How wiggling your head can make you LESS dizzy

Every week Dr Martin Scurr, a top GP, answers your questions

RECENTLY I suffered from severe dizzy spells, which lasted three weeks. I had extreme vertigo when rising from lying down, bending forward or turning my head quickly. My doctor diagnosed benign positional vertigo.

I have been told there may be neck movements that may help my balance. Is there anything I could be prescribed? I am 81 and my blood pressure is normal. M. Taylor, Chatham, Kent. ALTHOUGH these episodes are frightening, please be assured that your condition is harmless, even if disorientating. Benign paroxysmal positional vertigo is the most common type of vertigo we see in general practice.

First, let me explain that when doctors talk of ‘ vertigo’, they don’t mean a fear of heights, officially known as acrophobia. Rather, they are referring to the feeling that the whole world is moving, even when it is not.

patients often compare it to the spinning sensation you experience when you jump off a children’s roundabout, although sometimes it feels like an overwhelming sense of dizziness or disorientation.

With benign paroxysmal positional vertigo, the sensation lasts for a few seconds or perhaps a minute, and is triggered by head movements. What distinguishes it from other forms of vertigo is that each episode is brief, and the patient doesn’t suffer from deafness or blockage in the ears, or tinnitus (ringing, whirring or buzzing in the ears).

This dramatic problem is caused by something quite simple: calcium debris — or crystals — collecting in the fluid-filled canals in the inner ear. Moving your head suddenly causes these calcium crystals to tumble through the canals.

The problem is that the inner ear is a key part of our balance system — and the movement of the crystals confuses it. It then sends incorrect signals to the brain telling it that the body is moving, even when it is not.

The result is a person suddenly feels as if the room is spinning, when, in fact, they are rooted firmly on the spot. Very often doctors will prescribe motion sickness pills, but this is not a treatment, only an attempt to suppress the feeling.

Far better to be treated with the epley manoeuvre — a series of head positions designed to shift these calcium crystals out of the canals in the inner ear.

This is usually performed by a trained physiotherapist or specialist in neuro-otology (neurology of the ear), and normally involves the patient lying on their back while the specialist moves the patient’s head from side to side. This treatment, which usually requires only one session, can provide instant relief if performed correctly.

There is an alternative series of head movements, called the Cawthorne- Cooksey exercises, which can be taught during a session with a specialised therapist.

These involve moving the head forwards and backwards and side to side, and are practised at home. If performed daily, these can ease the condition within days or weeks.

This is what I would advise for you, and hopefully your Gp has suitable contacts in the world of neuro-otology or physiotherapy to whom you can be referred. I HAVE had Crohn’s for most of my life and after a number of operations and excellent treatment on the NHS I am now reasonably well. I was told to expect arthritis, and did indeed suffer from this. Now, however, among other pains I have developed painful arms and hands. What could this be and is there any treatment?

J. Goodchild, High Wycombe, bucks. FIRST, let me congratulate you for stalwartly coping with your condition for so many years, for it is not a straightforward diagnosis to manage.

You have been correctly informed: arthritis may occur as part of inflammatory bowel disease — the umbrella term for a range of conditions including Crohn’s disease and ulcerative colitis.

Crohn’s is caused by the immune system malfunctioning and mistakenly attacking the tissues of the intestine. This damages the walls and lining of the gut, causing ulcers and bleeding.

The symptoms are abdominal pain, diarrhoea, fatigue and loss of weight. However, for reasons that are not completely clear, the immune system starts to attack the tissues of the joints, too.

As a consequence, arthritis occurs in between 10 and 50 per cent of those who suffer from Crohn’s disease, causing pain, swelling and stiffness. But, unfortunately, in addition to suffering from arthritis of the joints, Crohn’s patients may also develop arthritis of the spine, or ankylosing spondylitis.

This affects up to one in four of those with Crohn’s and causes inflammation around the bones in the base of the spine.

SYMPTOMS include stiffness and pain in the back, especially after a night in bed, and this is often relieved by getting up and getting going, or exercise. The pain can also spread down to the hands and arms, as you have experienced.

Although immune-suppressing drugs used to treat Crohn’s are also effective at reducing symptoms of the arthritis, they make little difference to spondylitis.

Ordinary non-steroid anti-inflammatories, such as ibuprofen and aspirin, may ease the pain, but might also worsen your Crohn’s, as they can damage the lining of the intestines. Therefore they should be used for short periods, days or at the most weeks, and in reduced doses.

I’d hope and expect that you are under the care of a specialised unit for your Crohn’s disease. They should be able to put you under the guidance of a rheumatologist who has the knowledge and experience to help you control this new development of your disease.