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Unless you have experienced benign paroxysmal positional vertigo (BPPV), you cannot appreciate how distressing it is. I know first-hand because I have experienced it periodically over the last several years. The dizziness and/or spinning are both disorienting and disruptive! Trying to think clearly when the world is not quite stable is challenging. Is it possible to treat or prevent BPPV?
Symptoms of Benign Paroxysmal Positional Vertigo:
People describe this sensation in various ways. When I roll over in the bed the world starts spinning. The first time it happened I was trying to get out of bed. The intense dizziness and spinning made me sit right back down on the side of the bed. I started sweating profusely and I thought I would throw up.
Others say BPPV happens when they tip their head up to look at the ceiling or look down at their feet. Bending down to pick up something that has fallen to the floor can be extremely challenging as the spinning and dizziness take over.
BPPV often interferes with quality of life or the ability to carry out normal tasks. Playing tennis, for example, can be tough when you throw the ball up to serve and the spinning starts.
What Causes BPPV?
This condition apparently occurs when crystals inside the ear get out of place and end up in one of the semicircular canals. BPPV can be treated with a series of head movements (the Epley Maneuver) designed to get the crystals back where they belong.
Not all health professionals are familiar with BPPV and the strategy to “cure” it. The ENT technician who first diagnosed and treated me admitted that she frequently helps people who have suffered with this condition for years without a proper diagnosis. Several minutes with a trained professional who can perform the Epley Maneuver can make a world of difference.
Readers Describe BPPV and Treatment:
Jerry was one of the fortunate ones:
“I’m lucky enough to have three sources of healthcare: A great PCP doctor, a wonderful cardiologist, and a caring Veterans Administration (VA) team. On my last routine visit to the VA, I offhandedly mentioned that I have had minor headaches for years, so the doctor immediately thought, “brain problems.”
“She did an in-office test for balance and said she would feel better to schedule me for a CT scan. A week or so later, I received word that the CT scan did not reveal anything that she thought would contribute to my imbalance, so she requested approval for physical therapy (PT) sessions. I started to just ignore that, believing that PT couldn’t do anything about balance. I couldn’t have been more wrong. After an initial evaluation meeting with the therapist, our second session consisted of a series of tests for BPPV, after which she performed the Epley Maneuver. Performing it twice that same day, the vertigo was gone!
“She told me of the rapid eye movement during the vertigo, but naturally I didn’t know this was happening. I’ve been tested in subsequent PT sessions, and I haven’t experienced the vertigo again. She did tell me that it would probably return some time later, but that she would teach me how to take care of this at home. My first thought after this was that it was akin to magic! I never would have expected this result after years of putting up with this problem.”
Mike describes it this way:
“I also experienced BPPV. I went to my ENT and he had me see a therapist. After doing the Epley maneuver I was able to keep the world from spinning. Thank you Dr. Epley!”
How to Prevent BPPV from Coming Back:
Many people who suffer from this condition have recurrences. Is there any way to prevent BPPV from coming back?
Researchers in South Korea recruited more than 900 people who had been treated successfully (Neurology, Aug. 5, 2020). They wondered whether vitamin D and calcium would prevent recurrence.
About half of the people were chosen at random to have their vitamin D levels tested. Those with low levels took supplements of 400 IU vitamin D and 500 mg of calcium twice a day. The remainder of the individuals were in the control group. Those taking supplements were 24% less likely to have another attack during the following year.
The authors conclude:
“Supplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal.”
Vitamin D to Prevent BPPV Recurrences:
This is not the first time we have heard about vitamin D to prevent BPPV.
Several years ago we received this story from a reader:
“I have been diagnosed with vertigo (BPPV) and it’s the worst. Any time I move my head the world spins.
“But I recently found a study linking vitamin D deficiency to BPPV. My level was really low and so I started taking a supplement.
“I haven’t had a vertigo attack since then, but I still have some residual dizziness that is slowly fading. I hope I don’t get any more vertigo attacks.”
No Drugs for BPPV:
There is no medication that works for BPPV. We do encourage people to ask about the Epley Maneuver, a manipulation technique that can help get the crystals back where they belong. It does not work for other causes of dizziness, but can be quite helpful for BPPV.
Although it is possible to learn how to do the Epley Maneuver at home, it can be quite useful to have a well-trained professional do it the first time. Audiologists and ear, nose and throat specialists are a good place to turn for expert assistance.
Drugs that Cause Dizziness:
Many people do not realize that a surprising number of medications can actually trigger dizziness. This is sometimes perceived by health professionals as a “minor” side effect. We consider it a potentially deadly drug complication. If someone falls because of dizziness, it can lead to a head injury or a hip fracture. And dizziness can ruin the quality of a person’s life. Here is a link to an article we wrote titled “Dizziness is Driving Her Towards Suicide.”
Vitamin D to Prevent BPPV:
We were interested in your reference to low vitamin D contributing to this condition, and found that there has been some research (Journal of Neurology, March, 2013). More recently, a systematic review also recognized that low levels of vitamin D are a risk factor for BPPV (Frontiers in Neurology, June 23, 2020).
Another reader also tried this approach:
“After months of dealing with vertigo attacks several times a week, I finally tried supplementing with vitamin D. It has worked wonders over the last month and a half, as I’ve had only one attack a few weeks after starting vitamin D, and none afterwards. Vertigo is horrible: I have no balance or sense of equilibrium, everything spins and I suffer nausea, vomiting and exhaustion.”
Final Words:
We think that the Epley Maneuver is the first step in overcoming benign paroxysmal positional vertigo. There are other maneuvers that can also be helpful. A health professional can assist in determining the best approach. It is also important to prevent BPPV from coming back. Having blood levels of vitamin D assessed would be a good start. If they are low, adding vitamin D and possibly calcium might be helpful.
Please let us know how you have dealt with BPPV in the comment section below. Have you found the Epley Maneuver helpful. What about vitamin D? Share your experience. If you know someone with BPPV, please share this article by scrolling to the top of the page and sending it via email, Facebook or Twitter by using the icons you will find there.
Betty
I used the Epley maneuver the one time I had this problem, and I also take vitamin D3. It worked for my husband who we rushed to hospital after he thought he was having a stroke. ER dr diagnosed inner ear problem and recommended Epley. It worked, and we have used this treatment on the rare occasion we have this problem.
Pam
Epley maneuver is a lifesaver. But even at a highly respected medical center you need a Vestibular PT, not just any doctor. The wrong doctor can make it much worse; that happened to me when the head of ER thought he knew how to do the maneuver. Keep the phone # for that Vestibular PT handy in case you need them. When I get it (thankfully only every few years), I am instantly too sick and disoriented to do the maneuver for myself. Will definitely check my D levels. thanks.
Allisondelong
About a year ago I had a one-time case of sudden onset vertigo. I woke up with intense bed spins and nausea. When I looked at the light fixture above my bed it seemed to quickly zip side to side. After evaluating myself for signs of stroke or other 911 /emergency room worthy symptoms, I went back to sleep for about 3 hours and woke up feeling fine. It was very scary but the nausea and rapid eye movement reminded me of a few episodes our golden retriever had experienced in his old age for which the emergency vet prescribed 5 days of Dramamine (and possibly antibiotics for ear infection). I did lots of internet research and came across an article about “old dog syndrome” that essentially labeled it a vestibular migraine. I later asked a fire fighter friend about my self diagnosis, and he agreed that vestibular migraine is not uncommon (esp. in people past age 40 or 50) and recommended I keep Dramamine and Benadryl on hand in case of future episodes. I have not had a recurrence but will keep in mind the need to keep Vitamin D levels up esp given our climate and my indoor job.
Kara
I have had BPPV on and off for 20 years. My Vitamin D and Calcium levels have always been excellent. Please take my advice on this subject – I speak from personal experience. I finally found doctors and physical therapists who do nothing but deal with BPPV, and I finally got the treatment I needed. Lots of other doctors and physical therapists who THOUGHT they knew what they were doing did not and made it worse.
1. For me, Vitamin D and Calcium supplementation do NOTHING to help with BPPV.
2. For me, the Epley Maneuver works very well and is completely non-invasive and painless. BUT DO NOT bother trying to do it yourself. You will not be able to accomplish what a trained professional can. Once you’ve had it done a few times by a pro, you can try to do it yourself but you probably won’t get it right anyway. When I have a recurrence, I still go to a pro. They get it done right the first time.
3. Most ENT doctors know how to do the Epley but not all of them do it PROPERLY. I’ve been to bad ones. You can also search out a neurologist who specializes in balance disorders and have them do it.
4.Finally, there are some Physical Therapists who are highly trained in BPPV and the Epley Maneuver. BUT DO NOT just go to any PT who says they read about how to do it. It takes a lot of training and the person doing it should have a device that they use to look at your eyes while they are doing the Epley. By looking at your eyes, highly magnified, they can see if you are having nystagmus (which you DO have during a vertigo episode). Nystagmus means when your eyes are twirling back and forth very quickly as you are having the vertigo “spin”. By watching your eyes, they can tell WHICH DIRECTION to do the Epley in order to actually help you. You can’t tell that on your own.
5. I do NOT recommend the “half-summersault maneuver”. There has been no testing to prove that it helps and it can actually exacerbate the BPPV.
6. Some doctors automatically give you meclizine or other motion sickness drugs. These are generally USELESS for BPPV. They’ll just make you tired. They might possibly help with nausea but that’s all.
There are no medications that address the BPPV directly.
Some people get BPPV once and never get it again. Many people get it over and over again. Just so you know, it’s never as bad as it is the first time. That’s because you know what it is and it’s not so scary anymore. Untreated it can go on for months, although not as intense as it is the first day or two.
All the best.
Julie
I also suffered many bouts of vertigo until I stopped using my electric toothbrush. I also have stopped the dental hygienist from using the sonic cleaning device and asked her to go back to scraping by hand. I haven’t had an episode in two years and am very grateful that this simple change of behavior has worked so well.
Tom
I went to our prompt care, and the doctor quickly diagnosed BPPV. He gave me a handout for the Epley Maneuver but I later found out it was not correct. There are You Tube videos but they are often misleading. After a visit to my PT (who is a DPT) I got the correct instructions, and the condition quickly cleared up. I do take Vit D and Calcium but I don’t get my Vit D serum levels tested. I take 4,000 IU a day
Alice
I used to get BPPV and learned how to do the Eply maneuver and another exercise at home. I stopped getting it years ago, but in hindsight, the cessation was around the time I started supplementing with calcium and vitamin D for osteopenia.
Janet
My internist recommended the half-somersault maneuver as supposedly easier to do at home on your own. This was developed by Dr. Carol Foster at the University of Colorado. There is a YouTube video interview with her explaining what happens in the ear to cause this. Also by Dr. Foster there are online diagrams and specific instructions to do the half somersault for the left ear and right ear and follow-up instructions for the left ear and right ear after doing the half somersault. I didn’t know which ear was the problem and tried calling the Colorado Clinic, but was told as a non-patient they could not give me information. Would be interested if any reader knows how you determine which ear is the problem and can you cause a problem in an ear which doesn’t have the problem?
Ellie
https://www.youtube.com/watch?v=1VWyPgfMuvM
I found this site and always refer back to it when something like painting a ceiling causes my ear to get out of whack. It has always worked when you follow the instructions. It is explained by a doctor who deals with the inner ear.
Ronald
The only thing that helps my vertigo is Diazepam. My vertigo is caused by Meniere’s Disease. Terrible thing to have.
Carol
I’ve been taking D and calcium for years. I still got BPPV. My neurologist referred me for PT. The Epley Maneuver was done on my first visit twice and repeated again later. It worked like magic! Now if I think it is returning, I try to do it myself at home.
Eileen
In December 2017 I was admitted to the hospital with a case of severe coughing. No other symptoms but the coughing was so severe every time I took a breath I would cough really hard. This went on for about a week with dizziness so severe I could hardly walk. The hospital tested me and said it was the flu. After 5 days I was sent home. Still sick, coughing and dizzy.
About a year ago my doctor said I had nystagmus but I had a clear MRI and was seen by an eye doctor. Saw a Physical Therapist who was excellent, and the Epley Maneuver was done four times on each side and I’m still dizzy. Now I need to see a neurologist. I had been on Topamax 100 mg 4 x daily for migraine prevention and have tapered down to 25 mg 3 x daily with no problems, no major migraines. But my world is still spinning, and now at times I also have double vision, horizontal or vertical. I haven’t been driving and would definitely not try driving on the highway because I’m afraid I wouldn’t be able to tell which lane I’m in. I don’t drink alcohol and have never done illegal drugs. Within the last month my balance has gotten worse. I’m taking about 7,000 I.U. of Vit D but have been for years.
Mary
Halfsomersaultmaneuver.com explains and has a video of another technique which I find easier to perform than Epley.
Michele.catanese
I have suffered with BPPV on and off for years. I was taught how to do the Epley maneuver so that when it happens I can do it at home. It takes 10 minutes twice a day, and usually in a day or two I am better. But I also upped my D3 a few years ago, as well as started allergy shots since I am severely allergic to grasses, weeds and trees. All of this has helped. The allergy shots help with keeping the pressure in my ear from building up, and my sinuses from swelling. I have had one ENT disagree and one ENT agree that the sinus swelling makes a difference.
All I know is that when I feel the dizziness coming on, a dose of pseudoephedrine and some ibuprofen can help stop the sinus swelling. While I understand that BPPV is the crystals moving in the inner ear, this works for me. The sinuses and ears are connected so if the pressure does not build up, I do not have a flare-up.
Anonymous
I get recurrent BPPV. First episode I was sent to a local university hospital’s Vestibular center. Was taught Epley as well as vestibular stimulation exercises. The exercises are critical to fast recovery. It takes about 2 weeks of daily practice of both for the BPPV to recede. I take Vitamin D as well as calcium and my levels are fine so that is not my case.
It sure is miserable when it is full blown. Sorry for all who experience it.
Emmadelle
I’m pretty sure the medication the triggered my BP vertigo was Amoxicillan-Clavulanate. My prescribing PA dismissed this, even thought I subsequently researched and found that dizziness and vertigo are well-known side effects, especially in those over 60. My doctor and PA were unaware of the Epley, and I went through months of hell before a friend suggested a Physical Therapist specializing in vestibular problems. It was a miracle!
I also take Vit D daily, and it’s good to read in your article that this might be one reason that my serious vertigo has not reoccurred. I still get a little woozy when lights are turned out suddenly (a classic vertigo symptom) or in other minor situations, but essentially, life is back to normal.
Rachel D
I was diagnosed with BPPV after returning home from a cruise. I had been using a scopolamine patch to prevent motion sickness while onboard. I continued feeling the “ship rocking” for days after returning home. The dizziness and nausea became unbearable. The only thing that seemed to help was going to sleep. I ended up in the ER with continuous vomiting where they prescribed meclizine and PT.
The Epley maneuver was very effective, and I still use it. I have taken Vitamin D supplements for years and have suffered fewer recurrences of the BPPV in that time but couldn’t say if it is directly linked. What I have noticed is that colds and seasonal allergies do seem to cause the dizziness to return. Antihistamines and decongestants relieve the dizziness within a day or so.
Ethel
B-12 is also something that can stop it. Worked for me.
Rita
I have been suffering from vertigo for about 30 years & it is just awful. The last one I got was in May 2020 & lasted 10 days. I get at least 4-6 attacks in a year.
I do take Vitamin D 1000mg & Calcium 650mg – 800 mg /day in food & supplement but the vertigo still comes.
I’ve followed the instructions on U Tube for the Epley Maneuver when I get the vertigo, but I feel more sick doing it. My dr. has never recommended it or an ENT. I used to take Antivert for it , but don’t get it in Canada. I take Gravol 50mg and sleep with water & Gravol tablets under my pillow as the attacks start in the morning.
I’ve started something since my last attack in May – Every 3 weeks I put about 3 drops of olive oil in my ears thinking that this will prevent the crystals from falling in the ear canal. It’s too early to tell.
I would Like to know if it is good to do the Epley Maneuver often even when I don’t have the vertigo so the crystals don’t fall in the canal.
Sheila
I’ve had several bouts of BPPV over the past five or six years. Thankfully, the Epley Maneuver does help tremendously. Sometimes it takes multiple maneuvers for it to work.
I used to go to the ENT for the Epley, but now my husband and I perform the maneuver at home. There are several YouTube videos with the instructions of how to do the Epley.
This is the first time I’ve heard that a possible vitamin D deficiency might contribute to BPPV. Interesting!
Linda
I had BPPV over a year ago and found the Epley method by researching online myself. I did not go to a doctor for this. I did not know about the Vit D until reading this now. I do know that on my regular Dr. visit last year I was low on Vit D. I have been taking extra and have not had a recurrence so far.
Jessica
I have BPPV. First time it occurred, my PCP performed the Epley maneuver in his office. It worked, but later came back. I tried the maneuver at home, while sitting in my bed in case I fell. That seemed to work, so I try to do the head movements periodically before it comes back. Prescription Meclizine 12.5 mg tablets also help when dizziness becomes debilitating. But no one has ever mentioned, or tested my Vitamin D or Calcium levels as a possible cause. I’m going to try both supplements and see if it helps. Thanks!
Linda
Check out Dr. Carol Foster, University of Colorado, half somersault maneuver. Easier to do yourself than the Epley maneuver and works like a charm. Uses to have recurring bouts of BPPV. After doing half somersault, very rarely have it and take care of it right away using this maneuver.
Larry
While it may be difficult for you to articulate how to perform the Epley maneuver, this is the 21st century. YouTube is available universally and free. How about directing your teaders to YouTube for this information? There are dozens of credible videos there.
Sandy
I went to ER the first time I experienced this. It is very scary. I had a few more episodes while in the ER. They gave me some meds for nausea. Did not know much about it then. That was probably at least 20 years ago. Had a few more episodes but I had searched for myself and found the Epley exercises. I now take 2000 is of D and Calcium 500 every day.
Michael
I’ve used the Epley maneuver many times to stop BPPV and have found it to work extremely well. I highly recommend people with this condition learn from a professional how to do it at home because, it will more than likely return at some point.