Why am I dizzy? Is it BPPV?

Someone recently asked, “Do any medications cause vertigo?”

The answer depends on what you mean exactly. Many medications can cause dizziness. This can be the light headedness associated with blood pressure medications to the woozy feeling from narcotics to the sleepy feeling of sedatives. However, vertigo (spinning dizziness) is not often caused by medication unless damage is being done to the organ of balance in the inner ear.

In some cases damage can be temporary or it can be permanent. Some medications selectively target the balance portion of the inner ear and some target the hearing portion. The effects can either be permanent or may go away when the drug is stopped.

So yes – some medications can cause vertigo.

Of all drugs aminoglycoside antibiotics are the most vestibulotoxic (ex gentamicin) and are irreversible. Gentamicin in particular effects only the balance portion of the inner ear and causes vertigo.

Loop diuretics such as furosemide (Lasix) cause reversible ototoxicity, but often affect hearing.

Antineoplastic drugs such as cisplatin cause irreversible ototoxicity (typically they affect hearing only)

Salicylates such as asprin can cause reversible ototoxicity.

Quinine, which was historically used to treat malaria, can cause both vertigo and hearing loss.

Of course these comments are to be taken in a general context and any drug related concerns should be discussed with your own doctor.

Can I do the maneuver more than once a day? The short answer is “Yes” you can.

However, usually in active BPPV you get dizzy during the maneuver. Many people find this repeated vertigo too much to do again and again. Usually BPPV causes nausea but not vomiting, unless of course you induce the vertigo over and over by repeating the maneuver.

This is the reason I suggest you only do it once or twice a day.

Further, it is not know if multiple maneuvers within a single day is actually more effective than a single maneuver as there is something called fatigue. Fatigue is when, despite the BPPV still being there, you are no longer able to make yourself more dizzy. Perhaps this is something like riding a roller coaster again and again. Eventually it won’t make you sick anymore in the same day. The Nystagmus (eye motion seen by your doctor when you are dizzy) also fatigues so it is difficult to tell much when you have repeated the maneuvers several times. As such some doctors will perform the maneuver up to 3 times in hopes of it being more effective, but there is no evidence for the same day, others will do it only once in a day. There is evidence that a second maneuver ( at a later date) will increase the success rate of the treatment from about 80% to 90%. This is one of the reasons using a self treatment device is useful. You can repeat the maneuver at home and increase your success.

We usually recommend 1-2 times per day for 1 week (or less if there is no more vertigo during the maneuver). If there is still vertigo after 1 week then do the other side. If there is still vertigo after appropriately treating both sides then consult with your physician again about the cause of the dizziness.