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Traumatic Benign Paroxysmal Positional Vertigo (BPPV) after Head Trauma (t-BPPV)

  Home   |   Traumatic Benign Paroxysmal Positional Vertigo (BPPV) after Head Trauma (t-BPPV)

 Title: The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma


Authors: Helene Andersson, MS ; Greg Eigner Jablonski, MD, PhD; Stein Helge Glad Nordahl, MD, PhD; Karl Nordfalk, MD, PhD; Eirik Helseth, MD, PhD; Camilla Martens, MD, PhD ; Kjetil Røysland PhD,  Frederik Kragerud Goplen, MD, PhD 

Source: Laryngoscope, 132:443–448, 2022

A 2021 study into the onset of BPPV after head trauma aimed to investigate the pervasiveness of BPPV after varying severities of head trauma, and to create a risk-time curve for its onset. The study was conducted on 117 patients at Oslo University Hospital between August 2019 and March 2020. Around one-fifth of patients who had experienced minimal-to-moderate head trauma were found to have BPPV. Higher severity of injury was related to a higher risk of developing BPPV. The time immediately after the trauma showed the highest risk of onset. This risk subsequently decreased and stabilised. Most cases showed symptoms of BPPV within two weeks of the trauma. 

The study noted that there is not an internationally accepted standard criteria for traumatic BPPV (t-BPPV) at present. The cut-off time between trauma and development of symptoms used in literature varies anywhere from days to three months. 

Significant BPPV was found in cases with minimal head traumas, showing that even relatively minor injuries can result in BPPV. The risk of t-BPPV did not vary with age or gender. Additionally, the study found a different distribution of subtypes of BPPV compared to the reported distribution within cases of i-BPPV (there were more bilateral, lateral and anterior canal cases), highlighting the need to conduct the supine roll test on dizzy head injury patients. Due to the high prevalence of BPPV after head trauma, the study noted that BPPV should first be investigated before denoting symptoms to a concussion. 

To conclude, the study proposed that in head trauma cases where development of BPPV occurs within two weeks of the trauma, the trauma is the cause. Consequently, head trauma patients should be educated about the possibility of developing BPPV, and protocols should be developed specifically to diagnose and treat BPPV after minimal to moderate head trauma.