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.    

Ask the Doctor: Slow-to-resolve Horizontal canal BPPV (H-BPPV)

I recently had a few bouts of horizontal canal BPPV. A few log rolls and Gufonis took care of it, except this last one has been stubborn.

It seems between positions one and two of the Gufoni (lying on the  good side, then turning the head to face the bed), the particles are not making it back where they belong. They seem to get stuck before they can get to the utricle, and fall back into the canal either soon after I finish the maneuver, or when I lie back in bed (propped with two pillows).

Read more: Ask the Doctor: Slow-to-resolve Horizontal canal BPPV (H-BPPV)


This problem has to do with the anatomy of the canal.  All three canals are about 2/3 of a circle, with a sensor blocking one end, and the opening at the other.  You need to move all the particles out of the opening.  Imagine this as a clock face, with the sensor/block at 12 o’clock, and the canal circling from 12:00 clockwise around to 8:00, where the opening is.  Between 8 and 12:00 there is another structure, a sac called the utricle, where the particles came from and where you want them to end up.

In the usual Gufoni, you lie on your good side, facing forward, and then turn your head to face the bed.  This moves particles through about half of a circle, (180 degrees or 30 minutes on the clockface model).

This is fine if the particles are located between 3 and 8.  They will rotate 30 minutes or less on the clockface, and exit (the particles at 3 will rotate to the 9, moving them out of the canal at 8).  But the problem is greater if the particles are located near the sensor/block between 12:00 and 2:00 on the clock.  Now when you lie on your side, the particles can only move halfway around the clock, so a particle at 12 ends up at 6—not far enough to exit the canal at 8.  Using the log roll as a treatment for H-BPPV can cause particles to penetrate to this 12-2 position close to the sensor if you accidentally do the log roll toward the bad ear rather than away from it.

This means you must have an extra step to move the particles that start near 12 to the 6 o’clock position, and then a second movement to move them from 6 to 8 and out of the canal. 

The key is that in this circumstance, you need to lie on your good side with your head FACING STRAIGHT UP, not forward as in the original Gufoni.  You want to be looking at the ceiling.  You can tap behind your ear to help get particles moving if needed, and it’s a good sign if you feel dizzy in this step.  This position means that at the end, all particles that are loose will be at the 6:00 position.   Wait for at least 15 seconds or until the spinning stops, and then turn your head toward  the good ear over the course of 10 seconds or so, and roll a bit toward the good side until your head is facing the bed.  This will roll them out of the opening at 8. 

It’s possible for particles to get blocked in the canal near the sensor, because there is a natural narrowing  there.  In that case, vigorously shaking the head can sometimes break up the clump and allow it to pass out.  Repeated tries are usually necessary when there is a blockage, and you may need to see a provider for this.