Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief, episodic vertigo triggered by specific head movements. Vertigo occurs when the head is placed in a certain critical position. There is no hearing loss or other neurologic symptoms. Transient (seconds) vertigo precipitated by movement (typically, rolling over in bed or getting into or out of bed). Although it is benign, and usually self-limiting after weeks or months, patients are often alarmed by the symptoms. [1]
Key Features:
1. Benign: BPPV is a non-life-threatening condition.
2. Paroxysmal: Episodes of vertigo are sudden, brief, and recurrent.
3. Positional: Vertigo is triggered by specific changes in head position.
4. Vertigo: A false sense of spinning or movement of the environment.
Risk Factors:
Age: BPPV is more common in people over 50 years old.
Sex: Women are more likely to develop BPPV than men.
Family History: Having a family history of BPPV or vestibular disorders increases the risk.
Head Trauma: Head injuries, such as concussions or skull fractures, can increase the risk of developing BPPV.
Pathophysiology:
BPPV occurs when small calcium particles called otoconia become dislodged from the utricle and migrate into one of the semicircular canals. This causes an abnormal stimulation of the hair cells in the canal, leading to a false sense of rotation and triggering vertigo.[2]
Common Triggers:
1. Rolling over in bed
2. Getting up from a lying down position
3. Looking up or down
4. Bending or lifting
Sign and Symptoms:
Vertigo: A sudden sensation of spinning or moving, often triggered by changes in head position.
Episodes typically last less than a minute.
Nausea: A feeling of queasiness or the urge to vomit, often accompanying vertigo.
Nystagmus: Involuntary, rapid eye movements that occur during episodes of vertigo.
Diagnosis
BPPV is often diagnosed based on clinical history and physical examination, including the Dix-Hallpike maneuver.
1. Brief episodes of vertigo (<30 seconds)
2. Triggered by specific head movements
3. No other neurological symptoms
4. Normal hearing and vestibular function between episodes
Dix-hallpike maneuver– The patient sits on the examination table with their legs extended. The patient’s head is rotated 45 degrees to one side. The patient is quickly laid down on their back, with their head still rotated 45 degrees. patient’s eyes are observed for nystagmus (abnormal eye movements). The presence of vertigo and nystagmus indicates BPPV.
Differential Diagnosis
Meniere’s Disease:
Characterized by episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear.
Unlike BPPV, vertigo episodes in Meniere’s disease last longer (20 minutes to several hours).
Vestibular Neuritis:
Inflammation of the vestibular nerve, causing sudden, severe vertigo that can last for days.
Typically associated with nausea and imbalance, but without hearing loss.
Labyrinthitis:
Inflammation of the inner ear labyrinth, causing vertigo, hearing loss, and tinnitus.
Migraine-Associated Vertigo:
Vertigo associated with migraine headaches.
Accompanied by headache, light sensitivity, and visual disturbances.
Orthostatic Hypotension:
A drop in blood pressure upon standing, causing dizziness or lightheadedness.
Not typically associated with vertigo or nystagmus.
Rolling over in bed is a common trigger that may help to distinguish BPPV from orthostatic hypotension
Cervical Vertigo:
Vertigo resulting from neck problems, such as cervical spine disorders.
Triggered by head movements and often associated with neck pain.
Examination shows tenderness of neck, spasms of cervical muscles and limitation of neck movements. X-rays show loss of cervical lordosis. Exact mechanism of cervical vertigo is not known. It may be due to disturbed vertebrobasilar circulation.
Treatment
Treatment comprises explanation and reassurance, along with performing Epley’s manoeuvre. The principle of this manoeuvre is to reposition the otoconial debris from the posterior semicircular canal back into the utricle.[3]
Homoeopathic view on BPPV
Homeopathy offers a natural and holistic approach to treating Benign Paroxysmal Positional Vertigo (BPPV). The goal is to address the root cause of the condition and alleviate symptoms without side effects.
Homeopathic treatment for BPPV is individualized, meaning the remedy and dosage are selected according to the patient’s unique symptoms, modalities and overall health.
Homoeopathic Remedies for BPPV:
Homoeopathy have various remedies to treat BPPV, based on the individual’s symptoms and constitution. Some common homoeopathic remedies for BPPV include:
1. Cocculus: For vertigo and dizziness, especially when associated with nausea and vomiting. Vertigo while rising from bed or by motion of carriage, especially from rising or sitting up.
2. Phosphorus: For vertigo and dizziness, especially when associated with anxiety and fear.
3. Bryonia: For vertigo and dizziness, especially when associated with headaches and nausea. Complaints aggravated by slightest motion.
4. Conium: the strongest characteristic of it’s vertigo, which is much aggravated by Turning the head sidewise or turning in bed.
5. Gelsemium: For vertigo and dizziness, especially when associated with dullness, dizziness, drowsiness and trembling.[5][6][7]
References
1.Dhingra PL, Dhingra S. Diseases of ear, nose and throat-eBook. 7th ed. New Delhi, India: Elsevier; 2017.
2.Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson JL. Harrison’s principles of internal medicine, twenty-first edition (vol.1 & vol.2). 21st ed. Columbus, OH: McGraw-Hill Education; 2022.
3.Penman ID, Ralston SH, Strachan MWJ, Hobson R, editors. Davidson’s principles and practice of medicine. 24th ed. London, England: Elsevier Health Sciences; 2022.
4.Boericke W, Boericke OE. Homoeopathic materia medica with repertory comprising the characteristic and guiding symptoms of the remedies. 2nd ed. Savage RB, editor. Sittingbourne, England: Homoeopathic Book Service; 1990.
5.Allen HC. Allens’ keynotes: Rearranged & classified. New Delhi, India: B Jain; 2022.
6.Patil JD. Gems of homeopathic materia medica. B Jain Publishing Group, editor. New Delhi, India: B Jain; 2023.
Co-Author
Prof. (Dr.) Rajeev Sengar
MD (Hom)
Professor & HOD
Department of Physiology
Govt. Homoeopathic Medical College & Hospital, Bhopal.
