Vertigo, or a sense of spinning, is often caused by an inner ear problem. In many cases, a treatment that involves having a doctor move the head and body in specific ways can relieve symptoms, says Denise Schultz, NP-C, Nurse Practitioner with Rockland Neurological Associates in West Nyack, NY.

“If it’s not treated, vertigo can last for days, weeks, or even years, and can make life difficult,” Schultz said. “A person with vertigo can experience a loss of balance, dizziness, nausea, and vomiting, and just not feeling right.”

There are two types of vertigo. The most common type is called benign paroxysmal positional vertigo (BPPV), which occurs when small pieces of bone-like calcium (called crystals) break free and float inside small canals in the inner ear. This sends confusing messages to the brain about your body’s position, which leads to vertigo.

Most cases of BPPV do not have a specific cause. Some cases of vertigo are caused by head trauma, other inner ear problems, or lying in bed for long periods of time.

Diagnosing BPPV 
To diagnose BPPV, the doctor will ask about your symptoms—when they started, how long they last, and what triggers them.

Normal medical imaging, such as scans and X-rays, or medical laboratory testing, cannot confirm BPPV. Instead, a person with vertigo symptoms will undergo vestibular testing. This includes sitting in front of a machine wearing goggles and looking at still and moving targets. “The goggles have a video camera to record the movement of the eyes, to look for abnormal movement,” Schultz noted. Another test is called caloric testing. Alternating cool and warm air is blown into the ear to test the nerve that is involved in hearing and balance. The doctor will look for an involuntary eye movement, usually on the affected side.

The health care provider will also move your head into a position that makes the ear crystals move. If your eyes make a certain movement when this is done, it will confirm your diagnosis. 

Treatment
BPPV can be treated with the Epley maneuver—a series of head movements that relieves symptoms. The maneuver moves the crystals out of the canals so they stop causing symptoms.

To perform the maneuver, your health care provider will:

• Turn your head toward the side that causes vertigo.
• Quickly lay you down on your back with your head in the same position just off the edge of the table. You will likely feel more intense vertigo symptoms at this point.
• Move your head to the opposite side.
• Turn your body so that it is in line with your head. You will be lying on your side with your head and body facing to the side.
• Sit you upright.

Your provider may need to repeat these steps a few times. You will bring a soft cervical collar with you to the office. After the treatment, you will wear the collar while keeping your head straight for 24 hours. In many cases, the treatment will cure BPPV. Sometimes vertigo may return after a few weeks, and you’ll need to be treated again.

People who cannot undergo the Epley maneuver because of neck or back problems are instead treated with a type of physical therapy called vestibular therapy.

If you have repeated cases of vertigo, Schultz recommends you take the following steps to prevent symptoms:

• Get out of bed slowly.
• Don’t stand up quickly.
• Use a cane if needed to keep you steady.
• Don’t go on a ladder or drive while you’re experiencing vertigo symptoms.
• If you know a specific movement makes you dizzy, do it slowly.
• When you get up at night, move slowly. Make sure the area around your bed and bathroom are well lit.

“If your symptoms of dizziness or instability don’t get better in a few days to a few weeks after treatment, contact your doctor,” Schultz said. “You may have another medical problem that needs to be treated.” Her office will recommend these patients be seen by an ear, nose and throat specialist to see if the dizziness is being caused by a blockage in the ear canal or other ear problem.