From the Guidelines
Vertigo is most commonly caused by Benign Paroxysmal Positional Vertigo (BPPV), and its symptoms typically last less than one minute, triggered by head position changes, making it unusual for BPPV symptoms to persist for several minutes while sitting still. The causes of vertigo can be attributed to various conditions, including vestibular neuritis, Meniere's disease, vestibular migraine, and central nervous system disorders, in addition to BPPV. BPPV occurs when calcium crystals in the inner ear become dislodged and move into the semicircular canals, disrupting normal balance signals, as explained in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
Common Causes of Vertigo
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular neuritis
- Meniere's disease
- Vestibular migraine
- Central nervous system disorders
According to the patient information: frequently asked questions section of the clinical practice guideline: benign paroxysmal positional vertigo (update) 1, BPPV is characterized by brief episodes of vertigo triggered by movement, and it would be unusual for symptoms to persist for several minutes while sitting still. If vertigo symptoms last longer or occur without position changes, this suggests another cause such as vestibular neuritis, Meniere's disease, or a central nervous system disorder.
Diagnosis and Treatment of BPPV
- Diagnosis is typically made through simple bedside testing, such as the Dix-Hallpike test or supine roll test, which involves moving the patient's head into a position that triggers the vertigo symptoms 1.
- Treatment usually involves canalith repositioning procedures, which have high success rates and can be performed in a few minutes, with some patients experiencing brief distress during treatment but significant improvement in symptoms afterwards 1.
Anyone experiencing persistent vertigo should seek medical evaluation for proper diagnosis and treatment, which might include canalith repositioning procedures for BPPV, medications for symptom management, or vestibular rehabilitation exercises depending on the underlying cause, as the inner ear contains fluid and sensory cells that detect head movement and position, sending signals to the brain for balance maintenance, which explains why disruptions to this system result in vertigo symptoms 1.
From the Research
Causes of Vertigo
- The causes of vertigo can be categorized into four broad groups: otological vertigo, central vertigo, psychogenic vertigo, and undetermined or ill-defined causes of vertigo 2.
- Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and bilateral vestibular paresis 2.
- Central vertigo includes entities such as vertigo associated with migraine and certain strokes 2.
- Psychogenic vertigo occurs in association with disorders such as panic disorder, anxiety disorder, and agoraphobia 2.
Symptoms of BPPV
- Benign paroxysmal positional vertigo (BPPV) is a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position 3.
- The symptoms of BPPV are typically triggered by specific head movements and last for a short duration, usually less than 30 seconds to 1 minute 3, 4.
- However, it is not common for symptoms of BPPV to last for several minutes when a patient sits still, as the condition is typically characterized by brief episodes of vertigo 3, 4.
- The Epley maneuver, a canalith repositioning procedure, is a safe and effective treatment for posterior canal BPPV, and can help to resolve vertigo symptoms 3, 4.