Benign Paroxysmal Positional Vertigo and Ayurveda

Sometimes I get interesting questions from post graduate EIVS Ayurveda students. I usually post these on a separate blog http://ayuranswers.wordpress.com/ but have included this recent post because it might interest readers of my Ayurveda & Life Blog.

Student Question:

I have a client who had a bad reaction to a massage ten days ago and is still suffering, and I am unable to advise her…

She is a vata-pitta, in her 50s, menopausal. I did a Vata massage, plus facial massage. She was completely relaxed but as soon as she sat up was very dizzy. It seemed to start when the ears were massaged. She has low blood pressure and a history of poor balance and dizziness and says she is very sensitive to treatments. This is what she said the next day:

It was a lovely relaxing massage with you yesterday until I sat up. Since then I have spent the past 24 hours in bed so dizzy and nauseous that in certain positions when I open my eyes I get a kind of zig zag of dizziness in my eyesight and am finding it difficult to keep my balance. Together with extreme tiredness and slurring of speech. Strangely enough this all seems to be coming from the left side of my body and is worse when I turn to the right.

Has this ever happened before from giving massage? I have been known to have extreme effects from acupuncture before. This is also similar to allergy effects that I used to get more than 20 years ago and would spend 2-4 days in bed with dizziness.

I thought the nausea could be toxins but she relates it to the dizziness. Because of the slurring speech I referred her to a doctor, but they found nothing wrong. (The speech is OK now.) She is often tired after the massage but it usually passes. This time she actually spent five days in bed, and has not been able to work or drive since (ten days ago). She is now wondering if it’s a trapped nerve and is seeing an osteo, but not till next week.

What do you think has happened? Have you seen this before? Is there anything I can advise? (Fortunately she is a regular client and doesn’t blame me at all! But we both want to understand more.)

Alex’s Answer:

I assume you have read a little about vertigo and that she has gone through thorough medical assessments to rule out any more serious underlying problems of the inner ear? Nausea and slurred speech can be due to the vertigo. Low blood pressure and menopause are both increased risk factors for vertigo so it is not surprising she has a history of dizziness.

I have found what I judge to be an excellent PDF* about the most common cause of Vertigo “Benign Paroxysmal Positional Vertigo”, how it happens, and what can be done about it. You will see how the description of what happens fits perfectly with the Ayurvedic view of high Vata causing separation of tissue, and then that tissue finding its way into a channel that it then blocks or slows down normal movement. This internal inner ear desiccation, to my mind, is coherent with the ideas of Vata Vriddhi, and Sama Vata (hard crystalized particles that gum up the works!). If it were my patient, I would hand them the attached PDF and get them to meet their GP with it in their hand. The head movement exercises seem like a logical choice.

She obviously is not in a good underlying state of health, and her Doshas were balancing on the brink of aggravation. Vata is of course stimulated when we give massage, and yet at the same time Vata relaxes or lets-go. So tension in the Srotas is released and flow is encouraged. Ama and Kapha is also liquefied. I think that the combination of lying on her back for 1-2 hours, plus the stimulating yet relaxing effect on Vyana Vayu caused the calcium carbonate crystals called otoconia (ear stones) to break free from the utricle (a balance organ in the inner ear) and float into the semicircular canals, where they remain trapped and interfere with the normal function of the balance canals. However, even just relaxing and lying on ones back for a while could have brought on the release and movement of the ear stones into the posterior channels.

She is most likely suffering from a global Vata Vriddhi, signs of dryness etc? If this is the case, she should consider performing daily Snehana to her head via ears (drops of olive oil), nose (Nasya with e.g. Bramhi Taila) and mouth (Gandusha Snehana). She should also correct or compensate for any underlying Vata Vriddhi such as global dryness and deficiency with a Vata balancing diet and lifestyle. In particular, we would want to cleanse and increase her volume of Rasa Dhatu globally.

I would also recommend use of an appropriate but lower dose of either Ginkgo biloba or Valeriana officinalis (both are effective treatments for vertigo). Since treatment is for head, best time to take the herbs is before sleeping. Since the Dhatu medium is liquid / inner ear, we are targeting mainly Rasa Dhatu and Kledhaka Kapha, so we would consider a liquid preparation most effective (tea or decoction depending on the plants used). It may also be useful to use one of these plants in tincture form for 2-4 weeks for faster action. I would advise long term use (minimum 3 months) of Ginkgo along with other Dosha/Prakriti appropriate cerebral tonics. Vāta types should mix Ginkgo with Aśwagandhā (Withania somnifera) and Maṇḍukaparṇī (Centella asiatica) and Pitta and Kapha types with Maṇḍukaparṇī (Centella asiatica) for a brain tonic.

To summarise, assuming that the cause of dizziness or vertigo is Benign Paroxysmal Positional Vertigo, or Ayurvedically speaking Sama Vata / Rasa Gata Vata / localised dryness and ear stones in the inner ear, then the following treatment I would consider useful:

  1. Lifestyle to balance Vata in general and specific exercises to dislodge the ear stones (the canalith repositioning procedure (CRP) and the Semont liberatory maneuver).
  2. Local snehana (oleation) to head via ears, nose and mouth to cleanse and nourish Rasa Dhatu.
  3. Diet and herbs that reduce Vata, cleanse and nourish Rasa Dhatu, and treat vertigo.

Alex Duncan

*www.dbi.udel.edu/MichaelTeixidoMD/pdfs/BPPVhandout.pdf

Extract from the above PDF document

Benign Paroxysmal Positional Vertigo (BPPV) is a common type of dizziness caused by debris that has collected in the semicircular canals of the inner ear and that interferes with their normal function. This disorder increases in incidence with age, but may be seen in persons of any age.  In persons over the age of 50, about half of all dizziness symptoms are attributable to BPPV. In general, about 20% of dizziness is caused by BPPV and 9% of all older persons have BPPV.

The symptoms of BPPV include vertigo, light-headedness, disorientation, disequilibrium, imbalance and nausea. The most characteristic symptom of BPPV is a violent spinning which lasts for only 5 to 15 seconds. Activities which bring on symptoms will vary in each person but always involve movement or position changes of the head or body. A patient may be sensitive to certain position changes for days, weeks, or months. The strength of the symptoms tends to diminish before they disappear. Approximately 30% of patients experience recurrences of BPPV symptoms. The most characteristic provocative motions include rolling over in bed and tipping the head back to back to look up. Typical histories include severe bursts of vertigo which begin while using a hair dryer, when having hair washed in a beauty parlor, removing items from a top kitchen shelf or when looking up to change a ceiling-mounted light bulb. More constant non-episodic symptoms, such as chronic light-headedness or disequilibrium are also common, especially in individuals who carefully avoid all provocative movements and positions.

BPPV is caused by a displacement of tiny calcium carbonate crystals called otoconia (ear stones) from the utricle (a balance organ in the inner ear) into the semi-circular canals, where they remain trapped and interfere with the normal function of the balance canals. After otoconia are loosened, they are normally absorbed by special cells (dark cells) around the utricle where they arise. If too many otoconia fall off at once, they may find their way into the semi-circular canals before they can be absorbed. This typically occurs while the patient is lying down. The trapped particles continue

to move within the semi-circular canals after the head changes position, and cause the canals to send the brain inaccurate signals that the head is still moving. The result is bursts of severe vertigo brought on by changes in head position.

For BPPV to occur, otoconia have to be displaced from the utricle into the semicircular canals. More otoconia tend to fall off of the utricle as we age and off of a utricle which has been injured by a virus or migraine. BPPV is 3 times more common among patients with migraine. Otoconia are commonly shaken from the utricles in head trauma and even in high-impact fitness activities.

The most common form of BPPV comes from debris trapped in the posterior semicircular canal. This is the form illustrated above and in the animation below. Approximately 5% of patients may also have symptoms of BPPV from debris trapped in the horizontal semicircular canal. Even fewer patients have debris trapped in the superior semicircular canal. Most commonly, the horizontal or superior canals are affected in addition to the posterior canal.

Because BPPV is more likely to occur in a sick ear which may be causing symptoms of dizziness, the straightforward positioning symptoms of BPPV may not be easily recognized. Similarly, BPPV may continue to recur if the underlying trauma (e.g. migraine, high-impact exercise) is not recognized and treated or prevented. In cases with atypical findings and in which multiple balance system pathologies co-exist, a full diagnostic work up may be required in order to distinguish pathologies which will require different forms of therapy.

Also, this website gives a thorough treatment of the subject: http://www.dizziness-and-balance.com/disorders/bppv/bppv.html

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One thought on “Benign Paroxysmal Positional Vertigo and Ayurveda

  1. Please also see WebMD’s analysis and treatment – small crystals of calcium get loose in the inner ear and is the cause of BPPV. If the remedies suggested there solves your condition, do not sweat over this or make a mountain of a mole hill.

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