How to cope with Positional Vertigo

By Dr Harold Gunatillake - Health Writer

Vertigo in layman’s term means that your immediate environment like in a room starts spinning, whirling or tilting. It is a sensation you feel during an attack. Dizziness is different and you do feel light-headed or lose balance like a drunkard.

A sudden drop of blood pressure when you get up from a seated position causes dizziness due to the sudden momentary drop of circulation to the brain

Positional vertigo is also referred to as a ‘Benign positional vertigo’ The word ‘paroxysmal’ is also added sometimes to refer to attacks being occurring at intervals of weeks, months or years.

In America between 2001 and 2004, 69 million people over the age 40 experienced vestibular dysfunction vertigo according to the Vestibular Disorder Association. So, it is a common condition that afflicts aging people.

How does it happen?
The ear is divided into three compartments- outer ear -you see and touch, middle ear hidden by the ear drums and the inner ear containing a few anatomical structures like the semicircular canals containing fluid. When you move, walk, and change positions this fluid tend to move in these semicircular tubules. These canals are very sensitive to any movement of the fluid. This movement of fluid sensation signals your brain, the position of your body. This helps you to keep your balance.

There are two pouches attached to the canals, on both inner ears. These sacs or pouches are filled with minute crystals like salt. They contain bone like material. With age they tend to move into the canals from the sacs and float within them. Such release of crystals confuses the brain as far as balance is concerned.

Young people hardly get this situation. Most people over the age of 40 tend to suffer from vertigo (BPPV). The first attack is disastrous and you end up in hospital thinking that it is a stroke. The spinning lasts for a few minutes or a few days. When you are briefed with the nature of the condition, your panics lessens and you learn to cope up with the malady.

Some get attacks frequently, and with time the attacks get less and you may experience one after years.

Family history
BPPV occurs in among family members and hence a genetic factor may be involved. After head injuries one could get episodes of vertigo.
Those who get infections of the inner ear (labrynthitis) may get similar vertigo attacks

In some the attack is preceded by nausea and vomiting and then starts spinning. It is the sudden movements of the head that triggers attacks. From the sleeping position in bed as you get up in the morning you tend to move your head into about six positions. When you are in a hurry sudden getting up from bed may trigger an attack.

So what do you do?
Be conscious of the condition when moving your head. Close your eyes and get up slowly turning onto to your good side. In the sitting position at the edge of your bed, rest for a few seconds and then keep your feet on the ground and walk.

Sleeping on reclining chair is the best solution to avoid episodes. You adjust your back rest to a comfortable angle and sleep comfortably. You can turn from side to side with a bit of manoeuvring. When you get up from a reclining chair you invariably keep your head straight without turning your head. You feel so good to get up and walk out from a reclining chair. Try one and you’ll believe me. Think you are travelling business class on a plane Say good bye to vertigo.

When you sleep in bed you could turn to one side only- being the good side: when you turn to the other side you may get an attack- that would be your bad side.

Driving a motor vehicle is okay, because in the sitting position you hardly move your body except when you look through the mirrors for safe driving.

Looking down into a drawer or looking under the bed would trigger an attack. Go on your knees and move your head slowly in such exercises.
Medication

Doctors prescribe stemetil, stugerone and beta-serc for this condition. They make you dopy and my advice is to avoid those medications. Some are put on Serc for years.

When you get a severe repeated vomiting bouts having a stemetll injection and sleeping it over is comforting


Epley manoeuvre
This is a manoeuver or an exercise you could try to get relief. A person at home needs to be trained to carry out this manoeuver. It is a method of turning your head to extreme positions from side to side to send back those tiny crystals back into the pouches. The relief rate is about 30 per cent.
There are complications with these manoeuvers- the crystals may move into another canal or severe vomiting could occur during the manoeuver and worsen the condition. It is best the exercise is performed in a doctor’s office than at home. Sometimes, with this manoeuver neurological symptoms are provoked due to compression of the vertebral arteries.

There are many other manoeuvers described in the books. The fact that there are so many manoeuvres described means, they don’t seem to work. My advice is just forgetting them. They are all a waste of time and money.

Sleeping on a reclining chair is the solution and at other times restricts those head movements when you feel that you may have an attack.

Foods to avoid
A high sodium diet can offset fluid balance and regulation in your body. Stick to a very low salt diet.
Avoid sugary foods. Taking foods containing lots of sugar as ice cream, fruit salads cakes, beverages with high in added sugars should be avoided as they can trigger a minor attack.
Avoid foods containing tyramine like meats, cheeses, nuts and seeds. They are high in tyramine Avoid red wine and other alcoholic beverages.
Add plenty of ginger in your food, recommended herb to prevent vertigo.
Avoid sports where you need to turn your head frequently
Be careful when you recline on a dentist’s chair or hair washed at your saloon. Move very slowly, keeping your eyes closed.

Do some balancing exercises daily at home.

Brandt-Daroff exercises can be done at home to help your brain get used to the abnormal balance signals triggered by the particles in the inner ear.
Stand on one leg and count to 10 and then try with the other. One of the best balancing exercises.

Consult an ENT surgeon, if you still feel not right to get certain investigations done to rule out more serious situations.

Good luck.

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