulatory-related vertigo can usually be ruled out.

Positional vertigo diagnosis

Positional vertigo is usually easy to recognize by clarifying complaints and history in a medical consultation. In addition, the Hallpike test shows whether a defined, rapid sequence of movements triggers vertigo. If this is the case, a benign positional vertigo can be strongly assumed. Likewise, examination ofeye movements allows conclusions to be drawn about the diagnosis.

Does positional vertigo go away on its own?

How long positional vertigo lasts depends on the underlying cause. The free stones can become lodged, allowing natural breakdown. Often, benign vertigo thus regresses within a few days to weeks. However, prolonged persistence over months to years cannot be ruled out. Therefore, prompt treatment is recommended to reduce the duration of discomfort and thus prevent everyday strains.

Positional vertigo treatment

Although positional vertigo often disappears naturally on its own, simple exercises can be used to acceleratethe reduction of symptoms. Here one speaks of so-called position maneuvers. This refers to certain sequences of head movements that help settle the stones and thus combat the symptoms of vertigo. Your physician can guide you through such a maneuver; alternatively, the exercises can be performed at home.

Positional vertigo exercises

The exercises to treat positional vertigo can cause nausea due to dizzy spells. It is best to close your eyes to avoid nausea. Let a doctor guide you or perform the exercises with them if you feel unsafe.

Sémont Maneuver Guide

In this exercise, yourhead is turned 45° and you are sitting upright on a straight surface. You can tell which side your head needs to be turned to by which rotation causes dizziness when you lie down. Once you are in the starting position, quickly lie down against your line of vision on your side in the prone position. Meanwhile, your head always remains in the same position. Accordingly you are now with the view upward on the base. In this position you remain between two and three minutes long. Afterwards you lie down with swing around 180° to the other side, so that your view now points in the direction of the base. Finally, slowly return to youroriginal position and remain seated for three minutes. There should be several runs of the maneuver in a row, several times a day.

Epley Maneuver Instructions

Procedure of the Epley maneuver for deposits in the left ear. Source: health information

You sit with your legs straight and your back to your doctor or on a straight surface. Turn your head 45° to the affected side. Now quickly get intoback position and make sure that your head protrudes over the edge of the couch. This is called the head hanging position. Remain in this position until the dizziness subsides, which is usually afterone minute. Then turn the head 90° to the healthy side and remain in this position for about one minute. Then turn the rest of your body to the healthy side as well and remain for another minute. Finally, you can return to the starting position.