The crystals that cause vertigo spells in BPPV come from the utricle, a gravity sensor in the ear. This sticky sensor is covered by crystals that are held to it by a meshwork of fibers connecting them to each other, rather like a very sticky cargo net. When crystals break off the sensor, they can enter the spinning sensors and cause vertigo. The crystals are largely made up of a form of calcium: calcite, the same white substance found in seashells and chalk. This brings up the question, is there something one can take that can dissolve these crystals so they stop causing BPPV?
Vertigo from head turning: can you kink off blood flow to your brain?
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.
Does osteoporosis make maneuvers less safe for BPPV?
I have osteoporosis (which I understand can make one more prone to vertigo) and at times have had neck issues. I’m not sure if putting my head back and looking up to the ceiling would be okay for me to do. When one has osteoporosis, you have to careful with certain exercises. Coming up from the position on one’s knees may not be so great for the spine. I’m not sure if being in that position would be great for one’s hips either. Getting down on the floor is not so easy for me, but I would be willing to try.
This is great question. Let’s answer the easy parts first. You don’t need to get down on the floor, or arise from the floor after a maneuver. The half somersault can be done on your bed, so it’s simple to get down once you’re done.
Regarding knee problems, the fix is simple. The half somersault is usually done kneeling, but can also be done sitting, standing, or while lying on your stomach. All these variations are covered in the companion book to my videos, Overcoming Positional Vertigo. This means you don’t necessarily need to kneel at all, or even bend the knees more than 90 degrees. All positions do require some leg or hip movement to arise, and some head movement.
If you can’t tolerate any movement of the back, neck or knees you can seek out treatment in a special chair (Omniax chair) that straps you in and will rotate your whole body. Because of the special equipment needed, this costs much more than other maneuvers.
All other home or office maneuvers for BPPV require tilting the head and moving your legs. If you are worried about tipping your head back at home, this can be avoided to a certain extent. It’s only the position of the head in space that matters, not how far you tip your head up on your neck. You can choose to lean back with your whole body until you’re looking straight up, for example, rather than tilting your head. You can tilt your head as much as feels comfortable, and then lean back with your body to complete the position.
How dangerous is it to do maneuvers when you have osteoporosis? That depends on how much bone loss you have. Osteoporosis can cause the vertebra to collapse with minor trauma, but this is very unlikely while doing maneuvers. It’s best to avoid any movements you find painful, and to avoid very abrupt movements. If you are concerned, it’s best to have manuevers done by a professional.
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