Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo — the sudden sensation of spinning.

Sudden movements of the head typically trigger this vertigo, often occurring while rolling over in bed, lying down or standing up quickly, or standing and looking up.

Symptoms of BPPV

The main symptom of BPPV is the sensation of room-spinning vertigo. It is usually triggered by sudden head movement, especially in the plane of the affected ear. The vertigo typically lasts less than a minute, and most people feel completely normal in between episodes.

Other symptoms may include nausea, vomiting, or a momentary inability to focus the eyes. There is no hearing loss, pain, drainage, or neurological symptoms associated with BPPV.

Causes of Benign Paroxysmal Positional Vertigo

The balance center of the inner ear is called the labyrinth. Within the labyrinth are three fluid-filled, semicircular canals that are very sensitive to head movement.

When your head moves, the fluid in these canals also moves, allowing the brain to interpret the position of the head and body and maintain balance. Calcium carbonate crystals (otoliths) in the canals also aid in balance by sending information to the brain about gravity and horizontal acceleration.

These crystals are encased in a jelly-like substance. BPPV occurs when some of the crystals become dislodged from their gelatinous casings. Once dislodged, they float freely in the canal fluid, sending confusing messages to the brain about body position.

While the cause of this condition is unknown, BPPV tends to be more common in:

Diagnosing and Treating Benign Paroxysmal Positional Vertigo

The symptoms of BPPV are very consistent. Your doctor may be able to diagnose it by reviewing the history of your symptoms.

A physical examination for BPPV often includes a maneuver called the Dix-Hallpike. During the Dix-Hallpike, your doctor will hold your head in a certain position, ask you to lie backwards, and observe the results.

Medications, including antihistamines and motion-sickness drugs, usually do not help with the symptoms of BPPV.

Treating BPPV is typically very simple and involves a variety of repositioning maneuvers best done by a vestibular therapist.

Your therapist will identify the affected semicircular canal through a series of head movements that often recreates vertigo symptoms. The posterior semicircular canal is the most commonly affected. It is treated by a repositioning exercise called the Epley Maneuver. During this maneuver, the therapist moves the head into four successive positions for about 30 second each.

Many people will have complete symptom relief after only one or two sessions. If BPPV recurs later — which happens about 15 percent to 20 percent of the time — the maneuver can be repeated.