FARGO - A shampoo with a scalp massage at the hair salon does wonders for stress relief, but the feeling is quickly spoiled when the person sits up and the room starts spinning.
This happened to me at a recent appointment and literally threw me for a loop.
While the dizziness eased at the salon, it returned later in the day, especially with certain movements – for example, when I tilted my head back and to the side to reapply makeup.
As the week went on, the dizziness worsened to the point where, when I went to lie down in bed, the room spun wildly like Dorothy’s house in “The Wizard of Oz.”
The rest of that night was spent propped up in bed with a travel pillow around my neck – nauseated from the spinning, unable to sleep and feeling anxious that it might not ever go away.
It turned out to be Benign Paroxysmal Positional Vertigo or BPPV, a condition I’d never heard of and have since learned is pretty common, especially in people middle-aged and older.
Though not serious, BPPV can be frightening due to its paroxysmal, or sudden, onset and because it disrupts something we often take for granted.
“When things get messed up with your senses, people tend to think the worst,” said Samantha Kiecker, a chiropractor at The Clinic Family Health and Sports Chiropractic in West Fargo.
Kiecker said some people end up in urgent care or a local emergency room, fearing something is seriously wrong.
She most often comes across BPPV in patients by accident, when they tell her they get dizzy lying down for a back or neck adjustment.
“I tell them, ‘You realize that’s not normal.’ ”
Kiecker said all chiropractors who pass their national board exams are taught how to diagnose and treat BPPV.
An inner ear issue
Vertigo can be a sign of a serious illness or condition, such as a stroke or aneurysm, and Dr. Susan Mathison, an ear, nose and throat specialist at Catalyst Medical Center in Fargo, said a person should call for help or seek a doctor’s advice if vertigo doesn’t go away.
One major difference with BPPV is that vertigo happens only in certain positions and for short periods of time.
“If you settle down, it will go away,” Mathison said.
BPPV is sometimes brought on by head trauma, but often begins innocently enough when a person looks up at a high shelf in a store or rolls over in bed, or in my case, sits up from a salon chair.
Mary Jo Wagar, a physical therapist at Sanford Health Southpointe in Fargo, said she sees several patients a week with BPPV, and more often than not, they simply woke up with it.
“Lots of things can make people dizzy, but positional vertigo is pretty specific,” she said.
In the inner ear, complex mechanisms of canals, fluids, jelly-like material, tiny hair cells, nerves and crystals all work together to help us detect motion, keep our balance and determine our orientation in space.
Wagar said BPPV occurs when those tiny crystals detach or slough off and find their way into one of three semi-circular canals we have in each ear – a place they don’t belong.
“It messes up that normal trigger to your brain,” said Wagar, prompting what can be an intense bout of vertigo.
Some people become nauseated and vomit due to the sensation, especially those who tend to get motion sickness.
“The bottom line, you feel so miserable when it’s happening that you want help,” Mathison said.
Tests and treatment
A medical professional can test for BPPV in their office by holding the patient’s head and having them lie back on a table quickly, with head tilted to one side and slightly lower than the shoulders.
They immediately watch for nystagmus, or rapid, involuntary movement of the eyes and a sensation of dizziness that subsides while the patient is held in position – both telltale signs of BPPV.
If the condition is confirmed, a simple procedure known as the Epley maneuver, or canalith repositioning, can be done.
It’s similar to the test for BPPV, but involves an additional rolling of the body to one side, while the patient’s head is held in position.
“We’re trying to get the crystals to come out of that canal and settle in where they won’t bother,” said Wagar.
The maneuver is done three or four times, with the dizziness becoming less intense each time.
“About 85 percent of the time, people are better in one session,” Wagar said.
Others may require a few follow up sessions or in some cases, are given a revised maneuver they can do at home.
Mathison reminds her patients to sleep in a recliner for two nights after treatment and to take it easy for the next week.
“We don’t want them tipping back in exaggerated positions until those crystals are settled back in the jelly-like layer (of the ear),” Mathison said.
Kiecker said if a patient doesn’t get full relief from the Epley maneuver, a different procedure known as Brandt-Daroff exercises can also work.
Even when the dizziness clears, the patient can have a leftover “foggy” feeling, which I had for a couple of days.
Mathison said it’s not surprising when you think of all the electrical activity happening in those neurons while the brain is spinning.
“I’m sure they get very tired,” she said.
Once you’ve had positional vertigo, you may be more prone to getting it again, but patients shouldn’t get discouraged.
“BPPV, though awful, has a high success rate for going away,” Mathison said.
Readers can reach Robin Huebner at firstname.lastname@example.org. Huebner is also a 5 p.m. news anchor on WDAY-TV.