May 28, 2018
28 May 2018


Vertigo can be among the most disabling conditions clients present with at my office. Frequent sufferers often can’t even work. With vertigo, it often feels like the world is spinning or swaying around you. Dizziness, nausea, vomiting, sweating and difficulty walking are all common symptoms. It effects quality of life just as much or more than many very painful conditions. So why does it happen? Vertigo has multiple potential causes. Let’s review some of the different causes and what can be done about them.

– Ménière’s disease: Thought to be caused by excess fluid in the inner ear, Ménière’s often presents with frequent, sudden and severe bouts of vertigo in combination with ringing in the ears (tinnitus), a feeling of fullness in the ear, nausea, vomiting, imbalance and hearing loss. Surgery is often indicated for Ménière’s

Vertigo- The Body Mechanic

– Labyrinthitis: Caused by inflammation of the vestibular nerves, labyrinthitis causes similar symptoms to Ménière’s, with vertigo, dizziness, nausea and hearing loss. This is commonly treated with medication.

– Migraines: Vertigo is one of the more common and severe symptoms of migraines. Treatment varies depending on the primary cause. For more information on migraines, click here to read an article I wrote on the subject.

– Benign Paroxysmal Positional Vertigo (BPPV): This is among the most common causes of vertigo and often the simplest to treat. BPPV occurs when loose calcium carbonate debris has broken off and enters a semicircular canal thereby creating the sensation of motion. Treatment is aimed at getting the loose debris out of the semicircular canals. This can be done through a series of head movements known as the Epley maneuver. Before one does the Epley, a pre-test known as the Dix-Hallpike is performed to determine a) IF one has BPPV and b) Which side they have it on.

The following sequence of positions describes the Epley maneuver. You’ll want another person with you to help:

  1. You begin in an upright sitting posture, with the legs fully extended and the head rotated 45 degrees towards the side in the same direction that gives a positive Dix–Hallpike test.
  2. Quickly lower into a supine (face up) position with the head held approximately in a 30-degree neck extension with the head still rotated to the side.
  3. Your helper will notice nystagmus with the eyes. That’s a “jittering” motion of the eyes.
  4. Remain here for approximately 1–2 minutes.
  5. Rotate your head 90 degrees in the opposite direction so that the opposite ear faces the floor, while maintaining 30 degrees of neck extension.
  6. Remain here for approximately 1–2 minutes.
  7. Keeping your head and neck in a fixed position relative to the body, roll onto your shoulder, rotating your head another 90 degrees in the direction you’re facing. Now you should be looking downwards at a 45-degree angle.
  8. Your helper will again notice nystagmus. Remain here for approximately 1–2 minutes.
  9. Finally, have your helper help you up to a sitting position, while maintaining the 45-degree rotation of the head.
  10. Remain here for 30 seconds.

The entire procedure may be repeated two more times, for a total of three times. During every step of the procedure, you may experience some dizziness, and that’s totally normal.

– Other causes: There are plenty of other causes of vertigo, such as stroke and blockage of the eustachian tubes. Blocked eustachian tubes are usually easy to address with cranial work. Other easily treated causes include temporal bone dysfunction, imbalance of the extraocular muscles of the eyes, and overstimulated crude touch receptors around the head and face.

In most causes, vertigo is transient or at least caused by something relatively minor. If the Epley maneuver doesn’t do the trick for you, feel free to set up a consultation or come in for an appointment.

3 replies
  1. Tiffany Ehrmantraut says:

    I actually recently contacted you regarding vertigo for which I ended up suffering from BPPV that lasted 7 full weeks. It was extremely debilitating and super frustrating. I was able to diagnose myself using the Dix-Hallpike test you mentioned above, however, the Epley maneuver was proving to not be effective. After continued research (thank you Youtube), I found that I was suffering from the Horizontal Canal BPPV and not the Posterior Canal BPPV, for which the Epley is used to treat. For Horizontal Canal BPPV the Gufoni method was suggested and thankfully successful, although it still took many weeks for my vertigo to go away completely as the calcium carbonate debris kept getting loose and I would have to do the method almost daily. FINALLY, the debris lodged themselves back to their correct position and I’ve been vertigo free for almost a week, but oh man, was it a loooooong 7 weeks :(

  2. Hazel Owens says:

    That’s interesting that BPPV is the most common causes of vertigo and that it’s loose calcium carbonate debris that is in a semicircular canal that creates the sense of motion. My mom has been getting dizzy spells lately so I’m trying to figure out what may be the cause. We’ll have to take her in to see if she has BPPV so she can start treatment to get rid of the debris if that’s what’s causing the dizziness.

  3. vertigo chair says:

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