Evaluating Benign Positional Vertigo

QUESTION: I have a problem that has been with me for some time now. I get a
feeling that the whole world is spinning, usually when I am getting out of bed
in the morning. That's the worst time, although I can also feel this way when
I get out of a chair or a car that I have been riding in for some time. I
have no other symptoms with this, but am afraid of what the doctor may tell
me. Could I have your opinion first, please? I am a young woman of 71 years.
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ANSWER: Your description of your condition is very helpful, but without the
physical examination that your own physician will be able to conduct, my
opinion is really nothing more than an educated guess, but for what it is
worth here it is. You are describing a true vertigo, a sensation that
everything is moving about you, rather than that you had an episode of
dizziness (which would lead me to another conclusion). They have occurred
repeatedly, over a period of time, yet nothing else has happened, no other
complaints or additional symptoms, so it doesn't sound like a condition that
is getting worse or progressing. I believe you suffer from Benign Positional
Vertigo. It is common in young women of your age, or in people who have
suffered a head injury. It will only occur when you change a position, and
shouldn't last for more than a minute or two if you remain still. What is
lacking for my evaluation is to observe your eye movements while all of this
is going on. Your own physician may be able to provoke the sensation using a
technique called the Hallpike Maneuver (he is the doctor who discussed these
conditions over 35 years ago). By rapidly moving you backward while you are
sitting on the examination table, so that your head extends past the end of
the table and hangs downward at a 45 degree angle, and then turning your head
to the left, your symptoms may be provoked, and the movement of your eyes
observed. If nystagmus occurs (a rapid involuntary movement of the eyeballs,
in this case in a circular pattern) it is most probable that my diagnosis is
correct, and that you have nothing to fear. A series of exercises may be all
you need to reduce your problem considerably, and without the anxiety it has
caused, you will probably feel much better indeed.