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Benign Paroxysmal Positional Vertigo (BPPV)

Symptoms: BPPV is one of the most common causes of vertigo (the sudden sensation that you’re spinning) and results in brief episodes of mild to intense dizziness and may also include a loss of balance or unsteadiness, nausea, or vomiting which usually lasts less than one minute and can disappear for some time and then reoccur. Abnormal rhythmic eye movements, called nystagmus, usually accompany these symptoms. BPPV is usually triggered by specific changes in the position of your head, such as when you tip it up or down, when you lie down, or when you turn over or sit up in bed.

Causes: Often, there is no known cause for BPPV, it occurs most often in people age 50 and older, and is more common in women than men. Sometimes a specific event is the cause of BPPV, such as a head injury, a motor vehicle accident (whiplash, especially), after a fall, following a prolonged illness (especially involving sinus congestion, prolonged coughing/sneezing, or vomiting), prolonged positioning on your back (such as during surgery or an extensive dental treatment), or after an activity that involved prolonged spinning or sudden changes in gravity. Surgery to the nasal cavity, sinuses, or ear canal can be a cause and BPPV has also been associated with migraines.

Ear Anatomy and BPPV: Inside of your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head. Other structures called otolith organs monitor the movement of your head (up and down, right and left, back and forth) and your head’s position in relation to gravity. These otolith organs contain calcium crystals that make you sensitive to gravity. For a variety of reasons, such as the causes mentioned above, these crystals become dislodged and can move into one of the three semicircular canals, especially when you are lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to, which is what causes the symptoms of BPPV.

Treatment: The Epley Maneuver is a treatment which involves specific and sequential movements of the head to guide the crystals back into the otolith organs, much like tilting a box maze back and forth to move a ball into the hole at the end of the maze. This treatment addresses one of the three semicircular canals which most commonly contains these wayward crystals. By following your therapist’s instructions for the week following your Epley maneuver you may fully, or almost completely, resolve your symptoms, although a small percentage require a second treatment.

Additional Tips and Methods to Address BPPV

Water Intake:

· Make sure you are drinking sufficient amounts of water (8, 8oz glasses per day at a MINIMUM; more if you are working out in heat or exercising to sweat levels).

· Decrease your intake of caffeine, coffee, and sugar as these all lead to dehydration.

· Dehydration will not allow the crystals to move freely through the inner ear to settle where they belong.

Vitamin D3 Deficiency:

· This is one of the most common nutrient deficiencies in the world (especially common in young women, infants, the elderly, and people with dark skin color) and is very prevalent in areas north of the 45th parallel (Hamilton, MT is at 46 degrees latitude!). This is because we have decreased exposure to the sun during the winter months so our bodies do not naturally produce vitamin D. Vitamin D is essential in producing calcium in our bodies, and there is research to suggest this directly affects the calcium crystals in our inner ear.

· Recommended Daily Average: 400-800 IU or 10-20 micrograms (this is adequate for 97.5% of individuals). HOWEVER, if you are less exposed to sunlight, then you may have to take more. A daily vitamin D intake of 1000-4000 IU or 25-100 micrograms should be enough to ensure optimal blood levels. DO NOT TAKE MORE without first consulting your doctor.

· If you want to know if your blood levels are sufficient, you can order a test kit on


· If you feel “full” or have congestion in the inner ear, this may be preventing the crystals from settling into place.

· Ask your doctor if an anti-histamine, and at what dosage, would be of benefit.

Vitamin B12 Deficiency:

· Low levels of B12 will cause low blood pressure which means decreased blood flow to the brain and a feeling of being “off balance.” This may a reason why the Epley maneuver may not resolve your vertigo.

· Ask your doctor about a simple blood test to see if your B12 blood levels are low. You can also purchase a home test kit on

· Low blood pressure, whether or not caused by low B12 levels, can also cause dizziness, especially upon first standing up from a seated position. If this is your primary cause of dizziness, talk to your doctor.

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