Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV)

Abstract

(A) Any disorder of the central nervous system (CNS), (B) migraine, (C) active Ménière's disease, and (D) severe eye disorders. Symptom questionnaire ('yes or no' answers during a personal interview) and Dizziness Handicap Inventory (DHI) were used. Results We included 69 patients (20 males and 49 females) with a median age of 45 years (range 21-68 years). The median duration of the disease was five years and three months. The video-oculography confirmed BPPV in more than one semicircular canal in all patients. In 15% there was a latency of more than 1 min before nystagmus occurred. The Dizziness Handicap Inventory (DHI) median score was 55.5 (score >60 indicates a risk of fall). Seventy-five percent were on 50-100% sick leave. Eighty-one percent had a history of head or neck trauma. Nineteen percent could not recall any history of trauma. In our cohort, nautical vertigo and dizziness (81%) was far more common than rotatory vertigo (20%). The majority of patients (87%) reported pain as a major symptom: neck pain (87%), headache (75%) and widespread pain (40%). Fatigue (85%), visual disturbances (84%), and decreased concentration ability (81%) were the most frequently reported symptoms. In addition, unexpected findings such as involuntary movements of the extremities, face, neck or torso were found during otolith repositioning maneuvers (12%). We describe one case, as an example, how treatment of his BPPV also resolved his chronic, severe pain condition. Conclusion This observational study demonstrates a likely connection between chronic BPPV and the following symptoms: nautical vertigo/dizziness, neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. Implications Patients with complex pain conditions associated with nautical vertigo and dizziness should be evaluated with the Dizziness Handicap Inventory (DHI)-questionnaire which can identify treatable balance disorders in patients with chronic musculoskeletal pain.

Neck pain associated with clinical symptoms in dizzy patients—A cross‐sectional study

“…Studies have found patients with dizziness to have physical impairments (Iglebekk, Tjell, & Borenstein, ; Kvale, Wilhelmsen, & Fiske, ). Our study showed that patients in the DO group had increased physical impairment, including decreased CROM, neck and shoulder flexibility and a lower PPT in the neck, compared with healthy controls, indicating that patients with only dizziness (and not neck pain) have reduced physical function, which is usually explained by avoidance behaviour due to fear or anxiety of movement (Godemann, Schabowska, Naetebusch, Heinz, & Strohle, ; Lahmann et al, ).…”

“…Patients in the DN group were more likely to report a rocking sensation. A rocking or floating sensation, although describing illusory movement, has previously been associated with chronic types of dizziness (Fife & Kalra, ; Iglebekk, Tjell, & Borenstein, ) rather than ongoing vestibular dysfunction. Patients in the ND group were less likely to report a spinning type of dizziness, compared with those in the DO group.…”

“…Dizziness and neck pain are both common complaints with negative impact on work productivity and use of health-care resources (Benecke, Agus, Kuessner, Goodall, & Strupp, 2013;Hurwitz, Randhawa, Yu, Cote, & Haldeman, 2018;Neuhauser et al, 2008). Previous studies have shown that concurrent dizziness and neck pain are common in both patients with dizziness (Iglebekk, Tjell, & Borenstein, 2013;Wilhelmsen, Ljunggren, Goplen, Eide, & Nordahl, 2009) and patients with neck pain (Humphreys, Bolton, Peterson, & Wood, 2002) as their presenting complaint. Dizziness is a complex symptom, and in the absence of other diagnosis or explanations, concurrent neck pain is sometimes suspected to play a role.…”

Patient-reported outcomes measured with and without dizziness associated with non-specific chronic neck pain: implications for primary care

“…Dizziness is considered a common and challenging condition that is observed in primary care settings and has often been reported as one of the major symptoms associated with NSCNP (Wipperman, 2014; Iglebekk, Tjell & Borenstein, 2017). In addition, patients with NSCNP may suffer from cervicogenic dizziness with a frequency similar to patients who suffer from cervical spine degeneration and whiplash (Wrisley et al, 2000; Treleaven, Jull & Sterling, 2003; Kristjansson & Treleaven, 2009; Hain, 2015).…”

Efficacy of integrating vestibular rehabilitation and cognitive behaviour therapy in persons with long-term dizziness in primary care– a study protocol for a randomised controlled trial

“…This fear of provoking dizziness and discomfort may also lead to an "en block" movement pattern. Some studies on persons with persistent dizziness have also reported musculoskeletal symptoms (8), like for instance postural disalignments (9) and musculoskeletal pain (10), particularly in the neck-shoulder area (10)(11)(12). Longterm consequences of such avoidance strategies may hamper compensation strategies and functional improvements, eventually leading to occupational disability (13).…”