Ian Purcell MD PhD Monali Patel MD Otoneurology Call 858 223 2172
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Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo: brief spinning set off by changes in head position, caused by loose crystals in the inner ear.

At a glance

Symptoms
Brief spinning when rolling over, looking up, or bending down
Common causes
Loose calcium crystals (otoconia) moving into a semicircular canal
How it's diagnosed
Positional tests such as the Dix-Hallpike, with goggles recording the eyes
Treatment
Canalith repositioning maneuvers such as the Epley

Overview

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning. BPPV causes brief episodes of mild to intense dizziness, typically triggered by specific changes in the position of your head.

BPPV is related to the inner ear. Inside your ear is a tiny organ called the vestibular labyrinth, which includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor your head's rotation. Another structure in your ear, the otolith organs, contains crystals that make you sensitive to gravity. For various reasons, these crystals can become dislodged and move into the semicircular canals, especially while lying down. This movement can cause the inner ear to send false signals to the brain about your body's position, leading to dizziness and vertigo.

Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV)

Symptoms

Symptoms of BPPV can include:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • A loss of balance or unsteadiness
  • Nausea
  • Vomiting

The symptoms can vary in intensity and usually last less than one minute. Episodes of BPPV can disappear for some time and then recur.

Causes and risk factors

While the exact cause of BPPV is often unknown, it can result from:

  • A minor to severe blow to the head
  • Degeneration of the vestibular system in the inner ear, often related to aging
  • Infections of the inner ear
  • Disorders that damage your inner ear

Risk factors for BPPV include:

  • Age (50 and older)
  • Previous head injury
  • Osteoporosis
  • Migraine headaches

Diagnosis

BPPV is diagnosed through a series of tests that may include:

  • The Dix-Hallpike test
  • The Roll test
  • Imaging tests to rule out other causes

Treatment

Treatment for BPPV is straightforward and usually effective. It includes:

  • Epley Maneuver (Canalith Repositioning Procedure)
  • Semont Maneuver
  • Brandt-Daroff Exercises

In some cases, surgery may be considered if these maneuvers do not alleviate the vertigo.

Living with Benign Paroxysmal Positional Vertigo (BPPV)

While BPPV can be a recurring condition, it's generally considered not serious and can be managed with treatment. Modifications at home and work, along with careful attention to head movements, can help minimize the impact of BPPV on daily life.

Testing that can help

Testing is chosen from your history and examination. These are the tests most often used here.

DizzyDoctor Vertigo Recording GogglesHigh-resolution infrared video goggles used to document eye movements during dizziness and positional vertigo evaluation.Epley Omniax ChairComputer-assisted multi-axis positioning used for difficult or atypical positional vertigo cases.TRV ChairA mechanical repositioning chair used to evaluate and treat complex positional vertigo.Videonystagmography (VNG)A comprehensive eye-movement test battery used to evaluate vestibular and oculomotor function.
Specialty care: Vertigo (BPPV)Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of vertigo that results from dislodged calcium carbonate crystals in the inner ear.CupulolithiasisCupulolithiasis is a form of BPPV in which crystal debris sticks to the cupula of a semicircular canal, causing positional vertigo with longer-lasting eye movements than typical BPPV.Epley treatment maneuversThe Epley Maneuver is designed to relocate displaced otoliths (tiny calcium carbonate crystals) from the semicircular canals back to the utricle of the inner ear, where…BPPV characterization chartsCanalithiasis and cupulolithiasis characterization charts for head-neutral and head-down testing, with nystagmus pattern lookup and Epley Omniax treatment protocols.

When to seek urgent care

Call 911 or go to the nearest emergency department if dizziness or imbalance starts suddenly together with any of the following, since these can be signs of a stroke or another emergency:

  • Weakness or numbness of the face, arm, or leg, especially on one side
  • Trouble speaking or understanding speech
  • Double vision or sudden loss of vision
  • A sudden, severe headache
  • Inability to walk or stand
  • Chest pain, fainting, or a seizure

Further reading

This article is for general education and does not replace a medical evaluation. Testing and treatment are chosen for each patient after a full history and examination.