Benign Paroxysmal Positional Vertigo Treatment (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is characterised by the sudden onset of vertigo episodes that are triggered by head movements. Vertigo is a subjective, external experience of rotational movement. This happens regardless of any input from the environment.

At the Gold Coast Headache and Migraine Clinic, we assess and find out if a sensitised brainstem and dysfunction in your upper cervical spine are the cause of your BPPV. Then we are able to treat this using our world-leading, modern techniques. If this is the case, we can start treatment immediately.

With our clinic’s groundbreaking treatment for BPPV we usually see the condition effectively treated within the first 6 sessions, as we do with 85-90% of our patients. Book an appointment today.

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Understanding BPPV Symptoms

What are the symptoms of BPPV?

It is estimated that vertigo patients are diagnosed with BPPV 17-42% of the time and a yearly prevalence of 11-64 people per 100,000 per year. The main symptoms that BPPV patients experience are:

Vertigo

Dizziness

Nausea

Vomiting

Nystagmus (rapid, unidirectional and involuntary eye movements, unnoticed by the patient)

BPPV is easily diagnosed following physical examination and medical history collection by your health professional, scans are very rarely required. The physical tests will assess structures in your inner ear called cannula, which are known to be the cause of BPPV.

What causes BPPV?

BPPV is a common disorder affecting the otolith organs inside the inner ear. These otolith organs are essentially the inner ear balance system, designed to detect the gravitational and acceleration forces in our head during movement so that we can adjust and stay upright.

BPPV occurs when these organs become impaired through:

Inner ear disease (such as vestibular neuritis)
Head injury
Vestibular system degeneration from ageing
Damage caused by an inner ear disorder

The balance organs will detect head movements that are normally fine, and react by causing symptoms of vertigo. This lower threshold for quite severe symptoms of vertigo can be quite debilitating for BPPV sufferers.

BPPV Theory

There are two main theories regarding the cause of BPPV; both are regarding the endolymph flowing through the semicircular canals of the otolith organs:

The ‘Cupulolithiasis Model’

This theory suggests that matter within the endolymph becomes attached to the cupula, or the sensory organs located in the semicircular canals.

The ‘Canalithiasis Model’

This theory suggests that there are free-floating particles within the endolymph that are detected by the cupula, this abnormal detection is registered and vertigo is experienced as a result.

The standard treatment for Posterior Canal BPPV, the most common type of BPPV, is the Epley Manoeuvre. This canalith repositioning procedure involves having the patient’s head turned to a series of positions that are designed to shift any matter in the semicircular canals (most commonly the posterior semicircular canal) so that they no longer trigger symptoms. This manoeuvre is easy to perform at home once taught by a health professional, however it is common that symptoms persist after this procedure is performed. It’s worth noting that following Epley Manoeuvre treatment the patient should avoid tilting their head backward and forward as well as sleeping on the side of the affected ear for several days.

Organise Your Initial Assessment

About The Assessment Stage

What To Expect During The Assessment

1. Comprehensive and in-depth examination

We will perform a thorough and in-depth examination to identify all of the factors that may be related to your headaches and migraines. We will focus particularly on your upper cervical spine in our assessment.

2. Ligamental stability and vertebral arterial tests

In order to ensure the highest level of safety is maintained, we routinely will assess the stability of the important ligaments in your upper cervical spine, prior to any assessment or treatment.

3. Temporarily reproduce your headache and migraine symptoms

During our assessment and treatment process, we will be applying gentle and specific pressure to your upper cervical spine in order to temporarily reproduce your headache symptoms. This helps us to identify the specific cause of your headaches.

More about BPPV

Living with BPPV

In a lot of the patients that we see, they experience all of the symptoms of BPPV, but the results are often unclear when they undergo testing or they do not respond effectively to the standard treatment of BPPV. In these patients, it is likely that sensitivity in the central nervous system, specifically the brainstem, is the true cause. The afferent vestibular nerve sends normal information that reaches the sensitised brainstem, this information is wrongly interpreted as a threat and vertigo is experienced.

Symptoms of BPPV

BPPV is a condition that affects the inner ear. Small calcified crystals called otoconia can become dislodged in the canals of the inner ear, which can alter your body’s perception of balance and head position, causing vestibular symptoms like dizziness (vertigo). The similarity of these symptoms to those of vestibular migraines mean that sufferers of BPPV are commonly misdiagnosed as vestibular migraine sufferers by health professionals.

Many of the patients that we see at Gold Coast Headache & Migraine Clinic have all of the symptoms of BPPV, but do not respond to treatment or the physical testing cannot accurately diagnose them.

Different types of BPPV

Benign paroxysmal positional vertigo (BPPV) is primarily classified into different types based on the affected semicircular canal. The different types of BPPV are as follows:

Posterior Canal BPPV (PC-BPPV):

This is the most common type, where the displaced otoconia are located in the posterior semicircular canal of the inner ear.

Anterior Canal BPPV (AC-BPPV):

Less common than posterior canal BPPV, this type involves displaced otoconia in the anterior semicircular canal.

Horizontal Canal BPPV (HC-BPPV):

In this type, the otoconia are located in the horizontal semicircular canal. It’s less common but often more complex to diagnose and treat.

Multicanal BPPV:

This occurs when the displaced otoconia are found in multiple semicircular canals, as opposed to just one affected canal. This can cause complications in accurate diagnosis and benign positional vertigo treatment.

Our BPPV Clinic Treatment

The Dix-Hallpike test and the supine-roll test has been developed to detect faults in the posterior and horizontal semicircular canals respectively. These tests are designed to create a change in fluid -dynamics and the detection of the endolymph in the otolith organs.

Vertigo is experienced in a positive test and the therapist will observe for the presence and direction of nystagmus, or rapid beating of the eyes. It is very rare that the superior semicircular canal is at fault during BPPV, however if it were to be, the Dix-Hallpike test would again be positive, and the therapist would observe upwards beating nystagmus in the patient.

BPPV Treatment Gold Coast

I've tried everything, what else can I do?

Our patients have had mixed results with the Epley manoeuvre, some have tried motion sickness medications, some have even had surgeries, like neurotomies or posterior canal occlusion, in attempts to reduce their symptoms. Some of these methods have had some effect, though they have mostly been minimal or short-lived. This is likely because, in these cases, they haven’t been properly assessed to determine if a sensitised brainstem is the true cause of their symptoms.

In cases where we have assessed and found that a sensitised brainstem and dysfunction in your upper cervical spine are the cause of your BPPV then we are able to treat this using our world-leading, modern physical therapy and vestibular rehabilitation techniques. If this is the case, we can start treatment immediately, and we usually see rapid results, within the first 6 sessions, as we do with 85-90% of our patients.

The best part is that our BPPV treatment is safe, gentle, medication-free and non-invasive!

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