INFORMATION FOR WOMEN WHO HAVE BENIGN PAROXYSMAL POSITIONAL VERTIGO DURING PREGNANCY OR BREASTFEEDING
What is Benign Paroxysmal Positional Vertigo?
Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear that is characterized by the repeated occurrence of episodes of positional vertigo, a loss of balance that comes together with a feeling of rotation, or sliding when the person is not moving, that is set off by changes in the position of the head relative to the direction of gravity. Known in the past by various other terms, such as benign positional vertigo and paroxysmal positional vertigo, BPPV is not the same thing as dizziness. While the latter is a kind of off-balance feeling related to lightheadedness, vertigo specifically describes false or exaggerated sensations of motion. The most common reason for vertigo is BPPV, which is a problem specifically with one of three fluid-filled curved structures within the inner ear called semicircular canals. Usually (85-95 percent), the problem is in whats called the posterior semicircular canal, whereas most of the other cases involve the lateral semicircular canal (5 15 percent of cases). Less common are cases of BPPV involving the anterior semicircular canal, or more than one of the semicircular canals.
BPPV is thought to result from crystals of calcium carbonate (the substance thats also the main component of chalk, eggshells, and pearls) being displaced into one of the semicircular canals from another part of the inner ear called the utricle. Apart from being the most common reason for vertigo, the main feature that distinguishes BPPV from many other inner ear conditions is that the person does not suffer any problems with hearing.
How common is BPPV during pregnancy?
BPPV is extremely common in humans overall, as it strikes about 2.4 percent of people at some point in life, while accounting for 8 percent of cases of moderate to severe vertigo. Although BPPV occurs increasingly with increasing age, the condition tends to strike females twice as often as males, and changes in hormones may affect how vulnerable you are to the condition. Thus, BPPV is common during pregnancy.
How is BPPV diagnosed?
Suspicion that you have BPPV will be high if you experience sudden episodes of vertigo initiated by changing your head position relative to the direction of gravity. During physical examination, your doctor will be able to reproduce this vertigo by placing your head into particular positions, while the rest of your body is in different positions. During such maneuvers, the doctor will verify the presence of vertigo by observing whats called nystagmus, a type of shifting of the eyes, and make other observations.
Does BPPV cause problems during pregnancy?
BPPV can make you suddenly nauseous, thereby exacerbating the nausea that comes early in pregnancy, and this can lead to vomiting. BPPV episodes also place you at risk of falling, a risk that increases during the latter half of pregnancy as your weight increases and your bodys center of gravity shifts, making walking more difficult.
Does BPPV during pregnancy cause problems for the baby?
BPPV does not have any direct effects on the developing baby. However, the baby is at risk of being harmed if BPPV causes you to fall.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the BPPV
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat my BPPV during pregnancy?
Medications are available to dampen the response of your nervous system to head movements, the most commonly prescribed one being meclizine. Although there used to be some concern that this drug might harm the developing baby, it now is considered to be fairly safe. A drawback of meclizine, however, is that if your BPPV is fairly mild, or your brain is adjusting by learning to compensate, or your inner ear is on track to resolve the condition, its possible that meclizine can make your vertigo worse.
Who should NOT stop taking medication for BPPV during pregnancy?
If you are already taking an anti-vertigo drug, and it is working for you, it is reasonable to continue taking it, as stopping the drug can lead you to experience symptoms.
What should I know about choosing a medication for my BPPV during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat BPPV here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my BPPV when I am breastfeeding?
Meclizine has not been studied extensively in terms of levels that can accumulate in breast milk and what it could do to an infant, but generally, the concern is very low that it would cause a problem.
What alternative therapies besides medications can I use to treat my BPPV during pregnancy?
The main treatment for BPPV, other than waiting for the condition to resolve on its own, are special maneuvers that a doctor can perform, in which your head is put rapidly into particular positions. One procedure is called the Epley maneuver and the other is called the Semont maneuver. In both procedures, the idea is to shift the crystals out of the affected semicircular canal, into other parts of the inner ear where they do not produce symptoms. If performed correctly, these procedures work better than medication.
What can I do for myself and my baby when I have BPPV during pregnancy?
Keep an open mind to all treatments, including the Epley and Semont maneuvers.
Resources for BPPV in pregnancy:
For more information about BPPV during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
- Mayo Clinic: Benign paroxysmal positional vertigo (BPPV)
- Mayo Clinic: First Trimester Pregnancy: What to Expect