What can I do to prevent BPPV?

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo disease.  It can be easily diagnosed with a bedside detailed history taking and clinical examination by a physical therapist.  Subsequently, the treatment involves proceeding with the results of a clinical examination and performing the correct canalith repositioning manuever(s).  Therefore, in majority of cases, patients can have a diagnosis and treatment in the same session. 

There are many risk factors that are associated with idiopathic BPPV to why some individuals get it and some do not.  The most agreeable amongst clinicians, but still not fully supported in the literature, are:

• Age
• Gender
• Vitamin D levels
• Hypertension
• Hyperuricemia
• Hyperlipidemia
• Diabetes
• Osteoporosis

There are also secondary BPPV risk factors, including but not limited to;

• Cervical arthritis and pain
• Vestibular neuritis 
• Trauma (such as concussion, whiplash, fall, etc).

The previous lists help explain to patients “why do I have BPPV?” or even “what can I do to prevent BPPV?”.  

In our practice, we further break down the risk of BPPV into modifiable and non-modifiable factors. 

Modifiable risk factors are ones that you have more control over to prevent or reduce.  To name a few, these are diabetes, hypertension and hyperlipidemia.  Unfortunately, there are also non-modifiable factors, such as age, gender and trauma.  

Instead of just throwing your hands up and saying, “well I am a female, over the age of 60 and have bad genes that put me at risk for cardiovascular risk factors” — you can do what you can to adjust your modifiable risk factors!

The best strategy is to exercise. 

Yes, exercise!  Let me explain more. 

A 2020 study in Front Neurol examined if an unhealthy lifestyle is an important risk factor for idiopathic BPPV.  Believe it or not, the authors found no obvious relationship with the above risk factors BUT had this conclusion:

“In this study, poor physical activities and prolonged recumbent position time are important predictors for BPPV”

They went on to quote, 

changing unhealthy lifestyles may be the solution to decrease the morbidity of BPPV.

To put the quotes into general terms for you all, it basically means that having an active lifestyle through exercise and avoiding sustained lying down positions (i.e. recumbent positions) can be the solution to help preventing BPPV and reducing risk for it coming back!

This is especially important in the winter months when we are typically not as active, we have less sunlight for Vitamin D and typically more depressed.

We do recommend exercises that are not just linear, but involve rotation of your body, stimulate your vestibular system and involve multiple positions of your trunk and head.  These are highly prevalent in a yoga or Tai Chi practice.  

So, sign up for a series or class of Yoga in your community or work on a self-practice at home!