Turning the head is very commonly associated with dizziness. If you have a sudden loss of function in one ear, turning the head will make the vertigo worse. People with BPPV have dizziness when the head is turned in bed, and sometimes when they are upright and make a head turn. During a Meniere attack, turning the head will greatly increase the dizziness. There is another exceedingly rare but serious cause of dizziness with head turning. It’s called Bowhunter’s syndrome.
When hunting with a bow, the hunter will often have the head turned sharply to the side when aiming. Almost everyone is capable of doing this without the slightest problem. However, some people are predisposed to problems with blood flow in the neck, and these people are at risk if they turn their heads sharply. Normal people have a pair of arteries in the neck, the vertebral arteries, that supply blood to the brainstem and cerebellum (the balance and coordination center of the brain). The two arteries are connected, so even if you pinch off flow in one of the pair, the other is enough to prevent any loss of overall flow. Some people, however, have a very small or absent vertebral artery on one side, so if the only remaining one gets kinked, they have a problem.
Relying on just one artery is not enough to cause the syndrome, because normal head turns don’t cut off blood flow. In addition to having only one good artery, people with this syndrome must also have a bony spur in the spine or narrowing around the artery that adds to the problem when turning the head. This two-hit combination is what creates Bowhunter’s syndrome. If you have these two problems, turning your head strongly to one side for any reason can cause sudden symptoms.
Usually the room does not spin; instead most people with this problem feel as if they are about to faint. If the head remains turned, they can lose consciousness. If examined during a spell, signs of low blood flow affecting the brainstem can be seen, sometimes with nystagmus, hearing loss and nausea or vomiting, or even stroke signs like weakness or numbness on one side of the body. If the head remains turned sharply, a stroke can result, so testing must be brief and done by an experienced physician.
If you are dizzy when you turn your head, does this mean you need to worry? Over the many years I have seen people referred for this syndrome, almost none actually turn out to have it. It is incredibly rare and should only be considered if the symptom includes fainting or near-fainting with head turns. In almost all cases, dizziness with head turns will end up being BPPV, and can be simply and safely treated with head maneuvers. The nystagmus of BPPV is quite different from central nystagmus and it is possible to test for BPPV without turning the head much, so the two conditions are not hard for a physician to tell apart.
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