Benign paroxysmal positional vertigo (BPPV) can be defined as transient, position-induced torsional, vertical, or horizontal nystagmus with vertigo.

WHAT CAUSES BPPV?

The pathology is based on displacement of the otoconia in the semicircular canal (canalolithiasis) or attachment of debris/otoliths to the cupula (cupulolithiasis). It can be a primary issue or secondary issue from other conditions.

Unfortunately, the underlying pathology is often obscure and the “main” reason is not always known - hence, what we call idiopathic. In this case, we call it idiopathic BPPV.

WHAT FACTORS LEAD UP TO HAVING THIS DIAGNOSIS?

Considering most cases of BPPV are idiopathic, there are other factors associated with BPPV. Everyone wants to know “why” they have this diagnosis and as healthcare professionals, we can’t always pinpoint one specific reason. But, usually there are several reasons that then “overload” your system and cause a “spill-over” effect —- which means your body can’t compensate any further and you get symptoms.

HERE IS A LIST OF 18, YES 18, FACTORS ASSOCIATED WITH BPPV!

1. Aging
2. Migraine
3. Meniere’s Disease
4. Trauma (such as car accident, concussion, whiplash)
5. Infection
6. Vestibular Neuronitis
7. Idiopathic sudden sensorineural hearing loss
8. Sleeping habits
9. Osteoporosis and vitamin D insufficiency
10. Hyperglycemia and diabetes mellitus
11. Chronic head and neck pain
12. Vestibule or semicircular canal pathology
13. Pigmentation disorders
14. Estrogen deficiency
15. Neurological disorders
16. Auto- immune, inflammatory, or rheumatologic disorders
17. Familial or genetic predisposition
18. Allergy

Wow, that’s a lot of factors that could lead to you having BPPV!

WHAT DOES ALL OF THIS MEAN FOR ME IF I TREAT BPPV AND EVEN OTHER DIZZY/VERTIGO PATIENTS?

Basically, this means that the well-rounded treatment is more than just “a manuever”. Yes, we can all knock this out and do a pretty solid job with it! It is the more "complicated" cases that we aim for and can help the most.

Overall, we recommend getting trained in Vestibular Rehabilitation and Upper Quarter Manual Therapy to fully address these patients. Also, take the time and training to examine their symptoms and discuss lifestyle factors and other strategies to not only prevent BPPV from having again but overall, address the entire body and give it all to your patients.

HOW DOES BPPV RELATE TO CERVICOGENIC DIZZINESS?

For this article and our specialization under the realm of Cervicogenic Dizziness from Cervical Arthrogenic and Myofascial pain, I like to address 2 of the 18 points above -- numbers 4 and 11.

#4 Trauma (such as car accident, concussion, whiplash)

We consider someone who has had trauma under the realm of "double entity". This means that there are at least 2 systems involved (i.e. inner ear and neck pain). This is more common than generally Cervicogenic Dizziness is identified in the literature and quite frankly, we find some type of neck disturbance in pretty much every single one of these patients.

#11 Chronic head and neck pain

This coincides well with Trauma above but may need more explaining to the patient as there is not one single type of injury. This is what you can consider to be more of a single entity instead of just BPPV, but coincides in at least 70% of our BPPV patients. As we discuss in our clinic and courses, we recommend treating BPPV first via canalith repositioning manuevers, but adjunct it with manual therapies and exercises for the neck to fully treat the whole system.