Ending Vertigo Today

BPPV treatment: Turning 45 degrees?

A positional vertigo patient struggles to understand how to do the maneuver for the right ear:

TURN HEAD TOWARDS ELBOW? Which part of head, the chin or the back of the head? Picture shows back of head towards rt elbow. I don’t see any 45 degree angle; the head looks almost in same plane as back in the picture. R U saying 45 degrees relative to the plane of the back so the chin points slanted down towards the floor?

The handouts are in our book and at the bottom of the blog webpage, and our videos can help too, but it’s always disorienting to figure out what that means when your head is upside down! The best way to understand how to correctly move your head is to first practice the head turn when you are upright.

If the right ear is the problem ear, sit in a chair and turn your chin toward your right shoulder, stopping when you are halfway there. A 45 degree angle is the halfway point to looking fully over your right shoulder. If you turned all the way, your chin would be almost touching your right shoulder, so you don’t want to go that far. You will do this same halfway-to-the-shoulder move when you are upside down.

An easy way to know you are doing this properly when upside down on your hands and knees is to turn until you are looking straight at your right elbow . This places your head near the correct 45 degree angle. Your head should be completely upside down, so the chin is not tilted much up or down, although tucking your chin under slightly can help move some deeper particles.

If your problem is in the left ear, you will want to turn your chin toward your left shoulder and to look at your left elbow when upside down.

Ask the Doctor: Brief vertigo

For about 3-4 years now, I will occasionally get VERY strong episodes of vertigo where it feels like I am being very strongly pulled in a weird direction. Sometimes it feels like my head is shaking back and forth. These episodes usually last anywhere from 20 seconds to sometimes 5-7 minutes. They NEVER happen when standing or moving. They only happen when lying down or sitting down, completely still. … I don’t have migraines, I DO sometimes get spinning sensations… I’m struggling to find conditions that cause vertigo that are not brought on by head movements. I used to get these episodes once every 3 or so weeks maybe, but over the past 3 months, I get them now daily, sometimes multiple times a day. The only good thing is that I can get myself out of any episode by moving, slightly aggressively. All I have to do is stand up and walk around and the sensation will subside until I sit or lay again completely still.

Your description gives some important clues. These are spontaneous, non-positional vertigo spells that last for minutes. They are fairly mild because you don’t see the world spinning when they occur, although you mentioned some spinning sensations. The pulling sensation you describe can be coming from the spinning sensors if the spinning is very brief. With brief vertigo there will be a sense of tugging of the head along with a short rotation as if just starting to flip forward or back and toward one side. Very brief spells of vertigo don’t allow you to see the room spin because the sensation is not long enough to cause nystagmus (the rhythmic jerking of the eyes when vertigo is prolonged). Brief vertigo spells can progress to longer spells over time and might eventually cause you to see the room spinning if the condition is progressive. One condition that can cause these type of brief spells is superior semicircular canal dehiscence (SSCD). Sometimes a slight squealing sound can be heard if you turn your eyes strongly to the side in this condition, and loud noises, sneezing or coughing may set off a momentary feeling of tilting or spinning.

Pulling sensations can also be due to gravity sensor malfunctions. If the spells are brief and you are upright, you will see the floor appear to tilt momentarily. This type of vertigo strongly affects balance, but since yours have been while sitting or lying down, that hasn’t affected you yet. Gravity sensor vertigo can be brought on when lying down, but unlike BPPV it does not have a curving or spinning quality. It feels like you are rocketing in a straight line, often backward or up- or downward, as if in an elevator.

The most common cause of spontaneous vertigo lasting minutes is a form of migraine. While you deny headaches, it is possible to have this kind of vertigo even with fairly mild headaches. Headaches on one side of the head that are low grade can still be migraines. Sometime migraine presents with flashing lights in the eyes or seeing a rippling zig-zag or rainbow-like illusion. There is another important condition that causes migraine-like vertigo, however: sleep apnea. This is associated with snoring or pauses in breathing while asleep and frequent nighttime awakenings. If you have these symptoms, you should inquire about having a sleep study. The treatment, a CPAP machine, often resolves all the vertigo.

Pay attention to your hearing. When an ear has a progressive disorder, hearing can often decline. Rubbing your fingers next to each ear can allow to notice small differences in hearing–both ears should normally hear the same intensity and sound quality. Any ringing in the ear is also an important clue. Ringing is often thought of as a high pitched sound, but low sounds like the roar of a vacuum cleaner can also indicate a disease. A formal hearing test is much more sensitive and should be done in anyone with vertigo.

Your best bet is to have a full inner ear workup by an otolaryngologist. This should include a hearing test, videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP), and a sleep study if you have any of the sleep apnea symptoms above. These tests will show if there is any permanent damage to hearing or balance or any evidence for SSCD. If every test comes back perfectly normal, be prepared to re-test in 6 months as progressive inner ear disorders sometimes take time to develop signs of damage.

We’ve added a Learn page

Happy Holidays, readers! 2025 will see a new feature to make it easier to look up the topics you are interested in. At the top of our page will be a new page, LEARN, that will take you to our posts organized according to subject.

You can look up based on the name of the condition or use the short descriptions to guide your research. As I add new posts, I will also add links to these sections.

Please feel free to send me questions about your vertigo problems, and I will answer them in upcoming blog posts.

I wish you a Merry Christmas and the happiest of New Years!