Everything I’ve Learned About Benign Paroxysmal Positional Vertigo (BPPV) in the Week I’ve Had It
DISCLAIMER: I’m not a Doctor or medical professional in any way. Just a clever guy who is suffering from BPPV and has done a lot of research. If you’ve suffered head trauma or think you might have had a heart attack or your symptoms get really bad or don’t get better, go see a doctor immediately. With that out of the way, on with the story…
Vertigo
Last Wednesday at about 5:30AM I awoke to the early summer sun blasting my face through the window. I flipped myself over to get away from the sun and look at my wife laying next to me when BAM! The world around me just spun, my eyes were fluttering back and forth uncontrollably, and I go into a flop sweat. I was on my stomach at the time and instinctively splayed all of my limps and fingers out as far and flat as possible to give myself a large surface area. Eventually it calmed down and all I could think was, “What the hell was that!?”
As I stood up to go to the bathroom the room spun again. Each time I tilted my head in any new direction the spins started. I tend to get motion sick easily, so this is not a good look for me. Long story short, for the next 12 hours I’m living on the floor of the bathroom with a pillow and a blanket, trying to not move. I couldn’t keep any food down. Imagine having motion sickness on a rollercoaster you couldn’t get off of for 12 hours and you’ve kind of got the idea.
My wife does some googling and the results remind her that our friend Gary suffered from vertigo a few years ago so reaches out him. Gary emails us back promptly and gives us the short history of his experience with BPPV. Nothing we tried quite worked for me (more on that in a bit), so eventually we end up at the emergency room where they pump me full of fluids and anti-nausea meds for hours to little avail. Eventually we walked home, very slowly with my head pointed at my feet. I went to bed and felt a bit better the next morning. Today is Monday, so five days later and I still feel like I’m on a gently bobbing boat. Apparently it can take a while for your body to get back to normal.
I can’t sleep at night because I’m trying to sleep all day, so I thought I’d write up a post with everything I’ve learned in the event it can help anyone out there who experiences this strange condition.
BPPV
Benign paroxysmal positional vertigo manifests itself with dizziness and a sensation of spinning with certain head movements. It’s caused by small crystals of calcium carbonate called canaliths that break off in your inner ear and get stuck in the tubes (or canals) that tell your brain which way is up. Your two ears and your eyes all disagree and your brain doesn’t know what to make of all of this and it freaks out. Thus the reaction I had on Wednesday. Oh and the creepiest symptom is the crazy eye movement stuff called Nystagmus which is useful in diagnosing details of where in your ear the canaliths are and what you need to do to fix it.
It’s not life threatening per se (except if it happens at the top of a flight of stairs or the edge of the Grand Canyon), but in severe forms can be debilitating. It generally comes out of nowhere, but is more common as you get older (I’m 45). Apparently a course of certain antibiotics can increase your likelihood of getting it and a few other things, but mostly its luck of the draw, and way more common than I would have thought. I put a post on Facebook looking for advice the first day, and dozens of friends commented that they had been through it.
What To Do About It
The good news is there are non invasive ways to diagnose and treat it. Basically you’ve got to get those crystals out of the ear canals. And the best part is that you can do that at home.
The first diagnostic test most medical people will do or suggest is the Dix–Hallpike test. Which involves sitting up on a bed or table and the professional turns your head to the left and tilts your head back off the edge of the table and sees if your eyes start flipping out. Then they start again with your head turned to the right. Take a look at the video below.
From what I’ve read the Dix-Hallpike test is about 80% accurate, though a doctor used it on me at the ER and I did not react. Whether that was due to the amount of drugs they had pumped into me or that I was in the 20% I’m not sure.
Besides whether you’re suffering from BPPV at all, the other thing the test is designed to determine is which ear is having the problem since the maneuvers to fix are side dependent (typically inverted bilaterally, so you turn to the right on one, to the left with the other). I still needed to determine which side MY problem was on since the Dixx-Hallpike test was inconclusive for me. I didn’t notice my vertigo being from a repeatable head move to one side. Pretty much any direction I tilted seemed to cause The Spin. However on Saturday while massaging my finger up and down under my left ear right behind the jawline I would get a little tingle of the spins that did not happen when I did the same under my right ear. I never found anyone mentioning this test so it’s anecdotal, but his convinced me the problem is on my left side.
The standard treatment for a positive result in the Dix-Hallpike is what’s called Epley Maneuver which a Dr. John Epley came up with in 1980. What people did before 1980 I don’t even want to know.
My wife and I learned about the Epley while I was still on the floor of the bathroom and proceeded to give it a shot before eventually ending up at the ER. Part of doing the maneuver involves the patient experiencing all of the terrible symptoms over and over again. When you’re suffering, even if it’s going to help or even fix it, it can be a hard sell to tell someone the fix is going to make it worse for few minutes.
Fast Forward
A couple of days later I was feeling better, but because I was still not ‘cured’ wanted to learn more about this condition. I decided to go back and research the eye movements and found this somewhat creepy video full of examples:
In the first few sets examples the eyes had a distinctive downward dip which I didn’t experience. Only at the 1:15 mark did they show someone whose eyes went back and forth horizontally like I had experienced. That specific movement is indicative of Horizontal Canal BPPV where the crystals are stuck in a different place, which only affects 8% of BPPV sufferers, and requires a different maneuver to fix, hilariously called a BBQ roll. Ah ha! I feel like that’s starting to make more sense. It explains why the Epley didn’t help me as much and perhaps why the Dix-Hallpike test (which is designed to find the much more prevalent posterior canal BPPV which is 80% of cases) failed in the ER for me. So for the last couple of days I’ve been following THIS video which seems to be more effective for my specific form of vertigo than the Epley:
Unfortunately even once you find relief, BPPV often comes back, so make sure you’ve got your knowledge handy. I find the idea of these crystals basically stalking me to be terrifying. I can just imagine waking up the day of some big job (I’m a photographer) and I can’t tell which way is up. Yikes. So I’ve also read a few studies about whether these maneuvers have a prophylactic effect, basically whether doing them regularly can keep you from having an attack in the future. The results of these studies disagree. One that I found said nope it doesn’t help. Another said that it was about a 50% reduction in frequency of attacks. So the jury is still out. I think taking a couple of minutes every few days to roll around on your bed isn’t that high a price to pay. Your mileage may vary.
I’ve also tried a few medications to lessen the spinning and nausea. The hospital gave me Meclizine which is the active ingredient in Bonine over the counter. Basically they’re the same meds that you would take for motion sickness and I had my own for that. Years ago, while on a visit to the UK I went into a Boots and they sold me these chewable pills called Kwells whose active ingredient is Scopolamine sometimes known as Hyoscine. It’s the same drug that comes inside the prescription motion sickness patches they sell here in the US except it’s over the counter and chewable (It’s also what NASA gives astronauts with space sickness). I keep packs of this stuff in every one of my travel bags just in case, and often only need to take a quarter of a pill to keep my motion sickness in check on airplanes and trains. So I’ve been taking a similar amount the past few days when I feel a little off in an attempt to stave off the nausea.
I’m still not out of the woods yet and I’ve been told it can take a few days for your system to settle down even after you successfully get the crystals out. I just wanted to share what I’ve learned and have it all in one place for myself if and when it happens again.
Hope it helps everybody!
