An Introduction to Benign Paroxysmal Positional Vertigo (BPPV)

"There was no reason for trouble to start. I was sitting in a restaurant in Maui, chased indoors by heavy rains, looking forward to lunch and a piña colada. No sooner had the food arrived, without any warning, I suddenly felt a horrible twisting inside my head. I felt like I was being pulled out of my chair to the side and flipped over all at the same time. I grabbed the chair seat with both hands and managed to keep from falling off of the chair onto the restaurant floor. I looked around the restaurant and no one else seemed to be acting unusual. Nothing was moving except inside my head. The spinning stopped about 15 minutes later, returned briefly a few days later, and then disappeared for four months. But then it started to come back often and lasted 30 minutes, an hour, several hours at a time. Gradually, it was happening almost every day. During the worse spells, I could see the room shifting about me, and I noticed odd sounds and feelings in one ear, including roaring noises, clanking, and a sensation of stuffiness.

After a year of this torture, something new happened. One morning, when I rolled over in bed toward the bad ear, it felt like the room began to spin intensely. It was more violent than any of the prior spells but stopped after about 30 seconds. Trying to get out of bed set it off again, however, so I was only able to get out of bed when I moved very slowly. That morning, I went to see an ENT I had worked with previously, and he diagnosed Benign Paroxysmal Positional Vertigo (BPPV), but he also expressed concern that I had more going on in the bad ear than just BPPV. After experiencing months of BPPV spells and the daily vertigo, I had begun to lose hearing in the bad ear and was ultimately diagnosed with Meniere's disease.

My Vertigo Journey and the Half Somersault

At that moment, when I experienced vertigo on Maui, my entire life shifted and it would never be the same again. It was especially cruel because I was a physician, trained in otolaryngology, the field that deals with vertigo, so I had treated many people with these vertigo disorders and knew from my clinical experience just how horrible these disorders could be. There weren't many treatments that seemed to help, and I had witnessed the sufferers coming in again and again seeking help in their misery. Now I was one of them.

Over the next few years, I suffered from severe vertigo (a disease called Meniere's disease) until I was rescued by my residency mentor, Dr. Jeff Harris, who finally cut the nerve to my bad ear so it could no longer make me spin. What I had learned about vertigo as a physician didn't come close to matching what I learned from personally experiencing it. It was much, much worse than I ever imagined before it happened to me, and it became my life's mission to help as many other people with vertigo as possible. To that end, I did a fellowship in neuro-otology at UCLA with Dr. Robert Baloh and Dr. Vicente Honrubia, who had written a key textbook on vertigo disorders and taught me all the latest knowledge of vestibular diseases.

I moved to the University of Colorado in 1994 and began treating dizziness and imbalance. One of the most common dizziness problems was positional vertigo (dizziness in certain head positions), and I tested every patient for this. At the time, very few people in Colorado knew that it was most often a small mechanical problem involving crystals in the ears and could usually be treated with a simple maneuver. Over the years, I first saw hundreds, and eventually thousands, of sufferers and conducted the treatment maneuver and its variations many thousands of times. The ability to relieve an awful disease using your bare hands is so very unusual in medicine, and I enjoyed doing it as much as my patients loved being helped. There was one problem with this kind of positional vertigo, though: Even though it can often be cured by a simple maneuver, it can also easily happen again. Many patients would ultimately need another treatment, some would need to be treated over and over. I tried giving patients various maneuvers as home exercises to cure recurrences, but patients still returned because the home maneuvers did not help them enough. After more than a decade of seeking, I hadn't found the perfect home treatment. That changed in 2006, when I discovered the Half Somersault maneuver.

The discovery was serendipitous. I was getting up one morning to go to work and treat people in my vertigo clinic. When I rolled over in bed, I suddenly developed positional vertigo in my "good" ear. This had never happened to me before, and I knew it meant that I had dislocated some crystals into the wrong part of my ear. I tried to do the usual office maneuvers and ended up getting the crystals into other places in my ear that caused even more severe vertigo. I crawled back into bed with a bucket in case I got sick and tried to figure out an alternative. Using my fingers as rings I constructed a little model of the inner ear and moved it around to see if there was a way to remove the crystals more easily. After a few minutes I realized that a modified somersault position should work. I got down on the floor and did the Half Somersault maneuver for the first time. I arose completely free of vertigo.

Naturally, I added this exercise to the others I was already "prescribing" as home treatments. Patients that took the other exercises home often came back with recurrences, but those using the Half Somersault did not. This led me to assemble a team to perform a study of the new exercise. Our evidence-based research paper showing the effectiveness of the Half Somersault was published in 2012, and since then millions of people have downloaded videos and handouts of the exercise for home use.

What Is Benign Paroxysmal Positional Vertigo (BPPV)?

The most common vertigo disorder is Benign Paroxysmal Positional Vertigo, which we commonly refer to as BPPV. Although there are many ailments that cause vertigo, it is only this particular disorder — BPPV — that can be relieved using simple maneuvers. BPPV does not require surgery, medications, or prolonged physical therapy to treat; in most people, the vertigo caused by BPPV can be stopped in a matter of minutes. In BPPV, heavy crystals that are normally used by the ear to detect the pull of gravity accidentally fall into one of the spinning sensors of the inner ear. By placing the head in just the right position, the crystals can be shaken back out, restoring normal function and ending the symptoms of vertigo almost instantly.

The typical symptoms of BPPV are easy to recognize: The world spins briefly when you make certain rapid head movements. The vertigo can be severe enough to cause nausea and vomiting. Most BPPV spells...