BPPV cured?

Back story: A few years ago I had a nasty attack of BPPV, which months later progressed into MAV. Felt pretty good during recent pregnancy but the vertigo has been coming back post-partum.

I moved to a new state a few months ago, and have started looking for help here for my vertigo. Today I went to see a vestibular physical therapist about my BPPV. Although I am much much better with that than I was several years ago, sometimes I will still get attacks of it for a few days, where I start to spin more if I look down, or get out of bed too quickly, turn my head the wrong way in bed, or look under the couch, etc. I’ve been careful for years about not tilting my head in an odd way, or if I’m at the doctor or dentist, I tell them not to put me flat on my back. When I feel an attack coming on, I usually just put my head back to how it was right before, and I can pretty much stop it that way.

Anyway, first she wanted to test me and look for nystagmus. She had me quickly lie down with my head lower than my body, as she tilted my head and looked at my eyes (Dix-Hallpike test, I believe?) Amazingly enough, I didn’t get the spins at all…I was shocked, to be honest. It’s nothing I’d ever try at home, since the past few years I’ve been so afraid of the room spinning like that (I was alone during my first (and worst) BPPV attack, where I was literally trying to grip onto the floor and scared out of my mind).

She said I had no nystagmus either, and I don’t have BPPV (at least not now). She also said that when she treats patients, she does her treatment maneuver once and they are basically cured forever. I tried explaining over and over to her that while maybe I don’t have it this second, it does still happen sometimes (honestly, she was pretty obnoxious to me and not really answering my questions). I left there feeling really confused. Is she right and I am “forever cured” of BPPV? Then why do I still get positional vertigo sometimes? Why can’t I lay on my left side in bed sometimes without my head totally propped up? Is it all just MAV now, or is something else going on? Does my brain just think I should get dizzy if I move a certain way, and therefore I do, even if the debris in my ears is settled? As a MAVer, am I more prone to getting recurring BPPV attacks than someone who just has one attack of BPPV and then is “ forever cured”? Any help would be greatly appreciated.

Oh, she also said that there is another physical therapist there who will work on posture and it’s supposed to help with migraine…is there any truth to this? Do you think it’s worth making an appointment? Thanks.

Hi Cassada,

She is correct. If the head manoeuvre showed no nystagmus then the BPPV is gone. Your positional vertigo is likely just migraine related now. I have had two BPPV attacks and also have positional vertigo now. The two can be difficult to distinguish sometimes but in my experience and according to the literature a clear cut BPPV episode causes very discreet nystagmus – the eyes pulse towards the affected ear. By holding the head still, fatiguing occurs and the sensations stop. When the ear rocks are moved back into place you are effectively cured.

Your positional stuff is not unlike mine. I cannot sleep on my right or left side but must face the ceiling. If I wake on my side in the night, my heart is usually in my throat and I feel disorientated. It’s migraine and maybe even some left over damage from VN I had in 2003.

Cheers … Scott

in my experience, many of the PTs specializing in this do not include MAV in their world view.
and they can be really obstinate about it, and even demeaning, blaming patients for failure to push through the rehab exercises which for some will make things WORSE, not better, if it is not simple BPPV
But to be honest, I dont think anyone knows ultimately WHAT the relationship is between BPPV and MAV

Wow reading your post was practically like reading my own words… I am in the same boat! Have suffered from BPPV since I was 12. I used to call them my “dizzy spells”, no doctor could figure out what it was, but hindsight I’ve realized it was BPPV… ie: everytime I’d lay down or look down I’d get vertigo. It disappeared for a good 10 years before rearing it’s ugly head after a case of vestibular neuritis early this year. A few weeks ago I had an appt with a neuro-otologist where he did the same test you had and to my biggest surprise, no nystagmus or vertigo (and I was gripping onto that table for dear life thinking I was gonna start spinning like crazy). Just like you, I still experience strange positional things if I shift in bed on one side too fast, or turn my head. It’s so frustrating trying to figure out if it’s BPPV or MAV related!!! I, like you, take caution by not angling my head in strange positions and avoid sleeping on my “bad” side. I’ve also noticed that caffeine and beer (not other alcohol though, weird) can trigger it, so I avoid as much as possible.

As far as the posture thing I’ve never heard of that. If you don’t have to pay much out of pocket and have the money, I say go for it. And this point, I’d do just about anything for an ounce of relief!!

Hi Cassada,

I started off with BPPV (confirmed with Dix Hallpike and nystagmus) which developed into MAV. Whilst I was getting the MAV under control with medication, I had another bout of BPPV (confirmed with DH/nystagmus again). This was successfully treated with an Epley manoeuvre to a large extent, as immediately I was able to lie down and sit up again with starting off spinning, but I still got the odd bouts of positional vertigo (and had done so throughout my MAV experience, seemingly regardless of whether I had BPPV at the time or not). Anyway, once my MAV was under good control, I had a huge improvement in my other symptoms (constant rocking, visual vertigo, feelings of false movement etc), but still I got the funny positional stuff going on. I think my brain had adapted to that as being ‘normal’. At this point I went started VRT, and just doing Brandt-Daroffs totally cured this for me. It was so quick - less than a week - that I could hardly believe it, but it certainly worked for me :slight_smile: Have you tried these exercises at all? It was pretty unpleasant for the first few days, as it did provoke vertigo, it certainly was worth sticking it out.

Anyway, just one thing, where I think you can probably test whether it’s BPPV or MAV positional vertigo relates to your comment about stopping the vertigo by putting your head back where it was? As I understand it, if it’s BPPV the vertigo will pass regardless of whether you move your head back or leave it where it is (although it’s a natural instinct to move your head out of the position that’s provoked it, if you have, say an Epley done, you are kept in the position and it does still pass). If you keep your head in one position and it doesn’t pass after a couple of minutes, than I would guess that means it’s not BPPV.

Thanks for your responses everyone. I guess I didn’t realize that positional vertigo like this could be part of MAV…I’ve just been assuming all along that it was BPPV. Just goes to show that I even though I’ve had vertigo for years, I still have a lot to learn.

Scott - If it’s not BPPV, then why does it act so much like it sometimes? Granted, it’s not even close to as violent as my true BPPV attacks (where I often felt like I’d fall off the earth), but it was my left side affected by BPPV, and I still have trouble laying on my left side, for instance. Is it just damage from my BPPV attack, or does my brain just think I should be dizzy on that side?

dougiedd - I was definitely getting frustrated with the PT, although I guess she was right that it wasn’t BPPV. I just wish she had been a bit more sensitive to the fact that I also have MAV. I believe that the connection between BPPV and MAV was explained on here once as kind of a “big bang”…the BPPV is the big bang that leads to MAV, or MAV can first manifest itself as BPPV (perhaps migraine causes the ear rocks to be released). I think a lot of it is just theory right now?

suki530 - I was so so surprised that I didn’t start spinning. I thought I was going to have a panic attack as she was leaning me back to do the test. I’ve been careful for so many years now (first attack in 2006) about head positioning…it’s pretty much second nature. Now I am wondering, though, if maybe I should not be so careful all the time…maybe my brain is getting too used to it, and thinks I should be dizzy if I lay a certain way. I really don’t know.

beechleaf - that’s a good idea for testing whether it’s MAV or BPPV…I just always move my head back when I start to feel like I’m going to spin because, well, I don’t want to spin! What is the difference between the Brandt-Daroffs and the Epley? I just worry that trying to do anything at home might provoke something bad.

The balance-testing expert who posts on a dizziness mailing list I have read for many years (he runs a balance center and knows all about testing) ALWAYS told us that just because BPPV does not show during the Dix-Hallpike, that does NOT mean the patient doesn’t have it. Sometimes it “hides.” It can still be diagnosed from a description of the symptoms.

Just because it didn’t appear when you had the Dix-Hallpike does NOT mean it’s permanently cured. BPPV is known for recurring.

When you get it, try just doing the Epley maneuver at home, if you have no problems with your neck. I did when I had a four-day attack of BPPV once, and it cured me right away.

The Brandt-Daroff exercises for BPPV are sometimes given to patients, and they can help, but it’s the Epley that is the quick cure. Often it’s only a temporary cure and will need to be repeated whenever the BPPV recurs.

Dr. Hain has lots of BPPV info on his site (www.dizziness-and-balance.com).

For those who are interested in BPPV I suggest you read through this recent publication from the International journal of Otolaryngology, edited by Professor Bill Gibson here in Sydney. Gibson implants cochlear implants and is a Meniere’s guru among others.

[size=140]Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions[/size]

— Begin quote from ____

Central nervous system disorders can masquerade as BPPV, in particular intracranial tumours and migraine. Nystagmus features which strongly suggest a neurological cause are downbeat nystagmus, direction-changing nystagmus without a change in head position, nausea with up or downbeating nystagmus, and preexisting and continuing nystagmus. The cardinal distinguishing feature from BPPV nystagmus is that the patient does NOT experience brief rotational vertigo. Therefore patients with such nystagmus or symptoms of BPPV not showing resolution after repositioning require neurological examination and MRI scanning of the brain and posterior fossa.

Migraine is now a well-recognised cause of recurrent vertigo. During an episode positional testing can elicit upbeat torsional or horizontal nystagmus similar to BPPV. Features supporting migraine as a cause are headache, absence of brief acute vertigo induced by the Dix Hallpike test, disappearance of all nystagmus within days, and a recurrent pattern.

— End quote

Scott 8)

Wow, very interesting article, Scott–thanks for posting it!

Wait, now I’m confused…do I still have BPPV occasionally or not? (I tried reading the article multiple times but I’m having major brain fog and it’s just not making sense to me at the moment, sorry).

I still have BPPV temporarily when I run really fast up and down the stairs, and also turning my head really fast. I’m at a point where I’m used to it and the veritgo only lasts a few seconds - I’m alright with it, nothing that freaks me out.