This article was previously published on September 12, 2019 and has been updated with new information.
Benign paroxysmal positional vertigo (BPPV) is one of the most common forms of peripheral vertigo, meaning it stems from a problem in your inner ear, not your brain.1,2 BPPV refers to a condition in which calcium carbonate crystals in the labyrinth of your brain. loosen the inner ear and enter your ear canal.
While your external ear canal, eardrum, and middle ear are involved in the transmission and interpretation of sound, your inner ear is not directly involved in hearing. Instead, the organs in your inner ear act like a gyroscope, informing your brain about your body’s position in space and coordinating with your brain to balance your body as you move.3
The crystals disrupt the flow of fluids, confusing your balance organs, resulting in vertigo — the sensation of movement or spinning even when you’re standing still. As reported by Medical News Today:
“Moving the head can cause vertigo because the solid crystals react to gravity. The following head positions and movements can cause vertigo in people with BPPV:
Turning head Lying on the side of the head Rolling over in bed Bending head forward Leaning head back”
In severe cases, it can be difficult to maintain your balance enough to perform everyday tasks. It may also be accompanied by other nausea, vomiting, abnormal eye movements, headache, sweating, ringing in the ears, double vision and/or lack of coordination.
Other Causes of Dizziness
Aside from BPPV, which occurs when crystal deposits are misplaced, peripheral vertigo5 can also be caused by an abnormal production of fluid in your inner ear, which builds up pressure. This is known as Meniere’s disease
Inflammation (often caused by a viral infection7) in the labyrinth of your inner ear8 (labyrinthitis) is another possibility that can cause dizziness. In this case, since the labyrinth contains both organs of balance and hearing, your hearing is also affected.
Like labyrinthitis, vestibular neuritis refers to an infection of the inner ear, in this case affecting the nerves connecting your inner ear and brain, disrupting the normal flow of sensory information.9
Another less common cause of peripheral vertigo is acoustic neuritis, in which a noncancerous tumor grows in the cranial nerve of your inner ear. As the tumor grows, it pushes against adjacent nerves, causing dizziness, hearing loss, headache, and facial numbness.
Anxiety and stress can also cause vertigo, as the vestibular system (which is responsible for sensing your position in space) also interacts with areas of the brain involved in anxiety.10
Dizziness can also be caused by damage to your central nervous system (CNS, including your brain and spinal cord), known as central vertigo. Your CNS is responsible for controlling muscle movements and transmitting sensory stimuli to your brain. Central vertigo usually involves damage or dysfunction in your cerebellum, the balance center of your brain.11
Common underlying causes of central vertigo include concussion or traumatic brain injury,12 stroke,13 multiple sclerosis, vestibular migraine,14 and tumors affecting your brain and/or spinal cord.
BPPV Diagnostic Tests
Most cases of BPPV-related dizziness resolve spontaneously in a short time, but if the problem persists for days or is chronic, seek help from your primary care physician. Tests that can help diagnose BPPV include: 15
Dix-Hallpike test – While lying on your back, your doctor will turn your head. If you have BPPV, it will cause dizziness. Electronystagmography – This test involves observing your eye movements under various conditions, such as while moving your head or looking into a bright light. Electroencephalogram – EEG measures your brain activity and can be used to rule out a more serious neurological condition. MRI — An MRI scan may also be used to examine your head and ears to rule out a more serious condition.
If a doctor diagnoses you with BPPV, he or she may recommend physical therapy to move the crystal deposits in your inner ear to a location that won’t affect your balance.
There are several particle repositioning procedures that can accomplish this, including the Epley, Foster, Semont, and Brandt-Daroff maneuvers.16 If you suspect you have BPPV, you can also try these at home to get relief .
How To Perform The Epley Maneuver For BPPV Treatment?
In this video, Dr. Christopher Chang explains how to perform the Epley maneuver and how it works to resolve BPPV-related vertigo. A summary is as follows:
Lie on your back with a pillow under your shoulder blades, such that your head is leaning back 25 to 30 degrees. Tilt your head 45 degrees to the side causing the dizziness. Stay in this position until the dizziness stops, usually about 30 to 60 seconds. Move your head halfway to the other side (90 degrees) without lifting it. Wait another 30 to 60 seconds. Then move your body to the side so that you are looking down, at the floor, with your head turned 45 degrees from the horizontal. Wait 30 to 60 seconds. Slowly sit up. Avoid standing until or unless the dizziness has subsided
A study17 in the June issue of Therapeutics and Clinical Risk Management looked at data from 359 patients treated at a Chinese clinic. The two maneuvers mainly used were the Epley maneuver and the ‘barbecue roll’.
The most common cause of BPPV was the posterior semicircular canal (73.5%), followed by the horizontal semicircular canal (22.5%) and multichannel involvement (3.3%). Particle repositioning maneuvers resolved 95.8% of the posterior semicircular canal cases, 100% of the horizontal semicircular canal and 75% of the multichannel canal cases.
How to perform the foster maneuver
Some find the Foster Half Somersault maneuver easier to perform because you don’t have to be in bed. In the video above, Chang explains how to do that. Here’s a summary:
Kneeling on all fours, raise your head and gaze at the ceiling for a few seconds. Pull your chin toward your knees so the top of your head can rest on the floor. Wait for the dizziness to stop, usually about 30 to 60 seconds. Turn your head about 45 degrees to the side causing the dizziness. Wait 30 to 60 seconds Keep your head turned at a 45-degree angle and quickly lift on all fours so that your head is level with your back (tabletop position. Wait 30 to 60 seconds With your head still at a 45-degree angle to affected side, quickly sit up, repeat sequence after 15 minutes of rest if necessary
You can also find instructions for another similar particle repositioning procedure, accompanied by drawings showing body position, on the Cleveland Clinic website.18
Other Treatment Alternatives for BPPV
BPPV that does not respond to repositioning maneuvers can be treated with the drug betahistine. According to The International Tinnitus Journal19, betahistine “provides short-term relief for acute symptoms associated with BPPV by improving microcirculation in the labyrinth…”
An all-natural alternative is to take ginkgo biloba. This Chinese herb is often used to treat vertigo as it helps regulate blood flow to your brain. According to one study20, ginkgo biloba is just as effective as betahistine.
Ginger partition moxibustion, which would require a visit to a qualified acupuncturist, is another alternative. It involves placing a thin slice of raw ginger on the skin (in the correct location of the acupuncture point) and then a burning piece of moxa on top.
In one study21, ginger partition moxibustion at the acupuncture point known as Tinggong (SI 19) was found to improve vertigo more effectively than particle repositioning procedures alone.
Conventional Treatments for Other Forms of Vertigo
If there is an inner ear infection, treatment should address the infection. Because most inner ear infections are caused by viruses and not bacteria, antibiotics are usually not recommended, as they do not work on viruses. However, a number of natural remedies can be helpful, such as garlic, coconut oil or onion. For vertigo related to traumatic brain injury, you should look into concussion.
Of course, in cases where your vertigo is caused by a more serious chronic illness, such as MS or tumors, treatment should address those conditions as well. Ditto for anxiety and/or stress-related dizziness, in which case cognitive behavioral therapy may be helpful.22
If your vertigo is caused by a vestibular or balance disorder that originates in your CNS, vestibular rehabilitation therapy may be recommended. As explained by Vestibular.org:23
†[A]After damage to the vestibular system, people can feel better and function can return through compensation. This happens because the brain learns to use other senses (vision and somatosensory, ie body sense) to replace the defective vestibular system…
For many, compensation comes naturally over time, but for people whose symptoms do not abate and who continue to struggle to return to daily activities, VRT can aid recovery by promoting compensation.”
Other Alternatives to Home Treatment for Vertigo
Aside from the repositioning maneuvers discussed above, other home treatment strategies may provide relief from temporary or sporadic vertigo:
• Stay well hydrated — Even mild dehydration can cause dizziness, so make sure you stay well hydrated by drinking plenty of clean, pure water.
• Sleep with your head slightly elevated — When you wake up, move slowly when getting up and sit on the edge of the bed for a minute or two before standing up.24
• Making sure you get enough magnesium can help prevent or relieve dizziness. According to Vertigotreatment.org, vestibular disorders are rare in “parts of the world where magnesium is found in large amounts in diet”.25
You can also find out more about the “dizziness diet” used in the treatment of Meniere’s disease and vestibular migraines at vertigotreatment.org.26
• Try these folk remedies — Ginger, a folk remedy with a long history of use for nausea and motion sickness, may also help relieve dizziness. Another option is to make a shot of apple cider vinegar and honey. Simply mix two parts raw honey with one part apple cider vinegar. Stir and drink.
• Essential Oil Therapy — Essential oils known to treat nausea and dizziness associated with vertigo include peppermint, ginger, lavender, and lemon balm.27
This post Why am I dizzy? An important cause and a simple solution
was original published at “http://articles.mercola.com/sites/articles/archive/2022/04/18/positional-vertigo.aspx”