Everything You Need to Know About Benign Paroxysmal Positional Vertigo

Medically Reviewed By Seunggu Han, M.D.
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Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear that causes episodes of vertigo. This article will define BPPV. It will also discuss the symptoms, causes, and treatment of the condition.

What is benign paroxysmal positional vertigo?

Female with sunglasses turning her head
Milles Studio/Stocksy United

BPPV is the most common cause of vertigo.

Vertigo is the sensation of spinning or turning even though you are standing still. During an episode of vertigo, you may feel as though the room is spinning around you. This feeling can make it difficult to continue standing or walking.

BPPV’s name is descriptive of its characteristics:

  • Benign: This means the condition is non-life-threatening.
  • Paroxysmal: The condition comes on in sudden, brief episodes.
  • Positional: Certain movements or positions of the head trigger this condition.
  • Vertigo: The condition causes episodes of vertigo.

What are the symptoms of benign paroxysmal positional vertigo?

The main symptom of BPPV is the sensation of spinning, synonymous with vertigo.

Certain movements of your head or even movements of your eyes typically trigger BPPV. These movements generally include:

  • rolling over in bed
  • bending to pick something up
  • turning your head
  • lying down
  • looking up

You may also experience nausea and vomiting.

These episodes of vertigo tend to only last a few seconds to a few minutes. They typically peak in the morning and lessen throughout the day.

Click here to read about 7 things doctors want you to know about vertigo.

What causes benign paroxysmal positional vertigo?

Your inner ear canals are filled with fluid and oriented at various angles. The fluid in the canals rolls around whenever you turn your head. This rolling tells the brain how far, fast, and in what direction you have turned.

Within your inner ear are reservoirs in the saccule and utricle structures. In these reservoirs, there are calcium carbonate crystals. BPPV is the result of these crystals breaking loose.

When this happens, the crystals rub against hair cells within the canals, creating an illusion that you are moving when you are not.

The exact cause of this displacement is not known. However, some believe injury or the degeneration of the utricle could be the reason behind the crystals coming loose.

Possible causes of BPPV include:

  • head injury
  • aging, causing the degeneration of the vestibular system
  • damage due to an inner ear disorder

How do doctors diagnose benign paroxysmal positional vertigo?

In order to diagnose BPPV, your doctor will ask about your medical history and the symptoms you are experiencing. They will also conduct a physical exam. This exam typically includes a Dix-Hallpike test.

The Dix-Hallpike test involves:

  • sitting down with your legs extended on the exam table
  • the doctor rotating your head 30–45 degrees
  • the doctor helping you quickly lie down

If you are experiencing BPPV, this test should trigger an episode. Your response to this test and the movements of your eyes during it can help your doctor to differentiate BPPV from other causes of vertigo.

In order to rule out any other causes, your doctor may order imaging tests, such as an MRI.

What are the treatments for benign paroxysmal positional vertigo?

Typically your doctor will recommend canalith repositioning maneuvers to treat your BPPV. One of the more common types of this treatment is the Epley maneuver.

Typically, these maneuvers initially take place in the doctor’s office. However, your doctor may teach you the maneuvers so you can repeat them at home.

It is not uncommon for people experiencing BPPV to choose to watch and wait. BPPV may go away without any treatment.

If it does not go away on its own or does not respond to the canalith maneuvers, your doctor may recommend vestibular rehabilitation therapy (VRT). VRT focuses on exercises designed to help you compensate for inner ear deficiencies.

In rare cases, your doctor may recommend surgery to treat BPPV. However, this is generally only an option when less invasive treatments have not worked.

Click here to read about when you should see a doctor for dizziness.

Summary

BPPV is the most common cause of vertigo.

It results from calcium carbonate crystals coming loose within your inner ear.

Symptoms of BPPV include sensations of spinning or turning when standing still, dizziness, and nausea.

If you believe you are experiencing BPPV, contact your doctor.

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Medical Reviewer: Seunggu Han, M.D.
Last Review Date: 2022 May 17
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