Ask the doctors: Understanding vertigo and the epley maneuver

Dear Doctors: I had such a bad attack of vertigo that my boyfriend drove me to urgent care. The doctor got it to go away by having me lie down and then moving my head around. Why did I have that episode of vertigo, and why did that treatment help?

Dear Reader: Vertigo is the sudden onset of a sensation of spinning or whirling. It can feel like the environment around you is in motion, or that your own body is spinning through space. The resulting dizziness can be so intense it often causes nausea.

Most episodes of vertigo arise from problems with the delicate mechanisms of the inner ear, which aid in balance. This is known as peripheral vertigo. Less common is central vertigo, which involves the brain. This classification of vertigo can arise due to physical injury or trauma, migraine, infection, cancer or stroke. Vertigo can also be a side effect of certain medications.

From your description of the treatment you received, it appears you had an episode of what is known as positional vertigo. The full medical term is benign paroxysmal positional vertigo, or BPPV. It is the most common cause of episodes of vertigo. Although it can be extremely uncomfortable – and often frightening – BPPV is not life-threatening. However, it can adversely affect quality of life. The dizziness it causes can also increase the risk of falling, which is a leading cause of fractures in older adults.

To understand what happened, we need to talk about the vestibular system. This is a tiny but remarkably complex set of fluid-filled structures, receptors and neural pathways located in the innermost part of the ear. Working together, the components of the vestibular system help you sense motion and detect positional changes. The brain uses this information to calibrate the physical responses needed for movement and balance.

Among the elements of the vestibular system are miniscule calcium crystals, which help convey the sensation of motion. If these crystals become dislodged, tilting the head quickly can cause them to drift out of position. This leads to the delivery of faulty data to the brain, which in turn causes the spinning and whirling symptoms of vertigo.

When your doctor manipulated the position of your head, she was using the Epley maneuver. It is named for the physician who pioneered it. The treatment involves a precise rotation of the head, with the goal of redistributing the dislodged crystals. First, the person’s head is placed in a position that triggers vertigo. They will then lie down and, with the nape of the neck at the edge of the exam table, make a slow 180-degree turn of the head.

The next step is to reposition the body so that it aligns with the head. The person will then be asked to return to an upright position. Although not physically risky, the maneuver can briefly intensify the symptoms of vertigo, and it can cause nausea or even vomiting. In most cases, the Epley maneuver resolves positional vertigo. If not, one or more repeats of the procedure may be needed.

Send your questions to askthedoctors@mednet.ucla.edu.