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Demystifying Dizziness- BPPV

Dizziness can be a very unsettling and scary symptom to experience. The unpredictability of when an episode may hit or how long it may last can leave you feeling anxious and hesitant to participate in activities you enjoy. This blog series – Demystifying Dizziness – is intended to act as a quick reference guide to help you break down what can be a complex symptom into some of the most common causes and conditions presenting with dizziness and the most up to date treatment solutions.

To kick this series off we are going to take a deep dive into one of the most common causes of dizziness- Benign Paroxysmal Positional Vertigo or BPPV.

Have you ever rolled over in bed and felt the world start spinning? Chances are you may have had an episode of BPPV. BPPV is a type of positional vertigo, or spinning sensation, that occurs when you move your head in a particular direction and is one of the only conditions that can trigger dizziness when lying down. This sensation can happen suddenly without warning and typically lasts for a few seconds (under one minute). In addition to the intense spinning sensation, you may experience nausea and have feelings of unsteadiness (but not spinning) as you go about your daily activities.

So what is happening?

The great thing about BPPV is that it is a benign condition, as its name suggests, and the cause and treatment for it are well understood. BPPV was first recognized as a disorder of the inner ear in the 1950’s. Your inner ear serves two purposes- hearing and balance. The balance portion of your inner ear consists of organs that act as motion sensors to help orient you as you move through space.

There are two types of these motion sensors: the otolith organs and the semicircular canals. The otolith organs contain little calcium crystals which are sensitive to gravity- they tell you if you are moving up and down or forward and backwards. The semicircular canals contain fluid and detect rotational movements of the head. The semicircular canals are not sensitive to gravity; however, in BPPV, heavy calcium crystals from the otolith organs can become displaced and enter one of the semicircular canals, now making them sensitive to gravity. Every time you move your head in a particular direction it will stir up these displaced crystals and trigger a very uncomfortable spinning sensation for a few seconds until the crystal debris has re-settled.

By understanding the cause of BPPV, an otolaryngoloist, Dr. John Epley, developed a non-invasive positioning maneuver, known as the Epley maneuver, to help roll the calcium crystals out of the semicircular canals and reposition them back in the otolith organs where they belong. This maneuver is now used by chiropractors, physiotherapists, and medical doctors alike and is often assigned as a part of a patient’s homework if they have been diagnosed with BPPV.

*Important to note: diagrams of the Epley maneuver are readily available for public use; however, there are three semicircular canals in the inner ear and proper identification of the affected canal is necessary for optimal results when performing this maneuver. A trained healthcare provider can help you specifically identify which canal is creating your problem and give you the proper repositioning maneuver to solve it.

BPPV can affect people of all ages, but becomes more common as you age. A history of head or neck trauma, such as concussion or whiplash injuries, can damage the inner ear and increase the risk of someone developing BPPV. In addition, new research is demonstrating a correlation between having a history of migraine headaches and the development of BPPV, particularly in those under the age of 50. How migraines may increase the risk of developing BPPV is not fully understood at this time.

While BPPV can be very scary due to its sudden nature, it often responds well to treatment with repositioning maneuvers and rarely has lasting side effects. If you get the spins when going to bed or moving your head there may be a simple solution and working with a trained healthcare practitioner can help provide you with the specific tools you need to fix the issue.

Demystifying Dizziness Summary


Dr. Speranza is an upper cervical Chiropractor in Calgary, Alberta, Canada. She follows the protocols of the National Upper Cervical Chiropractic Association (NUCCA) to help people experiencing problems with postural related dizziness regain balance, return to doing the activities that they love, and ultimately take back control of their health.

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