2.4% of the general population will likely develop BPPV during their lifetime. It occurs more often in the elderly, and aging is a risk factor. Even with successful treatment, the condition can recur in up to 50% of patients within five years. Although BPPV is not associated with a severe brain or inner ear problem, it can be life-altering for patients with recurrent BPPV, prolonged dizziness even after treatment, or who suffer a fall from instability caused by vertigo.

This article will discuss a functional medicine approach to dealing with BPPV.

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What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign paroxysmal positional vertigo is a long and complex name, abbreviated as BPPV:

• Benign: non-life threatening
• Paroxysmal: a sudden occurrence of symptoms
• Positional: the symptoms occur when the head changes position
• Vertigo: a sensation that the room is spinning
  

What Causes BPPV

BPPV is caused by inner ear dysfunction and is the most common cause of peripheral vertigo. Tiny calcium carbonate crystals (canaliths) dislodge from an inner ear organ called the utricle and travel into structures called semicircular canals. The presence of the canaliths in the fluid of the semicircular canals causes vertigo. This vertigo can lead to nausea and vomiting, shaky eye vision, beating of the eyes (called nystagmus), falls, and subsequent fractures.

Residual dizziness that persists after the actual vertigo is treated can occur in up to 61% of patients with BPPV. This dizziness can last for days to weeks and is thought to be influenced by the length of time with vertigo before treatment.

BPPV Signs & Symptoms

The main feature of BPPV is vertigo (a sensation that the room is spinning around you). Vertigo usually follows a change of head position, for example, turning your head or rising from a lying to a standing position. The vertigo often lasts about 1 minute and can accompany nausea or vomiting. Other features include unsteadiness, blurred vision, rapid eye movements, and falls.

These symptoms can be frightening as patients often fear they are having a stroke or brain injury.

What Triggers BPPV?

The etiology of most BPPV cases is unclear, making it a complex condition to prevent. Some specific etiologies include:

• Head trauma
• Meniere’s disease
• Vestibular neuritis
• Ear infections (otitis media)
• Vestibular migraine

Risk Factors for BPPV

Initial presentation and recurrence are thought to include:

• Female sex
• Age 65 years and older
• Osteoporosis
• A meta-analysis of over 1900 patients demonstrated that those with BPPV had lower bone mineral density scores (T-scores) on a DEXA scan and a higher risk of having osteopenia or osteoporosis
• Vitamin D deficiency
• Anxiety
• Elevated blood pressure
• Diabetes
• Elevated lipids
• Wear and tear of the cartilage discs in the neck (cervical spondylosis)
• Coronary heart disease
• Extended periods of computer use
• Malnutrition

How is Benign Paroxysmal Positional Vertigo Diagnosed?

There are no specialized diagnostic tests, like blood or urine tests, for BPPV. It is a clinical diagnosis based on the patient’s symptoms, medical history, and physical exam.

A thorough history and physical exam are imperative to rule out other possible causes of vertigo and nystagmus, such as Meniere’s disease, inflammation or infection in the inner ear, and central nervous system conditions such as a tumor, stroke, or multiple sclerosis. Medications, especially some anti-seizure medications like phenytoin, can also cause nystagmus.

Once more serious conditions are ruled out, BPPV is diagnosed in the provider’s office with a positional test called the Dix-Hallpike maneuver. During this maneuver, the provider moves the patient in a specific manner and looks for nystagmus (an involuntary eye movement that may cause the eye to move rapidly).

4 Natural Treatment Options for BPPV

One of the most effective treatments for BPPV is repositioning the dislodged calcium carbonate crystals (canaliths) using a simple head positioning maneuver called the Epley maneuver. This maneuver positions the head at different orientations and allows the canaliths to work their way out of the semicircular canal, alleviating vertigo.  

Although more robust studies are needed, specific functional medicine approaches include acupuncture, vitamin D optimization, adequate nutrition, and herbal compounds.

Acupuncture

A small study out of China demonstrated that acupuncture with ginger moxibustion in combination with a canalith repositioning maneuver was more efficacious in treating BPPV than the repositioning maneuver alone.

Vitamin D

A recent retrospective case-control study found that vitamin D levels were lower in patients with BPPV.

Prealbumin

A recent study evaluated prealbumin as a marker of nutritional status in 320 patients with BPPV and 320 controls without BPPV. They found that patients with low prealbumin levels had 5.5 greater odds of developing BPPV than patients with normal prealbumin levels. Taking a thorough dietary history, including assessment of alcohol consumption and hematologic parameters, and evaluating prealbumin as a surrogate marker for nutritional status may be important in getting to the root cause of BPPV for some patients.

Herbal Compounds

Oral ginger is well known for its anti-nausea effects and can be a helpful adjunct before performing the Epley maneuver or if dizziness persists after the vertigo is resolved.

Functional Medicine Treatment for Residual Dizziness

Some patients suffer from residual dizziness (feeling off-balance) even after the canaliths have been repositioned and the vertigo is gone. Danhong, a traditional Chinese medicine injection, can be considered if this dizziness persists.  

A study of 86 patients found that residual dizziness from BPPV was significantly improved with Danhong injection. Danhong combines Dan Shen roots (Salviae Miltiorrhizae) and Safflower (Hong Hua). It is thought that this combination relaxes blood vessels, allows for better circulation, and modulates calcium metabolism.

Herbal compounds like ginkgo Biloba, lemon balm, and apple or grape polyphenols may also help treat residual dizziness, but more extensive, more conclusive studies are needed.

Functional Medicine Treatment for Recurrent BPPV

Up to 50% of patients will experience recurrent BPPV within five years. Vitamin D optimization can be beneficial for minimizing the risk of recurrent BPPV. Recent studies, including a systematic review and meta-analysis, demonstrated a decrease in BPPV recurrence with vitamin D supplementation in patients with low vitamin D levels.

At-Home Treatment for BPPV

Since BPPV recurrences are common, recognizing an episode of BPPV and prompt treatment with the Epley maneuver can eliminate the associated nausea, vomiting, and possible falls due to vertigo.

Your healthcare provider can teach you how to do the Epley maneuver at home if they feel confident that the new symptoms of dizziness or vertigo are associated with reoccurring BPPV and not a more serious health condition.

Summary

BPPV is a common but frightening condition. Lowering levels of inflammation, ensuring optimal vitamin D levels, having adequate nutrition, and reducing other risk factors like elevated blood pressure and diabetes may help. Working with a functional medicine provider can optimize your health at home and hopefully prevent future BPPV recurrences.