Vertigo case file

Epley manoevres

Vertigo case file is a nasty condition that responds to the Epley manoeuvres.

This page was last updated by Dr Barrie Lewis on 9th November, 2019.

It never rains but it pours. Whilst in Holland in full time practice I would treat at least one or two patients a week with vertigo, using the Epley manoeuvres. But now in semi retirement, it is probably 2 to 3 months since I have had a case.

Yesterday, we had two consecutive patients with the awful vertigo. One described the world as spinning, the other that it felt like she had water sloshing about in her head. In both cases, the classic neurological test for vertigo, known as the Hallpike Dix test was strongly positive.

Lying them rapidly down on their sides with the head in slight rotation and extension instantly produced giddiness and, looking at their eyes, they were spinning in the classic feature known as nystagmus.

Vertigo with the associated giddy feeling is a nasty condition in which small crystals come loose in the inner ear, blocking the movement of fluid in one of the semi circular canals. When the balance organs in right and left ears do not agree about whether the head is motion or not, vertigo ensues. 

Drugs are not the treatment of choice; the Epley manoeuvres are and are extremely effective. By the time we had been through the Epleys three times, both cases  had no further nystagmus.

If usually needs to be repeated for a few days.

Suffering from vertigo? Don't take pills, look for a chiropractor who knows about the Epleys. Tip: Don't let him or her adjust your neck at the same consultation. I learnt the hard way; a patient once vomited in the clinic for over two hours.

Here you can see an animated version of nystagmus on Youtube.

Vertigo case file

A vertigo case file remember are not research.

The first lady was elderly. It took 5 to 6 sessions of the Epleys done under my instruction by her daughter at home over a period of about a week to fix the vertigo completely.

Epley Manoeuvres

The Epley manoeuvres are the treatment of choice in every vertigo case file.

She also has chronic lower neck pain. A week later she returned for a follow up. Hallpike Dix test was negative and so I was able to adjust her neck without qualms. I resolutely won't adjust a patient's neck if they are suffering from vertigo, and have a spinning eyes; not until until the test is negative.

Why is that? Firstly research shows that dizziness is the one condition where chiropractors need to tread warily when adjusting the cervical spine.

Whilst it's only happened once, my experience has confirmed it. That patient started immediately throwing up for three hours after adjusting her neck and doing the Epley manoeuvre; it scared the heck out of me. You've probably heard of stroke chiropractic; it's extremely rare but it can happen. Fortunately it didn't.

Remember that any vertigo case files are only anecdotes and, as such have no scientific value; but there is a heap of research confirming that these are not blowing in the wind.

The difficulty is that sometimes a subluxation in the neck is the cause of the vertigo. But then Hallpike Dix will be negative. It is holy ground, and we have to be careful. Mind you, cervical manipulation should never be done in a casual or careless manner.

The second patient was cured within three treatments of the Epleys; this time it was a woman in her early sixties. Under my instruction, her husband continued the treatment at home, and it displaced those offending crystals within two more days.

She too has neck problems, not the cause of the vertigo. She too returned after a week for her neck adjustment. It needs to be very carefully done; gently.

Benign paroxysmal positional vertigo, the etiology of 70 percent of vertigo, is caused by crystals coming loose in one of the semicircular canals in the inner ear. When the eyes receive mismatched signals from the two inner ears, vertigo is the result. And it can be very severe with extreme nausea and vomiting, and falling over; not nice, to say the least. 

Research shows that the Epleys, not drugs, are the treatment of choice.

What's more, get up and move around, despite the discomfort. Extended lying in bed only aggravates the condition. Use a stick if necessary and remain close to the furniture and walls; falls are not uncommon and then you may have a broken hip to add even more excitement to your own vertigo case file.

Nystagmus eye movements during an attack of vertigo.

Home remedy for vertigo

Home remedy for vertigo will help as this condition tends to reoccur; once you know these exercises you can do them regularly as prevention; it's a horrible condition and to prevent recurrence of vertigo case file, do these regularly.

Brandt Daroff exercise

Brandt Daroff exercise for vertigo who have been developed for you to do at home; they might just save you from becoming a vertigo case file in some chiropractor's office.

If you have a serious attack of vertigo, then it's probably best not to start messing around with a home remedy for vertigo; unless you've had previous episodes and are familiar with what's happening. See lower down for the link to what you can do at home to help yourself.

This routine known as the Brandt Daroff exercises can be very useful in the prevention of further attacks.

Vertigo is a serious disturbance of the neurological system and really should be cared for by a practitioner familiar with the Epley manoeuvres and the Brandt Daroff exercises.

That may not be your medical doctor who will most like want to prescribe Stugeron, and nor your chiropractor too; she or he may want to adjust your neck and that is definitely not the treatment of choice, at least not in the acute phase.

Finally, a short summary about your own vertigo case file. Remember that 70 percent of the time this is a completely benign, albeit nasty condition. It responds usually to a very specific set of movements of the head; in fact, what you are really doing is turning the semicircular canals to dislodge the offending crystals.

If you have high blood pressure and particularly if you have previously had a temporary ischemic attack, then your first port of call should probably be your medical doctor to rule out a stroke.

That's also true if you have just had an upper respiratory attack; a cold, flu or sinusitis.

Finally there are some important things you can do to help yourself. Do not lie in bed; don't take medication and I recommend not allowing your chiropractor to adjust your neck in the acute phase, and perhaps not at all. Find a practitioner skilled in the Epley manoeuvres  and the Brandt Daroff exercises.

Be careful; you may fall and break a hip.


› Vertigo case file


Stones in my clog is chiropractor Bernard Preston's third book of anecdotes, this one from the polders of Holland. That's where he learnt the Brandt Daroff exercises. Home remedies for vertigo are vital for folk who suffer from this nasty affliction.

Don't in the first instance have your neck adjusted is Preston's advice. Think rather of the Epley manoeuvres.

Stones in my Clog cover has several stories about vertigo.

Vertigo case files are common in any busy chiropractic practice.

In one memorable case in the Netherlands, I literally lost all my cudos; to make it worse, it was shown live on regional television. Not one of those days that one remembers fondly in life, but it certainly gave me something to write about in my third book of Chiropractic anecdotes, Stones in my Clog.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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