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How can benign positional vertigo be managed?

Q: I am a 36 years old male suffering from vertigo for the last three weeks. For eight days, I have taken Vertin (16 mg). The symptoms are head heaviness, difficulty in reading and concentrating. I feel as if everything is spinning around when I look down or change positions in bed. The doctor told me that everything is normal and it was benign positional vertigo. X-ray of cervical spine and MRI brain are normal. How can vertigo be managed?

A:Benign Positional Vertigo is a very common condition. Though it is very scary to have vertigo, the word "benign" itself means that this condition does not progress, and does not endanger life or cause any physical debility like paralysis.

Inside each ear, there are three curved tubes (semicircular canals) filled with fluid, aranged one in each dimension. The fluid within the tubes moves in the opposite direction of the head movement. The movement of this fluid generates impulses that give our brain the exact information of the position of head. This is very important and crucial for balancing oneself. Most of us will remember that when one rotates around oneself and suddenly stops, the surroundings still appear to be revolving around. This is because the fluid inside the tube will keep on moving due to its physical properties.

Similarly, when the fluid is thickened or has some solid matter as precipitate inside the tube, it moves slowly, and that confuses the brain about the head position, thus resulting in vertigo or "spinning" sensation. The most common cause of such thickening is age, though allergies (cold, dust, medicines, pollen etc.) and infections also can cause similar vertigo. In many cases, an identifiable cause may not be found. All these types of vertigo tend to worsen with stress, lack of sleep, moving fast, fever, fasting.

Sometimes, such vertigo can also start after a head injury. However, there are certain dangerous medical conditions which may mimic Benign Positional Vertigo, and these should be ruled out by proper medical examination and relevant investigations. Some of these include blockage of blood circulation in the lower parts of brain, tumors in this region or on the nerve that carries hearing sensation, blood vessel abnormalities in the brain, low blood pressure etc.

In addition to vertin (try 24 mg Three times a day), it is advisable to take a mild sedative (e.g. clonazepam 0.25 mg or diazepam 2 mg twice a day) for a week, with bedrest. Once the vertigo subsides, a special set of exercises to treat vertigo can be learnt from a trained physiotherapist, and continued.

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