Acupuncture

By Qineng Tan, L.Ac., Ph.D. and Xiaomei Cai, L.Ac. Ph.D.

Dizzy when lying down? Waking up dizzy? Head spinning sensation when you move from one position to another? These could be BPPV symptoms. Benign Paroxysmal Positional Vertigo (BPPV) is a common vertigo cause. Acupuncture and TCM offer an alternative or adjunct BPPV treatment to help relieve positional dizziness.

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo, a condition characterized by a feeling that the room is spinning. 

BPPV is an inner ear disorder that affects the vestibular system, which controls your sense of balance. BPPV causes you to feel dizzy. The words “positional vertigo” in the name refer to the fact that the dizziness happens after you move your head, either by tilting or turning it, or you get dizzy when getting up from laying down.

Unlike some other forms of vertigo, BPPV is considered relatively harmless; hence the word “benign” in the name. However, its sudden and unpredictable nature can be very unsettling, and have a real impact on your daily life.

BPPV occurs when small calcium particles called otoconia, which are normally located in the inner ear, become dislodged and migrate into one of the ear’s semicircular canals. When these particles move with changes in head position, they can disrupt the normal flow of fluid in the canals, sending incorrect signals to the brain about the body’s position. This mismatch between visual and vestibular signals leads to the characteristic symptoms of BPPV.

What Causes BPPV? 

In most cases, doctors do not find a clear BPPV cause when patients see them about recurring dizziness. However, it is possible for certain conditions to possibly cause BPPV. These could include:

• Head injury, head trauma
• Migraine headaches, vestibular migraine
• Meniere’s disease
• Labyrinthitis

Migraine associated vertigo is common, and vice versa; people with BPPV are more likely to experience vestibular migraine, or a migraine headache due to problems with the inner ear. Patients who have BPPV treatment in the form of repositioning, as discussed below, may also be more likely to have migraines afterwards.

Top 10 BPPV Symptoms

That dizzy, spinning sensation is the primary, recognizable symptom of vertigo, but when a person has BPPV, there may be other signs, too. These are the most common symptoms of BPPV:

1. Dizziness: Sudden and intense episodes of dizziness, often triggered by changes in head position, such as rolling over in bed or tilting your head back.
2. Vertigo: A spinning or whirling sensation, as if the room is rotating around you. This sensation is usually brief but can be severe.
3. Light-headed: feeling faint or dizzy.
4. Nystagmus: Involuntary, rapid eye movements, typically triggered when changing head position. These eye movements are a hallmark of BPPV and can help doctors diagnose the condition. It may feel like you’re seeing wavy lines or objects around you “jumping” or moving.
5. Blurred Vision: the inner ear is connected with the eye muscles, so this imbalance can affect vision, and even cause foggy vision, double vision, and/or sensitivity to light.
6. Imbalance: Difficulty maintaining balance, especially when getting up from a lying or seated position. This can lead to unsteadiness and an increased risk of falling.
7. Nausea: Some people with BPPV may experience nausea or vomiting, particularly during severe vertigo episodes.
8. Fatigue: The unpredictability of BPPV attacks and the effort required to maintain balance during episodes can lead to feelings of exhaustion.
9. Anxiety: BPPV can cause anxiety, as individuals may fear the sudden onset of vertigo and its potential impact on their daily activities.
10. Tinnitus: Some individuals with BPPV may experience ringing in ear or buzzing in the affected ear, or even hearing loss.

BPPV Treatment and Diagnosis

There really are no lab tests that confirm a diagnosis of BPPV. A doctor will usually perform a test called the Dix-Hallpike maneuver, in which you are asked to turn your head and lie down, and then sit up again 20 to 30 seconds later. During this test, the physician will carefully observe for signs of nystagmus, the rapid eye movement that is one of the classic signs of BPPV.

A doctor may perform other tests like an MRI or CT scan to rule out other possible causes of vertigo.

Sometimes, doctors will recommend a wait and see approach, as many times, BPPV symptoms will resolve on their own in a matter of weeks or months.

Benign paroxysmal positional vertigo treatments can include vestibular suppressant medication. Medications for BPPV aim to provide vertigo treatment that reduces symptoms of dizziness and nausea. 

Benzodiazepines, like Valium, may be prescribed because they can help reduce acute vertigo and the sensations of motion sickness. These medications can be habit-forming and have side effects. They also have to be reduced gradually, because of withdrawal symptoms.

Antihistamines, like Benadryl, may be recommended, as they can also reduce feelings of nausea. 

Anticholinergics are vestibular suppressants that block receptors in the nervous system. They are used to treat many conditions that involve involuntary movement. However, they can cause a lot of side effects and worsen other conditions like prostate problems, irregular heartbeat or rapid heartbeat, glaucoma, dementia, and depression.

None of these medications address the root cause of dizziness. 

The preferred treatment for BPPV is usually a canalith repositioning procedure (CRP) can be done with one of a few different maneuvers that doctors can perform to try to move the particles in the inner ear that are causing BPPV. These are often helpful in the short term to relieve vertigo, but often patients do have a recurrence of BPPV symptoms again.

For some people, repositioning is not a good option—if you have problems with your cervical spine, or serious cardiovascular problems, for example.

Acupuncture and TCM offer an alternative treatment for BPPV that can relieve dizziness and other vertigo symptoms without any unwanted side effects.

Can Acupuncture Help BPPV?

According to TCM theory, phlegm is one of the pathogenic forces that can take hold in the body, along with things like dampness, dryness, etc. Phlegm builds up when fluids in the body are not being transported and moving the way they should; they get caught in an area and become condensed and thick, causing blockages of energy and movement.

The San Jiao, or “triple burner,” is an important concept used in TCM theory; the San Jiao controls the movement of fluids in the body. In cases of vertigo, phlegm and heat become stagnant due to the malfunctioning of the Jiao. This causes phlegm to be pushed upwards in the body.

In TCM, we may diagnose BPPV and other vestibular problems as having their root cause in a buildup of phlegm in the head that is causing a blockage in the inner ear. 

Wind is another pathogenic force that can get into the body and cause problems that seem to come and go. Some cases of dizziness may be due to wind in the head.

Thus, the TCM protocols for BPPV treatment will aim to clear dampness, phlegm, and wind, and get fluids and Qi energy moving again.

Herbs can play an important role in treating vertigo. Chinese herb formulas that warm Yang energy and strengthen the kidneys and spleen can help to clear phlegm.

Use of specific acupoints with acupuncture treatment can help relieve vertigo—sometimes patients feel much less dizziness, even after one treatment. Not only can TCM treatment for BPPV help improve vertigo right away, but regular acupuncture session can help prevent bouts of dizziness from happening.

Acupuncture Near Me for BPPV in Los Angeles, Santa Monica

TCM is a great modality for helping to relieve dizziness due to all types of health conditions, including migraines, POTS, Ehlers-Danlos Syndrome, Meniere’s disease, multiple sclerosis (MS), diabetes, sinus issues, ear infections, and the side effects of medications. Acupuncture can be an excellent alternative for vertigo if other treatments have not helped. Dr. Tan and Dr. Cai at Art of Wellness in West L.A. can help get to the bottom of recurring dizziness, so you can feel steady again.

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.