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David Fisher, MD, MPH: A Simple Cure for Vertigo

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Saturday, June 27, 2009

A Simple Cure for Vertigo

One of my favorite Alfred Hitchcock movies is Vertigo. Jimmy Stewart plays the detective who becomes an unwitting foil in a complex murder scheme, then goes too far in orchestrating a second chance to absolve his gnawing guilt for failing to save a woman's life. The twisting plot and gripping finale will make your head spin.

And speaking of spinning heads, your head was made to spin without causing you to lose your balance. This happens thanks to a delicately designed system contained in the inner ear. The semicircular canals are three looping arcs that sit behind the eardrum and are oriented in three separate planes. They contain fluid which moves as we move, triggering the movement of tiny hairs that line the inner surface. These hairs send messages to the brain, letting it know the direction our body is oriented in space. This allows our brain to coordinate our eye movements, blood pressure, and depth perception so we do not lose our balance. This video illustrates the role of the canals in maintaining our equilbrium (Notice: the audio is in German, but this was the best video I could find that accurately demonstrates the function of the inner ear).

This is a wonderful system until it malfunctions. Those who have experienced vertigo know how severely debilitating this condition can become. Even the smallest head movement or change in position can literally send the walls spinning. Vertigo is often accompanied by nausea, sweating, and feelings of wanting to faint. The fact that you can sit up, lie down, and turn around without launching into these symptoms is often taken for granted unless you have experienced a bout of vertigo.

The most common cause of vertigo is Benign Paroxysmal Positional Vertigo (BPPV). This temporary condition is caused by irritation of the interior canals and the tiny hairs that deliver information to the brain. The nerves are overstimulated and send faulty data to the balance center, causing our brains to think we are spinning when we are not. The Mayo clinic offers a succinct description of BPPV.

Often the irritation is the result of tiny stones or sediment that collect in the canal fluid. This sediment can be removed from the canals by a technique called the Epley maneuver. By manipulating the head through a series of positions, the force of gravity is used to draw the sediment out of the canals. Your doctor can perform this maneuver, but it is something you could do at home as well. Though you can do this yourself, I recommend recruiting as assistant, just to ensure you do not fall off the table or bed. The technique is demonstrated in this video. Each successive position will likely reproduce your symptoms if you truly have BPPV. The video instructs the patient to wait 30 seconds between positions; in reality, you should wait until the dizziness resolves and then quickly move into the next position.

If this technique does not solve your vertigo, see your doctor. There are medications that can help with the symptoms, and there are other causes of vertigo besides BPPV that your doctor can diagnose.

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