For some people, a slight tipping of the head can trigger vertigo. They tilt their heads to look down or up, or simply roll over in bed, and suddenly the room is spinning. Accompanied by symptoms of dizziness and nausea, this condition can call a halt to regular day activities.
“Episodes of BPPV can last for a few seconds, a few days, a few weeks or a few months,” says neurologist and dizziness expert Neil Cherian, MD. “Because BPPV is so common and so fleeting, it’s hard to get good data on its incidence.”
What is Benign Paroxysmal Positional Vertigo?
While vertigo is a very individual experience for each person who suffers from it, the dizziness from Benign Paroxysmal Positional Vertigo (BPPV) is caused by shifting the position of one’s head. Vertigo usually lasts only a few minutes but can range from a mild to severe intensity.
The spinning can initiate other symptoms like:
- A sense of imbalance 
BPPV is usually not a serious issue and can disappear on its own within six weeks. However, the symptoms associated with it can be alarming, and even dangerous for older individuals who may fall and fracture a bone due to the unsteadiness of the vertigo reaction. Some patients go to great lengths to avoid moving their head and don’t realize when the condition has healed.
Head trauma is the most common cause of BPPV and it occurs at similar rates between men and women. Elderly people are at an increased risk of developing BPPV from natural body degeneration. A study of this population assessed them for non-balance-related complaints found that 9% had undiagnosed BPPV. 
What causes Benign Paroxysmal Positional Vertigo?
In the inner chamber of the ear, calcium carbonate crystals, also called otoconia can become loose and shift within the semicircular canals. These canals assist the brain with balance and coordination.
The otoconia are a normal part of the ear structure, but they can be loosened from an injury, infection, or age. They land in the utricle, a sac-like part of the ear, where they dissolve naturally.
However, loose otoconia in the semicircular canals do not dissolve that same way. Instead, they roll around and push the tiny hairs lining the canals as the head positions shifts.
These hairs, also called cilia, are the body’s sensors for balance by sending messages to the brain whenever the head is moving. The crystal matrix is the body’s motion-sensing mechanism until some crystals loosen and roll around in one of the three semicircular canals. This stimulates the cilia and results in vertigo.
“When the crystals are all connected, the fluid in the canals settles down as soon as your head stops moving,” explains Dr. Cherian. “But when the crystals are disconnected, they keep moving in the fluid for up to a few seconds afterward. The brain has to figure out why there is movement when it doesn’t see it. And that is what makes you dizzy.”
How Do You Treat Loose Crystals?
Fortunately, the treatment is simple and requires no medication. It’s called the Epley maneuver, and it’s a self-reposition exercise to shift the crystals back into place. They are easy to do at home or in any comfortable environment. Once the symptoms clear, there’s no need to continue the exercises (unless loose crystals are a recurring issue.)
“When done in a medical setting, the success rate for these exercises is up to 90 percent,” says Dr. Cherian. “Doing them properly on your own can be quite effective for BPPV.”
However, the Epley maneuver may not help in cases where:
- Both ears are affected.
- There are too many loose crystals involved.
- The crystals moved into more than one semicircular canal.
- The vertigo is from a different condition.
In cases like these, it’s recommended to see a specialist who can safely administer the exercises to move the crystals back into place.
Medication used to be prescribed for this condition, but a double-blind study showed they were mostly ineffective.
Not all cases are not helped by these exercises. Surgery is only reserved for recurring or difficult versions of this condition, and the ear is scanned first to rule other possible sources of vertigo. 
For instructions on how to safely conduct the Epley maneuver click here. This maneuver is generally very safe, but check with your doctor if you have:
- neck or back disease or injuries
- vascular conditions
- retinal detachment
Loose Crystals Without Vertigo?
It is possible for someone to have loose crystals in the ear and not experience any symptoms of the room spinning, nausea, etc.
“Many patients with BPPV don’t even feel dizzy, just lightheaded, unsteady or a bit off,” says Dr. Cherian, “but when we test for crystals in the office, there they are.”
It is possible to have leftover crystals after a bout of BPPV if the patient avoids turning their head in a way that previously triggered vertigo. However, the Epley exercises should restore a person to their normal functioning selves.
Are there natural approaches to treating vertigo?
In addition to the Epley maneuver, there are various home remedies that can be employed.
Ginger – Also known as Zingiber officinale, ginger has been shown to help with symptoms of vertigo induced nausea . In another study, ginger was shown to help reduce symptoms of vertigo when used in combination with manual repositioning. The combination worked better than manual repositioning alone .
Ginkgo Biloba – A herb used traditionally in Chinese Medicine, Ginkgo Biloba works by helping to increase blood flow. In one study Ginkgo Biloba worked better than the medication betahistine .
Hydration – Staying hydrated is important when trying to prevent vertigo symptoms.
Other natural approaches to managing vertigo can include aromatherapy and acupressure .
Try to avoid other substances that can either hinder circulation and/or increase the risk of dehydration. These include but are not limited to alcohol, caffeine, and tobacco.
Is There a Cure?
As of now, BPPV is not preventable. It could be identified and treated, rather like the common cold, but there are no ways to avoid it, especially since it is related to head injuries, which nobody can predict, and natural degeneration with age.
Practicing the Epley maneuver is a good tool for those who have experienced BPPV and are concerned the crystals may become loose again.
However, notice the intensity of the symptoms. If nausea prevents a person from holding down liquids, or the spinning is accompanied by weakness, numbness, or visual disturbances, don’t wait a few weeks hoping it will subside. This may be an indication of a more serious problem, such as a stroke. 
- Benign Paroxysmal Positional Vertigo https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo?_ga=2.149391414.1288948726.1559167524-1025942982.1558548853
- Diagnosis and management of benign paroxysmal positional vertigo (BPPV) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC202288/
- BPPV: Why Loose Ear Crystals Make You Dizzy and How to Fix Them https://health.clevelandclinic.org/bppv-why-loose-ear-crystals-make-you-dizzy-and-how-to-fix-them/
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