How to Stop Vertigo

BPPV occurs when tiny calcium carbonate crystals, which normally reside in an inner-ear organ called the utricle and help you keep your balance, break loose and travel into the semicircular canals of the inner ear. This may be part of the normal aging process. “BPPV is a degenerative change in the inner ear,” Rauch says. “A degenerative utricle will shed crystals from time to time, like shingles falling off the side of an old house.”

Sometimes a bump on the head dislodges the crystals.

“BPPV is positionally triggered,” says Kim Bell, a San Diego-based doctor of physical therapy who specializes in vestibular rehabilitation. When you move your head in certain ways — dropping it forward to pick something up off the floor or attempting a Downward-Facing Dog yoga pose, for instance — you can cause these crystals to move and bring about an attack of vertigo.

Experts say seasonal allergies may play a role. “It’s interesting — there may even be a link to allergies, though we don’t know if it’s a direct relation,” says Devin McCaslin, director of audiology at the University of Michigan Medical School. “I had one patient who would come the same time every month, once a year, and it would pop up.”

Vertigo is often triggered when you’re lying down: You go to bed feeling perfectly fine, then roll over toward your bad ear to get out of bed in the morning, and wham!

The shifting of the crystals sends a faulty signal from your inner ear to your brain about how you’re moving, which leads to that “world is spinning” sensation.

Those dizzy spells typically last for less than a minute but can return anytime you pitch your head and trigger another brief, brisk spin. Some attacks can be merely annoying, says Brian McKinnon, M.D., an ENT-otolaryngologist in Philadelphia: “Others can be debilitating and dangerous, making you feel off-balance and putting you at risk for falls.”

Treatments for vertigo

BPPV usually goes away on its own within weeks of the first episode, though it can last for months or even years. If you want immediate relief from those bouts of spinning, you might consider something called the canalith repositioning procedure (CRP). The treatment — typically performed by a vestibular rehabilitation therapist (a specially trained physical therapist), occupational therapist, audiologist or ear, nose and throat doctor — involves moving the head in a series of precise positions, allowing the crystals to migrate out of the semicircular canals back to the original vestibular organ they came from — the utricle, where they won’t cause dizziness. “It's kind of like playing one of those small handheld pinball games,” Bell says, “tipping it right and left, trying to get the silver ball through the maze.”

Gerlach can attest to CRP’s steadying effect. “For me, the treatment was nothing short of magic,” Gerlach says. “It takes minutes and offers immediate results. All you need to do is take it easy for a few weeks. I was able to get back to normal, and I haven’t had an attack since. But it’s always in the back of my mind, and I try to avoid anything that could potentially bring on that feeling again, like doing exercises that whip my head around.”

Typically, BPPV can be eliminated in 85 to 90 percent of patients with one or two treatment sessions, though it can recur periodically. “A few of those little crystals get loose, and the whole thing starts all over again,” Rauch says. If this happens, your doctor or therapist can teach you how to perform CRP on your own at home.

Ways to prevent and handle a vertigo attack

There are ways to prevent or ride out an attack:

1. Avoid rapid head movements

Move slowly and methodically, so you don’t trigger it. And take time when standing up.

2. Get a lift

People who sleep without a pillow or a very low pillow are more prone to vertigo, says Carol A. Foster, M.D., an otolaryngologist and author of Overcoming Positional Vertigo. When you lay supine, the crystals may detach and fall into the posterior circular canal. “Sleep with your head propped up with two pillows,” Foster says.

Kevin Smith, a vestibular physical therapist with Clarity Rehab and Physical Therapy in Orange County, California, offers a different tack. “People sometimes avoid bending forward or lying flat because it may cause the crystals to get loose and trigger symptoms. While it’s OK to do this until you have the crystals repositioned, I recommend after I reposition patients that they resume all of their activities as they would normally do and not to avoid positions thinking that it will prevent the crystals from getting loose. Based on recent research, moving into those positions may actually decrease your risk of getting BPPV again.”

3. Try relaxation

“What’s making that dizzying sensation worse is oftentimes the anxiety associated with it,” Smith says. “Getting anxious is going to exacerbate symptoms.” After experiencing an episode, take deep breaths, try to relax and let that spinning sensation run its course. “If you’re experiencing nausea, ice packs placed on the neck goes a long way — but don’t leave it on there for longer than 20 minutes,” Smith says. “Cooling down your nervous system is going to help with those residual symptoms.”

4. Take vitamin D

Studies have found a link between vitamin D deficiency and recurrences of BPPV. Some researchers theorize that a diet lacking in D can lead to a demineralization of those little calcium carbonate crystals — perhaps creating a problem with how they’re forming and causing them to get displaced. What’s more, vitamin D can bolster your bones, lowering the risk of falls and fractures. If you have a D deficiency, consider taking a daily supplement.

Help with unsteadiness

Even after BPPV has been treated, some people have residual symptoms of imbalance or unsteadiness. These can usually be resolved by working with a vestibular rehabilitation therapist who will help patients use specific exercises to regain their stability. It might include walking on different types of surfaces, stepping over thresholds or maintaining one's balance in a stationary position. Smith offers exercises you can try at home. Perform them at your discretion, depending on your capabilities.

1. Walking head turns

Walk with your head turned to the left for three steps, then turn your head to the right for three steps. Continue for two or three minutes. 

2. Unstable surface stand

Stand on a couch cushion or pillow in the corner of a wall with a chair in front of you. Close your eyes and move your head left and right for one minute, trying to stay as still as possible. Repeat, moving your head up and down, as if nodding yes.

3. Gaze stabilization

Stand in a wall corner with a chair in front for safety, hold a sticky note with a letter written on it for a visual target, move your head left and right (about 20 degrees to the left and 20 degrees to the right), trying to move your head faster as long as the target is in focus. Repeat, this time moving your head up and down.

Unsettling symptoms aside, BPPV isn’t life-threatening. “If your symptoms are centered exclusively around the ear, and you want to wait it out, there’s probably no big danger in doing that,” Rauch says. However, he notes, there are times when dizziness can point to more serious disorders, such as heart disease, stroke, diabetes, brain tumors or multiple sclerosis. If you have symptoms in any other part of your body — say, your vision has changed, or you have numbness, weakness, confusion or slurred speech — it’s worth taking a trip to the ER and getting it checked out by a doctor.