Benign Paroxysmal Positioning Vertigo (BPPV): Post Head Trauma including Impact, Concussion and Whiplash

1.7 million Americans suffer concussions or mild TBI (mTBI) each year according to the Centers for Disease Control (2012). Almost one-half million ER visits as a result of head trauma each year are by children 14 years of age or younger. Older adolescents age 15-19 years and those aged 65 years and older are the most likely to suffer from a concussion. The recently released American Academy of Neurology Updated Sports Concussion Guideline (March 13,2013) estimates that more than one million athletes experience a concussion each year.

Complicating the typical concussion symptoms, a common complaint is true vertigo with head or body positioning. Head trauma is recognized as a leading non-otologic cause of Benign Paroxysmal Positioning Vertigo (BPPV) in both children and adults. Although BPPV is common to otologic and unrelated medical co-morbidities (Roberts and Gans et al, 2005 visit Research for reprint) it is often seen post head impact. Hoffer et al (2004) reported 28% of military personnel with post-traumatic vertigo were diagnosed with BPPV.  Dispenza et al, (2010) have reported the presence of BPPV even in non-head impact conditions consistent with whiplash injury.

Our clinical experience at AIB treating over 10,000 BPPV patients since 1994, has shown the following for BPPV post head trauma:

  1. Youngest post head trauma BPPV patient, 8 years old  ranging to the oldest at 106 years old. Secondary to sports concussions, job related head impact, motor vehicle accidents, and falls.
  2. BPPV secondary to head trauma has a higher incidence of bilateral involvement.
  3. Treatment may be somewhat more resistant requiring more than the statistical 1.25 treatments reported (Roberts and Gans, 2006).

Case Study:

  • Eight year-old male. Fell off a skateboard, was taken to ER with a diagnosis of a concussion.
  • Within several days of the fall he began with an acute and severe onset of vertigo which occurred only “at night”.
  • Multiple returns to ER with subsequent CT, MRI, and EEG for possible seizure disorder.
  • Child referred to AIB for consultation due to the “dizziness” complaint.
  • Modified Hallpike testing revealed bilateral PC-BPPV, with no other vestibular involvement.
  • Child was treated with GRM treatments for both ears within the same visit. He was deemed to be clear and was then medically released by pediatrician and pediatric neurology for soccer camp the next week.