Vertigo is a sensation of spinning when you’re not moving (or at least not moving the way that you feel). There’s a variety of causes, from head injuries to infections, but the majority of cases are probably caused by relatively non-serious underlying conditions and can often be resolved relatively quickly without medication.

For the sake of this article, I’m going to be focusing on what’s known as Benign Paroxysmal Positional Vertigo (BPPV), as opposed to vertigo associated with other disorders, such as Meniere’s disease.

The popular assumption of the cause of BPPV is otoliths, also called otoconia or canaliths, which are crystals that form in the fluid of the semicircular canals of the inner ear. The semicircular canals have sensitive hair cells that relay information on the movement of fluid in the canals in response to head position and movement. It is thought that otoliths alter the fluid dynamics in the semicircular canals and alter the brain’s interpretation of movement.

While there are medications for this, a popular treatment is a series of head movements, called the Epley maneuver, that’s intended to move the otoliths out of the semicircular canals through a system that acts kind of like a garbage disposal for such debris in the fluid.

There’s numerous videos and illustrated guides that show you how to do the Epley maneuver, as well as methods to determine which side you need to do it for (such as the Dix-Hallpike Test). When in doubt, I suggest doing the Epley maneuver for both the left and right side, and see which works the best. In some cases, both sides may need to be treated.

I won’t go into the specifics of how to do the Epley maneuver, as there are plenty of guides freely available online and easily found with any search engine. Suffice it to say, once you’ve familiarized yourself with it, the procedure is pretty quick and easy to do, and it often brings about immediate improvement in vertigo symptoms. Full resolution may take several sessions over a period of days or a few weeks.

The Epley maneuver is simple and effective, but in my experience there’s often a faster way to substantially reduce or eliminate vertigo assumed to be BPPV. That’s chiropractic correction of joint alignment/mobility in the cervical spine, most often in the upper few spinal segments.

The upper cervical spine has some attachments of the coverings of the brain and spinal cord, collectively known as the meninges. One theory of how cervical misalignment/dysfunction may cause vertigo is that there may be abnormal tension placed on the meninges that is transmitted up into the brainstem, creating pressure on, and altering the function of, the vestibular nerve (which relays information from the inner ear to the brain).

It should be noted that vertigo can be a symptom of impaired circulation in the blood vessels going up the neck to the brain, and if the vertigo is significant with even upright head movements and/or there are other symptoms indicating circulation issues (such as visual disturbances, weakness, numbness/tingling, impaired speech or swallowing, etc.), manual cervical chiropractic treatment should be avoided until circulatory issues can be ruled out or resolved.

In my experience, chiropractic adjustments tend to greatly reduce vertigo in most cases in less than a minute, although there sometimes is an initial increase in the spinning sensation for a few seconds as the nervous system “resets.” Chronic cases may require several sessions, but I’ve found that for many patients, just one or two treatments clears things up.

Upper cervical spine dysfunction may have associated muscle tension in the muscles of the area, so stretching and/or massage may be helpful in addition to chiropractic adjustments.

In some cases, there may be contribution to vertigo from both cervical spine issues and otoliths, and therefore treatment for both will be necessary for maximum improvement in such cases. In addition, sinus congestion and pressure may also contribute, and addressing those issues may be necessary as well.

While medication is available, and may be necessary in some cases, in my experience, most non-complicated cases of vertigo can be managed more effectively in the long-run with methods that more directly address the underlying causes.

Until next time…

George F. Best, D.C.