When you get out of bed, turn around, or look up, do you suddenly feel like the whole world is spinning around you? At that time, you can't even stand up, and you feel very uncomfortable, along with a feeling of nausea. Although this dizziness subsides in a few minutes, the fear you feel at that time is great. Many people have had similar experiences. So today, let's talk about the main cause of this and the simple test that doctors use to diagnose it.
Why does my head spin like this? What is BPPV?
The main and most common cause of this sudden dizziness is a condition called Benign Paroxysmal Positional Vertigo . We call it (BPPV) for short. Although the name is a bit long, the meaning is very simple.
- Benign - This means that it is not dangerous or life-threatening. It is not something like cancer.
- Paroxysmal - means it starts suddenly and subsides spontaneously after a while.
- Positional - This means that it occurs when the head position changes.
- Vertigo - refers to the dizziness we know.
Simply put, BPPV is a non-threatening condition that occurs suddenly and then subsides after a short period of time when the head is moved.
Okay, now let's see why this happens. Inside our ear, the inner ear, there is a very sensitive part that controls the balance of the body. Inside this are very small calcium carbonate crystals. Think of them as grains of sand. Normally, these crystals are arranged in an orderly manner in the places they should be.
But sometimes, as we age, when we get a little bump on the head, or for no reason at all, some of these crystals can slip out of place and into a system of channels (`Semicircular canals`) that are responsible for balance. Now imagine that there are some small pebbles in a bottle of water. When you shake the bottle, those pebbles move back and forth, stirring up the water, right? Similarly, when you shake your head, those crystals that have gone to the wrong place also move back and forth, collide with the fluid inside those channels, and send a false signal to our brain that "you are dizzy now." Even though we are not actually dizzy, the brain believes that signal, so we feel dizzy. That's what happens in BPPV.
So, how does a doctor accurately diagnose whether you have BPPV?
If you have this type of vertigo, when you go to see a doctor, he or she should make sure that you really have BPPV or that it's vertigo caused by something else, because there can be other causes of vertigo.
The main and most accurate test used by doctors around the world to diagnose BPPV is the Dix-Hallpike Maneuver . This is a very simple test that has been used since 1952 and does not use any machines or drugs.
In this test, the doctor carefully turns your head in a series of specific positions. When you do this, those displaced crystals that we talked about earlier start to move again. When that happens, you feel dizzy, and your eyes start to move in a special way. The doctor looks at that movement.
How to do the Dix-Hallpike test step by step
You might be scared when you hear this. " Oh , are you shaking your head like you're dizzy?" But there's no need to be scared . The doctor does this very carefully and with your head completely under his control. This only takes a few minutes.
| Steps | What is happening? |
|---|---|
| Step 1: Sitting | You will be made to sit upright on the exam table with your legs spread out. |
| Step 2: Head turning | The doctor will turn your head about 45 degrees to the right or left. At this time, you will be asked to keep your eyes open. |
| Step 3: Lie down quickly | Next, with your head in the same position as you turned, the doctor will quickly lay you down on the bed, holding your head and shoulders. Here, your head will be slightly raised off the bed, meaning your neck will be slightly bent. But since the doctor's hands are supporting the entire weight of your head, you won't have any discomfort. |
| Step 4: Monitoring | The doctor will hold you in that position for about 30 seconds, and look closely at your eyes. You may feel dizzy during this time. Also, if you have BPPV, your eyes will move rapidly (back and forth) in an uncontrollable manner. This is called nystagmus . |
| Step 5: Sitting back and checking the other side | Then you are carefully seated again. Wait until the dizziness subsides, then turn your head to the other side and do the same test, because these crystals can be in the right or left ear. |
What is Nystagmus?
This is the main sign that confirms BPPV. When you tilt your head back like that, the inner ear crystals move and send incorrect signals to the brain, and in response, your eyes start to beat rapidly. It's like a clock ticking. You can't stop it. If your doctor sees this, he can be almost 100% sure that you have BPPV.
Are there any risks with this test?
The Dix-Hallpike test is generally very safe . However, if you have a neck injury, back pain, or have recently had a stroke, your doctor may decide to skip the test or perform a modified version.
For example, you can do this by placing a pillow under your shoulders and resting your head on the bed. This way, there is no pressure on your neck. Be sure to tell your doctor if you are pregnant. He or she will do everything in the safest way possible for your condition.
What are the results of the test?
The biggest advantage of this test is that you can know the results immediately. You don't have to wait for days for the report to come. The result can be either "Positive" or "Negative".
If Dix-Hallpike Positive...
This means that you have been diagnosed with BPPV . This is good news! Because BPPV is a condition that can be almost completely cured without medication, with a simple exercise program.
If the test is positive, most of the time the doctor will treat you right away. The technique used for this is called the Epley Maneuver . This is similar to the Dix-Hallpike, where you turn your head in different positions. But the goal of this is to move the crystals that have gone to the wrong place back to where they should be.
If Dix-Hallpike is negative...
This means that your dizziness is not caused by BPPV. It means that there may be another cause. At that time, your doctor will refer you to other tests based on your symptoms to try to find the exact cause of your dizziness.
Dix-Hallpike and Epley Maneuver - What is the difference between the two?
Many people get these two names confused. Although both are related to BPPV, they have different functions.
| Characteristic | Dix-Hallpike Maneuver | Epley Maneuver |
|---|---|---|
| Main objective | Diagnosis - Finding out whether you have BPPV or not. | Treatment - Repositioning the crystals to correct the BPPV condition. |
| When will it be done? | When symptoms occur, the first thing to do is to find the cause. | The Dix-Hallpike test is done after it is "positive". |
| Result | Confirming the disease or not. | Relief of symptoms, disappearance of dizziness. |
Very important: Never try to do this test yourself at home. This should only be done by a trained doctor. Doing it incorrectly can cause damage to the neck and lead to a misdiagnosis.
Sometimes, after your doctor has confirmed that you have BPPV, they may teach you how to do the Epley Maneuver at home. But that should only be done under your doctor's supervision.
The Dix-Hallpike Maneuver is a very effective and simple method that has been used to diagnose BPPV for over 70 years. Although it does not cure the condition, it can help you find the exact cause of your vertigo and start the right treatment. So, if you have these symptoms, don't hesitate to see a doctor and talk about it.
Take-Home Message
- The most common cause of sudden dizziness when moving your head may be BPPV (Benign Paroxysmal Positional Vertigo).
- BPPV is a non-threatening condition caused by the displacement of small crystals in the inner ear.
- If your doctor suspects you have BPPV, the main test to confirm it is the Dix-Hallpike Maneuver.
- This is a very safe test that can be done in just a few minutes. You may experience slight dizziness during the test.
- If nystagmus (involuntary eye movements) occurs during the test, it is strong evidence of BPPV.
- Never attempt to perform this test at home on your own. It should always be performed under the supervision of a doctor.
- The treatment for BPPV is another simple procedure called the Epley Maneuver, which can often be done on the same day as the test.
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