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BPPV
BPPV is brief spinning triggered by head position, caused by displaced inner ear crystals. We reposition them, calm the system, and ask why they loosened and why they keep returning.
What you may be noticing
You roll over in bed and the room spins. You tip your head back to reach a high shelf, or bend to tie a shoe, and the world lurches for twenty or thirty seconds. Then it settles, leaving you queasy, cautious, and reluctant to move. Some mornings you wake afraid to turn your head.
Vertigo with double vision, slurred speech, facial droop, weakness, a severe new headache, or trouble walking is an emergency. Call 911, because these can be signs of stroke.
Why it is rarely one thing
BPPV is mechanical at its core. Tiny calcium carbonate crystals called otoconia normally rest on a membrane in the utricle of the inner ear. When some break loose and drift into a semicircular canal, every change in head position moves fluid that should be still, and the brain receives a false signal of spinning.
The reposition is often simple. The deeper questions are why the crystals loosened, and why they return. Head injury, prolonged bed rest, migraine, and inner ear inflammation are known triggers. Research also links recurrent BPPV with low vitamin D and reduced bone density, since otoconia depend on calcium metabolism much as bone does.
There is a second layer. The inner ear sends the signal, yet the brain decides how long you stay on guard afterward. After repeated episodes, many people keep a stiff neck, fixed gaze, and cautious gait between attacks. Not only loose crystals, but a nervous system that has adapted to brace. Your brain is the master system for balance, and it can be retrained.
Patterns we look for
- Which canal is involved and on which side, from positional testing.
- Vitamin D status, calcium metabolism, and bone density history.
- Prior head or neck injury.
- Migraine and vestibular migraine overlap.
- Inner ear inflammation after a viral illness.
- Estrogen changes in perimenopause and menopause, which influence calcium handling.
- Central compensation: whether the brain has recalibrated, or remains on guard.
- Autonomic balance, breath pattern, and movement avoidance that keep the system sensitized.
How I evaluate it
The comprehensive functional neurological exam includes positional testing with video-assisted observation of the eyes, because the direction of the nystagmus identifies the affected canal. I also assess saccades, smooth pursuit, the vestibulo-ocular reflex, balance on firm and foam surfaces, cervical function, and autonomic responses, so that other causes of dizziness are not missed.
Functional labs may include vitamin D, calcium, magnesium, parathyroid hormone when indicated, and a bone health review. When symptoms do not fit the classic positional pattern, I refer for imaging or specialist evaluation.
How we address it
Sequence matters. Mechanics first, then regulation, then retraining, then terrain.
- Reposition the crystals with the canal-specific maneuver matched to your exam findings, and confirm resolution with repeat testing.
- Calm the system: slow nasal breathing with a long exhale and gentle vagal work, so the brain stops reading head movement as danger.
- Retrain central compensation with gaze stability and graded vestibular exercises, in short sessions kept below your symptom threshold.
- Restore vitamin D and mineral status where low, which research associates with fewer recurrences.
- Address contributing terrain: migraine, inflammation, and bone metabolism.
- Provide a home plan so you can recognize and respond early if it returns.
Stillness should feel still again. Your inner ear can return to telling the truth.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.