What is the diagnosis and treatment for vertigo, dizziness when moving my head, and nausea when standing up quickly?

Diagnosis and Management of Your Vertigo Symptoms

Most Likely Diagnosis: Benign Paroxysmal Positional Vertigo (BPPV)

Based on your symptoms of vertigo triggered by head movements and dizziness when standing up quickly, you most likely have BPPV, which is the most common cause of vertigo and is highly treatable with physical repositioning maneuvers rather than medications. 1

Key Diagnostic Features

Your symptoms strongly suggest BPPV because:

• Positional triggers: Vertigo occurs with head movements and position changes (rolling over, looking up, bending down) 1
• Brief duration: Episodes typically last less than one minute (seconds to a minute) 1
• No hearing loss: BPPV does not cause hearing loss, tinnitus, or ear fullness 1
• Nausea: Feeling sick is common with BPPV, especially during acute episodes 1

The dizziness when standing up quickly may represent orthostatic symptoms, which can coexist with BPPV 2

Confirmation Testing Required

You need a Dix-Hallpike maneuver performed by a healthcare provider to confirm BPPV. 1 This test involves:

• Moving from sitting to lying down with your head turned 45 degrees to one side 1
• Observing for characteristic spinning sensation and eye movements (nystagmus) 1
• A latency period of 5-20 seconds before symptoms start, with symptoms resolving within 60 seconds 1

First-Line Treatment: Canalith Repositioning Procedures

The Epley maneuver (canalith repositioning procedure) is the definitive treatment for BPPV, with 80% success rates after 1-3 treatments, and should NOT be treated primarily with medications. 1, 3

Why Repositioning Works:

• BPPV is caused by calcium crystals (otoconia) displaced in your inner ear canals 1
• The Epley maneuver physically moves these crystals back to their proper location 1, 3
• Success rates reach 90-98% when repeated if the first attempt fails 1

Why Medications Are NOT Recommended:

• Meclizine and other vestibular suppressants do not treat the underlying cause of BPPV 3
• Studies show repositioning maneuvers have 78.6-93.3% improvement rates versus only 30.8% with medication alone 3
• The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends AGAINST routine medication treatment for BPPV 3

Limited Role for Medications

Medications should only be used for SHORT-TERM management of severe nausea/vomiting, NOT as primary treatment. 4, 3

When Medications May Be Considered:

• Meclizine 25-50 mg: Only for severe nausea during acute episodes, used as-needed (PRN) rather than scheduled 4, 3
• Prochlorperazine 5-10 mg: For severe nausea/vomiting that doesn't respond to meclizine 4
• Duration: Maximum a few days, not continuous use 4, 3

Important Medication Warnings:

• Significant fall risk, especially if you're older 4, 3
• Drowsiness and cognitive impairment that interferes with driving 4, 3
• Delays recovery by interfering with your brain's natural compensation mechanisms 4, 3
• Anticholinergic side effects: dry mouth, blurred vision, urinary retention, confusion 3

Treatment Algorithm

Step 1: Confirm Diagnosis

• See a healthcare provider for Dix-Hallpike testing 1
• Rule out central causes if you have neurological symptoms (see red flags below) 1, 5

Step 2: Epley Maneuver

• Performed by trained provider 1, 3
• May cause temporary worsening of symptoms during the procedure 1
• Expect 80% resolution after 1-3 treatments 3

Step 3: Reassessment at 1 Month

• If symptoms persist, repeat Epley maneuver (success reaches 90-98% with additional treatments) 1
• If still failing after 2-3 attempts, consider alternative diagnoses 1

Step 4: Vestibular Rehabilitation

• If symptoms persist beyond repositioning attempts 6, 2
• Helps with residual imbalance that can last days to weeks 1

Red Flags Requiring Urgent Evaluation

Seek immediate medical attention if you have any of these symptoms, as they suggest central (brain/stroke) causes rather than BPPV: 5

• Severe headache, especially new or different from usual 1, 5
• Double vision or visual loss 1, 5
• Difficulty speaking (slurred speech) or swallowing 1, 5
• Weakness or numbness in face, arm, or leg 1, 5
• Severe imbalance or inability to walk 1, 5
• Vertigo lasting continuously for more than 24 hours 7
• Loss of consciousness (fainting) - this is NEVER from BPPV 1
• New hearing loss or tinnitus (ringing) - suggests Ménière's disease or other conditions 1, 8

Addressing Your Orthostatic Symptoms

The dizziness when standing up quickly suggests orthostatic hypotension, which requires separate evaluation:

• Have your blood pressure checked lying down and standing up 6, 2
• Stay well-hydrated 4
• Rise slowly from lying to sitting, then sitting to standing 2
• Review medications that might cause low blood pressure 1

Expected Timeline

• Immediate: Symptoms may resolve immediately after successful Epley maneuver 1, 3
• Days to 2 weeks: Residual mild imbalance is common and improves with time 1
• 1 month: Reassessment to confirm resolution 1, 4
• Recurrence: BPPV can return in some patients, but is retreatable with the same maneuvers 1

What NOT to Do

• Do NOT take meclizine or other vestibular suppressants as primary treatment 3
• Do NOT avoid movement - gradual return to normal activities speeds recovery 1
• Do NOT delay seeking care - BPPV is highly treatable and you don't need to suffer 1, 3
• Do NOT assume it will resolve on its own - while 20-80% resolve spontaneously over months, treatment provides immediate relief 1

Lifestyle Modifications

While awaiting treatment:

• Avoid sudden head movements temporarily 1
• Use caution with activities that require balance 1
• Sleep with head elevated 30-45 degrees for the first night after treatment 1
• Limit salt intake, caffeine, alcohol, and nicotine (especially if Ménière's disease is considered) 4
• Maintain adequate hydration and regular sleep 4