Benign Paroxysmal Positional Vertigo Management Strategies

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, or dizziness, that is associated with movement of the head (though some motions may be more problematic than others) that goes away when movement ceases. Essentially, BPPV is caused by crystals becoming displaced within the semicircular canals (inner ear), which causes eddy currents in the fluid that circulates in the canals. Instead of the normal flow that bends small hair-like nerves in the same direction telling the brain that you’re standing, laying, running, etc., the brain is essentially given mixed messages of what position you’re in, resulting in a “sea-sickness” type of sensation.

There are several “canalith reposition maneuvers” available, and the choice of which maneuver to use depends on which canal(s) is affected. According to the Mayo Clinic, these maneuvers consist of several simple head movements, which can provide release in up to 80% of BPPV patients within a few treatment sessions, though the problem can recur.  

In an August 2020 study, researchers set out to determine whether vitamin D and calcium supplementation could prevent the recurrence of BPPV. A group of 518 BPPV patients from eight participating hospitals were provided with a twice daily 400 IU vitamin D and 500mg calcium carbonate supplement for a year. Another 532 BPPV patients served as a control group that did not receive a supplement.

The data show that patients in the supplement group were less likely to experience a recurrence in the following year (37.8% vs. 46.7%), especially those with low vitamin D levels at the start of the study. The researchers concluded that vitamin D and calcium can be considered in patients with frequent attacks of BPPV, especially when their blood level of vitamin D is low.

Interestingly, another study published in August 2020 found that vitamin D deficiency may be associated with up to a 3.29 times increased risk for BPPV recurrence, giving individuals yet another reason to spend time in the sun, take a vitamin D supplement, and eat vitamin D-rich foods to improve their vitamin D status.

 A review of your health history and an examination can reveal if your vertigo/dizziness symptoms are indicative of BPPV. If so, your doctor of chiropractic can train you in the various canalith reposition maneuvers to relieve those frequently debilitating symptoms. He or she will also counsel you on nutritional supplementation and diet. As noted in the recent study, the recurrence rate of BPPV is high and the intake of vitamin D and calcium can significantly reduce that rate.

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