Dizziness, Cervical Vertigo and BPPV

Cervical vertigo is dizziness or vertigo that is associated with neck movements or neck disorders. Up to 58% of people who experience head/neck trauma or whiplash will experience vertigo. It is associated with upper neck dysfunction and/or pain, but may also involve the vertebral artery, hearing loss, tinnitis and at times ear pain, CSF leakage, or migraine. Your physiotherapist can consider the cause and will treat accordingly. Treatment may include radiographic investigations, manual therapy and manipulation, motor control exercises, acupuncture and dry needling, ergonomic and postural advice, postural taping or supports and upper body strengthening exercises.

BPPV (Benign Paroxysmal Positional Vertigo) is a common vestibular condition which affects the inner ear and causes dizziness. It is very effectively treated by physiotherapy with the Epley manoeuvre once it is correctly diagnosed. It is a vestibular condition where calcium crystals (otoliths) within the inner ear become dislodged and roll around when you turn your head. The movement of the crystals triggers movement of little hairs within the inner ear. The hairs tell the brain that we are moving so when the crystals are rolling back and forward our brain thinks that we are moving and your eyes move with this thus creating room spin even when you have stopped moving your head.

It is more prevalent over the age of 50 and usually there is no known cause however there is some coloration with BPPV post trauma, head injury or ear infection. There also appears to be an association with migraine in some individuals. The symptoms you will experience with BPPV will be acute vertigo with sensations of room spinning with or without nausea following one specific head movement. The common situations that will trigger BPPV vertigo are turning over in bed, looking up, or bending over.

BPPV is diagnosed by combining the history of your symptoms with a test called the Hallpike Dix test. This is a positional test that your physiotherapist will complete on the assessment. The aim of the test is accurately diagnose BPPV by reproducing your symptoms. While this might be unpleasant at the time it is good to have a positive test as BPPV can be treated very effectively. Treatment for BPPV is the Epley manoeuvre or another positional relocation technique. The Epley manoeuvre is a series of movements and head positions that your physiotherapy will do with you. The aim of the Epley manoeuvre is to relocate the crystals to an area of the inner ear that will not cause problems.

Once the Epley manoeuvre has been completed you will be given advice on dos and don’ts for the rest of the day. In 90% of cases your symptoms will be completely resolved in just one to three treatment consultations.