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Vertigo

Over twenty years ago, my receptionist at the time was occasionally plagued with bouts of vertigo. During these bouts, when she had to move around the office she’d move ever so carefully, trying to turn her head as little as possible and as slowly as possible. The wrong move or turn of the head would send her world spinning and she’d have to grab onto something to keep from falling. Just as miserable, the spinning sensation would leave her nauseated, or occasionally even trigger vomiting. Obviously, at its worst, the vertigo would necessitate her staying home to ride it out.

We had diagnosed her with a type of vertigo called benign paroxysmal positional vertigo (BPPV) and would treat her with medicines such as meclizine. This would dampen the spinning sensation and reduce the nausea, but certainly didn’t cure the problem. So she would tough it out until the vertigo faded away again.

I had been hearing about something called the Epley maneuver which was claimed to almost instantly cure the problem by just putting the patient through a specific series of movements. I remember telling my receptionist that it sounded a little too good to be true but still seemed worth a try given the success I had heard about it. So off she headed, looking unsteady and nauseated. An hour or so later she was back grinning from ear to ear and practically shouting, “I’m cured!” That was my first experience with the Epley maneuver and it left a lasting impression.

So let’s back up a little and explain a few things. When people say they’re dizzy, we first need to sort out a couple of things. Dizzy is used for two rather different sensations. There is lightheadedness, where a person feels woozy or faint, like they might pass out. Then there is vertigo, which is a sensation of whirling or loss of balance. The two very often have quite different causes.

The next important point is to realize that vertigo is just the name of a symptom; it’s not a diagnosis. So if a patient says to me, “Whenever I turn my head a certain way, the room starts to spin for several seconds and I feel really nauseated,” and I respond, “I think you have vertigo,” I really haven’t told them anything other than to put a name on their symptom – kind of like responding to someone who tells me their temperature is 103 by informing them, “I think you have a fever.” Fine, but what’s causing it?

So, once we know we have true vertigo, and not just lightheadedness, the next question is what is the specific cause of the vertigo? We don’t have space to go through the list, which includes entities such as Meniere’s disease and labyrinthitis, but the most common of all is the one my receptionist had, BPPV.

The onset of BPPV is usually sudden. A person may wake up with it, first noticing it when they go to sit up from bed. Then each time they turn their head or move in a certain way, it triggers a sometimes violent sensation of spinning which lasts some 20-30 seconds. At its worst this may cause vomiting. The eyes tend to beat spasmodically during the vertigo, a phenomenon called, nystagmus.

There is quite a list of causes of vertigo, even once we distinguish it from lightheadedness. Happily, there are treatments for many of them, and for BPPV, there is often a rather quick cure. So if you’re waking up dizzy these days, don’t just tough it out – get it checked out and see if it’s one that can be fixed.

Andrew Smith, MD is board-certified in Family Medicine and practices at Trinity’s Maryville office located at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835

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