What Causes Vertigo?
Calcium Carbonate Crystals in the Inner Ear (BPPV): Symptoms, Distinguishing from Stroke, and Balance Exercises
Most cases of vertigo originate in the inner ear, but it is crucial to know which types require immediate action.
Triggered by changes in head position
Based on a survey of adults in Germany (2007)
Within 48 months;limited evidence available
Do not wait for it to resolve on its own
Many elderly individuals experience a sensation of the room spinning upon turning over in the morning—to the point where they must close their eyes.(The room spins, forcing them to close their eyes.)The sensation usually subsides after remaining still for a moment;it often originates from the inner ear.However, family members should be aware of which types of dizziness require an immediate trip to the hospital.
This information is for general reference only;it is not intended for self-diagnosis, nor does it recommend any specific medication.
Contents of this article:
1. What causes vertigo? How do calcium deposits (otoconia) in the inner ear make the room spin?
Short answer:Vertigo triggered by changes in head position is often caused by BPPV—a condition where small calcium deposits (otoconia) within the inner ear become dislodged and enter the semicircular canals. When the head moves, these deposits shift, sending false signals to the brain that the body is rotating.
The clinical practice guidelines from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS, 2017 update) define BPPV as:An inner ear disorder characterized by recurrent episodes of vertigo triggered by changes in head position.Associated factors include a history of head trauma, previous inner ear inflammation (labyrinthitis/vestibular neuritis), or a family history of the condition (MedlinePlus).
A population-based study of adults in Germany (von Brevern et al., 2007) estimated the prevalence of BPPV.2.4%The condition becomes more common with age and is associated with migraines, hypertension, hyperlipidemia, and stroke.A limitation of this study is that it relied on telephone interviews conducted in a single country;therefore, the data may not be representative of the Thai population.
Vertigo caused by BPPV typically occurs when rolling over in bed or getting up from a lying position.
2. What does vertigo from BPPV feel like, and how does it differ from general dizziness?
Short answer:Typical BPPV causes brief episodes of vertigo—lasting from a few seconds to about a minute—triggered by specific head movements. It is not accompanied by focal neurological deficits.If symptoms such as weakness, numbness, slurred speech, double vision, or an inability to walk occur, it is essential to urgently investigate other potential causes or underlying medical conditions.
| Characteristics | Consistent with BPPV | Requires urgent hospital visit |
|---|---|---|
| When does it start? | Upon moving the head or changing body position | Occurs spontaneously;unrelated to body position |
| How long does it last? | A few seconds to about one minute per episode | Continuous spinning sensation lasting for hours, even when lying perfectly still |
| Associated symptoms | Nausea, mild unsteadiness | Slurred speech, weakness, numbness on one side of the body, double vision, severe headache |
Summarized from AAO-HNS (2017), MedlinePlus, and the NHS.This table is intended to help determine the urgency of seeking medical care;it is not for self-diagnosis.
3. Types of vertigo that could indicate a stroke—call 1669 immediately
Short answer:If vertigo is accompanied by a sudden loss of hearing, seek emergency evaluation, as this could be a serious condition.Other warning signs include weakness, numbness, slurred speech, double vision, or an inability to stand or walk.These are signs that may indicate a neurological cause, such as a stroke. Call 1669 immediately—even if the symptoms seem to improve on their own.
What kind of vertigo could be a sign of a stroke?→ Call 1669 immediately.
• Slurred speech, inability to speak, or difficulty understanding others.
• Weakness or numbness in an arm or leg (on one side of the body), or facial drooping.
• Double vision, sudden loss of vision, or sudden hearing loss.
• Inability to stand or walk, loss of balance, or difficulty maintaining balance even while sitting.
• Persistent, continuous spinning sensation (even when lying perfectly still), accompanied by a severe headache unlike any you have experienced before.
Even if symptoms have resolved, you must still go to the hospital (NHS).Do not drive yourself.Learn how to recognize the warning signs using...BEFAST: Stroke Warning Signs
Why extra caution is neededA stroke affecting the back of the brain may not present with obvious facial drooping or arm weakness;instead, it often manifests as vertigo (a spinning sensation) and an unsteady gait.The "HINTS" examination is reserved for cases of "acute vestibular syndrome"—characterized by persistent, acute vertigo accompanied by nystagmus (involuntary eye movement), nausea or vomiting, an inability to tolerate head movement, and unsteadiness.It is not applicable to brief episodes of vertigo triggered by specific head positions (such as in BPPV) and should only be performed by a trained medical professional.Family members cannot use this method on their own to rule out a stroke.(Kattah et al., *Stroke*, 2009). Read more at...Which types of dizziness or unsteadiness are signs of a stroke?
4. How do doctors diagnose BPPV? Is an MRI or medication required?
Short answer:Doctors make a diagnosis based on the patient's medical history and physical maneuvers—such as the Dix-Hallpike test—by positioning the head and observing for nystagmus. If the findings meet the criteria for BPPV and there are no other concerning symptoms, the AAO-HNS guidelines do not recommend routine brain imaging.
- Dix-HallpikeMoving the patient from a sitting to a supine (lying on the back) position while turning the head is used to test for posterior canal BPPV. The physician observes for symptoms of vertigo accompanied by torsional, upbeating nystagmus (involuntary, rhythmic eye movements).
- Supine roll testTurning the head from side to side while the patient is in a supine position is used to test for horizontal (lateral) canal BPPV.
- Differentiating from other causes.Including other inner ear disorders and neurological conditions.
- Medications.Clinical guidelines do not recommend the routine, primary use of anti-vertigo (vestibular suppressant) medications.Any medication should be prescribed by a physician;do not self-medicate.
Positional testing and the observation of eye movements help physicians confirm a diagnosis of BPPV.
5. What is the Epley maneuver?Can family members perform it on the patient?
Short answer:The Epley maneuver is a procedure designed to reposition otoconia (calcium carbonate particles) from the posterior semicircular canal to an area where they no longer trigger symptoms.It is used to treat posterior canal BPPV that has been confirmed by a physician.It should not be performed by family members without a formal diagnosis, as the maneuver must be specifically tailored to the affected ear and the particular semicircular canal involved;furthermore, some individuals may have cervical spine (neck) limitations that preclude its use.
A Cochrane review (Hilton and Pinder, 2014) analyzed 11 trials involving 745 participants. It found that the Epley maneuver resulted in the complete resolution of vertigo in 56% of cases, compared to 21% in groups that underwent a sham or control procedure (5 trials, 273 participants; OR 4.42, 95% CI 2.62–7.44).No serious adverse events were reported, though documentation of side effects was limited.Nausea occurred in approximately 16.7–32% of participants during the procedure.Some individuals were unable to undergo the maneuver due to cervical spine (neck) issues.Recurrence rates of up to 36% within 48 months have been reported; however, long-term evidence is inconsistent and derived from only two small-scale studies.
- Perform only after a medical diagnosis has been established.This maneuver is ineffective for vertigo caused by other conditions and may lead to a failure to recognize a stroke.
- Consult your physician before performing the maneuver.Disclose any cervical or spinal issues, as well as any underlying medical conditions.
- Perform at home only if instructed to do so by a physician.Follow the provided instructions, ensure someone is present with you, and rise slowly after the procedure.
- Schedule a follow-up evaluation.Guidelines recommend a follow-up assessment by a physician within one month; if vertigo persists, the physician will check for residual debris (otoconia) or other underlying conditions.
6. Balance Training and Fall Prevention at Home After Experiencing Vertigo
Short answer:Based on AAO-HNS guidelines, a physician or physical therapist may recommend vestibular rehabilitation, tailored to an individual’s balance assessment, fall risk, available home support, and any lingering symptoms.
- Pre-training AssessmentA physical therapist will evaluate your balance and gait using standardized assessment tools to create a personalized plan.
- Rise SlowlySit on the edge of the bed for a moment before standing up;use a sturdy handrail or support.
- Fall-Proofing Your HomeInstall nightlights in hallways and grab bars in the bathroom;clear away electrical cords and slippery rugs.Read more at:5 Ways to Make Your Home Safe and Prevent Falls
- Balance ExercisesPerform only the exercises recommended and taught by your physical therapist.Ensure someone is standing by to assist, and keep a sturdy chair positioned against a wall.See examples at:Tandem Walking (Heel-to-Toe) and Balance Training
Balance training with a physical therapist, following a medical diagnosis.
“If you experience vertigo accompanied by slurred speech or weakness in your limbs, do not wait for it to go away on its own—always call 1669 immediately.”
How can KIN Hospital (Sukhumvit 107) assist your family?
KIN Hospital (Sukhumvit 107), located in Soi Bearing 10 near the BTS Bearing station, is a registered hospital specializing in physical rehabilitation.Not an emergency roomFollowing a medical diagnosis, our team provides support for balance and walking.
- Multidisciplinary medical teamCare is provided by neurologists and physiatrists (rehabilitation physicians) during scheduled appointments.Our team encompasses 5 medical specialties and 8 allied health professions.Seeour team members
- Balance assessment and gait training for fall preventionConducted by physical therapists using standardized balance assessment tools.
- Outpatient physical therapyPersonalized training plans based on assessment results.
- Inquire about our services or visit our facility—available daily.09:00–18:00 (Excludes medical consultations/treatments)
Contact Kin Hospital, Sukhumvit 107 |Free consultations and facility tours
Balance training following a medical diagnosis of vertigo/dizziness ·If you experience vertigo accompanied by neurological symptoms, please call 1669 first.
Other KIN Rehabilitation locations
Central Hotline:02-096-4996| Home-based Physical Therapy: 095-767-6307 |Nursing Care & Equipment Rental: 061-881-9399 |For Emergencies, Call 1669
Frequently Asked Questions – Answered by KIN’s Medical and Multidisciplinary Team
What causes the sensation of the room spinning upon waking up or when turning over?
This is often caused by calcium carbonate crystals in the inner ear (BPPV).You should see a doctor for a formal diagnosis. If you also experience slurred speech, weakness, or double vision, call 1669 immediately.
What kind of vertigo is a sign of a stroke?
If vertigo occurs with sudden hearing loss, seek emergency assessment because it may indicate a serious condition. If it occurs with slurred speech, weakness or numbness in an arm or leg, facial droop, double vision, or inability to stand or walk without assistance, call 1669 immediately, even if the symptoms have improved.
Can vertigo go away on its own?
BPPV may resolve on its own in some individuals, but the duration varies significantly.A population-based study in Germany reported a median duration of 2 weeks for the most recent episode, with a range spanning from 0.5 days to 104 weeks. Therefore, one should not assume it will resolve within 2 weeks;it is important to get a medical evaluation to ensure the symptoms are not caused by something else.
Can I perform the Epley maneuver by myself at home?
You should only perform it after a doctor has diagnosed you with BPPV and identified which ear is affected.If your doctor has instructed you to continue the maneuver at home, follow their specific instructions and ensure someone else is present with you.Do not have a family member perform it on you without a prior medical diagnosis.
What position should I sleep in after the Epley maneuver?Should I avoid bending over or looking up?
The AAO-HNS guidelines do not recommend restricting your movements or positions following the canalith repositioning maneuver.There is no need for any special sleeping position, but please get up slowly; you may experience nausea during the process.If you also develop neurological symptoms (symptoms related to the brain), please call 1669.
What should I do if the spinning sensation has stopped, but I still feel unsteady or wobbly when walking?
You should have a physical therapist assess your balance and your risk of falling.Vestibular rehabilitation is an option recommended by the AAO-HNS guidelines.In the meantime, please stand up slowly and hold onto a handrail.
- Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) — Bhattacharyya N et al., Otolaryngol Head Neck Surg, 2017
- Epidemiology of benign paroxysmal positional vertigo: a population-based study — von Brevern M et al., J Neurol Neurosurg Psychiatry, 2007
- The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo — Hilton MP, Pinder DK, Cochrane Database Syst Rev, 2014
- HINTS to diagnose stroke in the acute vestibular syndrome — Kattah JC et al., Stroke, 2009
- Benign positional vertigo — MedlinePlus (reviewed 2025)
- Vertigo — NHS (reviewed 2023)
- Stroke: Symptoms — NHS (reviewed 2024)
Medically reviewed by Dr. Krittha Phuengcharoen (License No. 40781), Neurologist | Supervised by Dr. Thongchai Chokthanomsap, Chief Executive Officer | Last updated: October 2026 |This article provides general information only; it is not a diagnosis or individualized medical advice. It does not recommend any medication. A canalith repositioning maneuver should be performed only after a medical diagnosis. Research figures are not outcomes of patients who received KIN services.