Hi everyone,

Every winter I start to hear a familiar story in clinic:

“My dizziness always seems to come back when it gets cold and dark.”

“Rolling over in best makes the room spin again”

“I feel off balance for days after a vertigo attack”

If that sounds like you (or someone you care about), you’re not imagining it.

New research shows that one of the most common causes of vertigo – benign paroxysmal positional vertigo (BPPV) – really does have a seasonal pattern, with more cases in the winter months, especially in countries with colder climates and less sunlight. 

This month, I wanted to unpack why vertigo can flare up in winter, who is most at risk, and what you can actually do to lower your risk and feel steadier.

What do we mean by “vertigo”?

People often use “dizzy” to mean many different things – lightheaded, woozy, unsteady, or like the room is spinning.

Vertigo usually describes a false sense of movement, most commonly:

• The room spinning around you

• You feeling like you’re spinning or tilting

• Symptoms triggered by head movements – rolling in bed, looking up, bending forward

BPPV happens when tiny calcium crystals (otoconia) inside the inner ear become loose and drift into the wrong place. When you move your head, those crystals move too, sending the brain confusing balance signals.

Typical BPPV symptoms include:

• Sudden, brief spinning episodes (seconds to a minute)

• Triggered by position changes (bed, looking up, bending)

• Often worse first thing in the morning or at night

• Sometimes followed by hours of “off” feeling, nausea, or imbalance

The good news: BPPV is very treatable with specific repositioning manoeuvres and, when needed, vestibular rehabilitation. (One of the more satisfying things for me in clinic is helping with someone with vertigo. 98% success rate after 3 treatments)

Why does vertigo flare up in winter?

A recent systematic review pooled data from over 18,000 people with BPPV and found that 9 out of 11 studies showed a clear seasonal pattern – with higher rates in winter compared to other seasons. 

There isn’t one single cause, but several likely contributors:

1. Less sunlight and lower vitamin D

Shorter days mean less sun exposure, especially in northern countries. Lower vitamin D levels have been repeatedly linked to both BPPV occurring and coming back after treatment. Vitamin D is involved in calcium regulation, which is important for the health of those inner ear crystals.

2. Colder weather and less movement

In winter we tend to:

• Spend more time indoors

• Sit more and move less

• Exercise less consistently

Some studies suggest that low physical activity and long periods lying down are more common in people with BPPV. Reduced movement may influence bone health and how the inner ear is stimulated day to day.

3. More infections and inflammation

Upper respiratory infections and sinus symptoms are more common in colder months. These can irritate or inflame parts of the inner ear and may be one of several triggers for vertigo episodes in susceptible people.

4. Changes in atmospheric pressure

Several studies report that higher barometric (atmospheric) pressure is associated with increased BPPV episodes. The exact mechanism isn’t fully understood, but shifts in pressure may affect inner ear fluid and, in some people, make crystal dislodgement more likely. 

None of these factors act alone, but together they help explain why winter can be a “perfect storm” for vertigo in some people.

Who is more at risk?

Research over the last few years has highlighted a set of risk factors that increase the chances of developing vertigo (especially BPPV) or having it come back.

Non-modifiable (things you can’t change):

• Age: Risk increases with older age, but BPPV can occur at any stage of adulthood.

• Sex: BPPV is more common in women than men.

• Genetics: Certain genetic variants involved in inner ear structure and function appear to increase risk in some people.

Medical and metabolic factors:

• Low vitamin D

• Osteoporosis or low bone density

• High blood pressure, diabetes, or high cholesterol

• Migraine

• History of head injury

These don’t guarantee you’ll develop vertigo, but they do shift the odds.

Lifestyle & behavioural factors:

Research suggests that the following patterns are linked with higher vertigo risk:

• Very low levels of physical activity

• Lots of sedentary time (television, sitting, long periods in bed)

• Irregular sleep or frequent daytime napping

• Lower levels of educational attainment (often a marker for other health and social factors)

On the positive side, regular physical activity and more years of education seem to be protective in large population studies.

Psychological factors:

• Anxiety and depression are associated with both the risk of certain vestibular disorders and with persistent dizziness after an initial vertigo episode.

• Even when the inner ear has recovered, the brain can sometimes stay in a “high alert” state, keeping symptoms going.

What does seasonal vertigo feel like in real life?

Many people describe patterns such as:

• “Every winter my symptoms come back when I roll over in bed.”

• “After a cold or sinus infection, I feel like the room spins when I tip my head back.”

• “The big spin attacks settle, but I’m left with weeks of foggy, floaty imbalance.”

We also see:

• Residual dizziness after successful repositioning – especially in older adults, women, and people who waited a long time before getting treatment.

• Increased worry about movement – people start avoiding turning their head, lying flat, or leaving the house, which can unintentionally make things worse over time.

If this is you, you’re not alone. The important message is: seasonal vertigo is common, but it is not “just in your head” and it is usually manageable.

When is vertigo an emergency?

Most BPPV and vestibular problems are uncomfortable but not life-threatening.

However, vertigo can occasionally be a sign of something more serious, such as a stroke. Seek urgent medical care if dizziness or vertigo comes on with:

• Sudden difficulty speaking, swallowing, or understanding others

• New weakness, numbness, or clumsiness in your face, arm, or leg

• Double vision or loss of vision

• Sudden, severe headache unlike anything you’ve had before

• Chest pain or shortness of breath

If in doubt, err on the side of caution and get assessed.

What you can do this winter to stay steadier

You can’t control the weather or your genes, but there are practical things you can do to lower your risk and support recovery.

1. Protect your vitamin D and bone health

• Talk to your GP about checking vitamin D levels, especially if you’re older, have osteoporosis, or rarely get sunlight.

• Follow local guidelines on supplementation if needed.

• Make sure you’re meeting your calcium needs and keeping bones strong through diet and resistance exercise where appropriate.

2. Keep moving (even when it’s dark and cold)

• Aim for some daily movement, even 10–15 minutes at a time.

• Short walks, gentle exercises at home, or simple balance drills can all help.

• Avoid long periods of lying flat during the day unless medically necessary.

3. Prioritise regular sleep

• Try to keep consistent bed and wake times, even over the holidays.

• Limit long daytime naps that leave you wide awake at night.

• Good sleep helps both the brain and inner ear recover.

4. Look after your heart and metabolic health

• Work with your healthcare team to manage blood pressure, blood sugar, and cholesterol.

• These same risk factors that affect the heart and brain also seem to influence vertigo risk.

5. Don’t ignore your mental health

• Persistent dizziness can be stressful and frightening and that stress can feed symptoms.

• If anxiety or low mood is becoming part of the picture, mention it to your clinician.

• Sometimes combining vestibular rehab (with a physiotherapist) and psychological support (such as CBT) leads to better outcomes than either alone.

6. Seek early assessment for vertigo

• If you’re getting repeated spinning attacks with head movement, a vestibular-trained physiotherapist or ENT can often diagnose BPPV and treat it with specific manoeuvres.

• Starting treatment sooner rather than later may reduce the risk of prolonged “residual” dizziness.

Practical takeaways

Seasonal vertigo can feel confusing and frustrating, but it isn’t random.

• Winter really does see more BPPV cases, likely due to a mix of less sunlight, lower vitamin D, less movement, more infections, and changes in atmospheric pressure. 

• Your age, sex, bone health, heart health, and lifestyle all influence risk – but many of these factors are modifiable.

• Early assessment and treatment, combined with steady habits around movement, sleep, mood, and bone health, can make a real difference.

If you or a family member notice vertigo that seems to “follow the seasons,” consider this your nudge to get it properly assessed rather than waiting for it to pass.

As always, this newsletter is for education, not a substitute for personal medical advice. If you’re worried about your symptoms, please speak with your GP or a qualified vestibular specialist.

Until next month, wishing you a steady, well-rested December 🌙

Kosta Ikonomou