What Is Vertigo & What To Do About It? Part 1

What Is Positional Vertigo?

Positional vertigo is a spinning sensation that happens when the position of your head changes.(1) This occurs when crystals in the inner ear balance system (The Vestibular System) move from a place where they normally are located to a place where they should not be located.(2)(3)(4) When these crystals get into the wrong spot(4) they stimulate nerves(5) which unnaturally cause the vertigo and usually weird eye movements (Called nystagmus).(6)

This disorder where crystals get into the wrong part of the inner ear balance system (Vestibular System) is called Benign Paroxysmal Positional Vertigo (BPPV). Risk of BPPV increases in middle age(1)(7) but can also happen in the 30’s.(6)(8)(9) The cause in most cases is unknown, but BPPV can also be caused by trauma such as head injuries(6)(7)(8)(10)  or as a consequence of other inner ear balance disorders(6)(8)(10) and even from hospitalizations.(8)

Even though in most cases the exact cause of BPPV is unknown, a link is beginning to be seen with bone health(11)(12)(13)(14) and other medical complexities.(15)(16)  So diet and exercise are, as always, an important way of preventing another health problem.


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Health Advice Disclaimer

We make every effort to ensure that we accurately represent the injury advice and prognosis displayed throughout this blog. However, examples of conditions and their prognosis are based on typical representations of those conditions that we commonly see in physical therapy. The information given is not intended as representations of every individual’s potential condition. As with any injury, each person’s symptoms can vary widely and each person’s recovery can also vary depending upon background, genetics, previous medical history, psychological status and history, motivation to follow physical therapy advice and various other factors.

It is impossible to give a 100% complete accurate diagnosis and prognosis without a thorough physical examination and likewise the advice given cannot be deemed fully accurate in the absence of this examination from a vestibular specialist.

Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this blog.



1 .Bhattacharyya N, Gubbels SP, Swartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical Practice Guildeline: Benign Parosysmal Positional Vertigo (Update). Otolaryngology-Head and Neck Surgery. 2017;156(3S) S1-S47.

2. Hornibrook J. Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions. In J Otolaryngol. 2011;2011:1-13.

3. Parnes LS, McClure JA. Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope. 1992;102(9):988-992.

4. Kao WT, Parnes LS, Chole RA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope. 2017;127(3):709-714.

5. Gacek RR. Transection of the Posterior Ampullary Nerve For the Relief of Benign Parosysmal Positional Vertigo. Ann Otol Rhinol Laryngol. 1974;83(5):596-605.

6. Fife TD. Recognition and Management of Horizontal Canal Benign Positional Vertigo. The American Journal of Otology. 1998;19:345-351.

7. Katsarkas A. Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta Otolaryngol. 1999;119(7):745-749.

8. von Brevern MN, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710-715.

9. Yeo SC, Ahn SK, Lee HJ, Cho HJ, Kim SW, Woo SH, et al. Idiopathic benign paroxysmal positional vertigo in the elderly: a long-term follow-up study. Aging Clin Exp Res. 2018;30(2):153-159.

10. Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647-652.

11. Han W, Fan Z, Zhou M, Guo X, Yan W, Lu X, Chen C, Wu Y. Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. Acta Oto-Laryngologica.                       2018;138:5,443-446.

12. Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y. Decreased  serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260(3):832–838.

13. Talaat HS, Kabel AMH, Khaliel LH, Abuhadied G, El-Rehem HA, El-Naga A. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016; 43: 237-241

14. Wu Y, Gu C, Han W, Lu X, Chen C, Fan Z. Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients. American Journal of Otolaryngology – Head and Neck Medicine and Surgery. 2018;39:31-33.

15. D’Silva LJ, Staecker H, Lin J, Sykes KJ, Phadnis MA, McMahon TM, Connolly D, et al. Retrospective data suggests that the higher prevalence of benign parosysmal positional vertigo in individuals with type  2 diabetes is mediated by hypertension. Journal of Vestibular Research. 2015;25:233-239.

16. De Stefano A, Dispenza F, Suarez H, Perez-Fernandez N, Manrique-Huarte R, Ban JH, et al. A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigoAuris Nasus Larynx. 2014;41:31-36.

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